Universal Healthcare in Sweden

Universal Healthcare in Sweden

September 9, 2022

Providing healthcare for just under 9.5 million people (www.scb.se), the Swedish national healthcare system is regularly ranked as one of the best in the world and continues to improve through innovative solutions and investment in the latest technology.

Health in Sweden
Sweden boasts high life expectancy rates – 79 years for men and 83 years for women, high cancer survival rates, as well as one of the lowest infant mortality rates in Europe, with an average of 3 deaths per 100, 000 children born (2008). It has the EU's highest rate of physicians per capita, at 3.3 per 1,000, which allows patients to have quick and easy access to healthcare professionals and a well-established and efficient preventative healthcare service. Compared to many other EU member states, Sweden also has a very high rate of efficiency in healthcare service delivery, despite restrictions in state funding and investment. However, like many other industrialized countries, Sweden also has a low fertility rate, which has resulted in negative natural population growth since the late 1990s, although real population growth is on the rise due to positive net migration into Sweden. 

Today, Sweden has one of the world's oldest populations, with more than 17% of the population being aged 65 years or older and 5.2% aged 85 years or older. Although mortality due to diseases of the circulatory system has been significantly reduced during the last 30 years, this remains the leading cause of mortality, accounting for over a third of all deaths. Chronic diseases that require monitoring and treatment and often life-long medication also place great demands on the healthcare system. One positive fact is that Sweden has relatively few smokers – almost 85 percent of Swedes are non-smokers, which is reflected in the low rates of certain smoking related cancers.

Healthcare Reform
The Swedish healthcare system has undergone a number of reforms and changes but, in general, the basic structure of the system has been relatively stable. The major reforms since 1970 have been result of demographic changes, with increasingly ageing population and increases in the number of people with complex non-communicable diseases. 

One of the main changes in healthcare and social services came in 1992 when responsibility for elderly care was transferred from county councils to local authorities (municipalities). Since hospital treatment is more costly, the aim was to care for elderly persons as far as possible in their own homes or in settings within primary healthcare. 

Since 1995 the municipalities have also taken over the responsibility for persons with long-term mental illness and all kinds of disabilities. Over the last decade, GP visits have steadily grown while specialist interventions have fallen. Sweden has also sought to drive patients more quickly through the hospital system, which has allowed more investment into community services and primary healthcare.

Here are some important facts to know about the Swedish healthcare system:

Type of healthcare system: Universal

Average cost of an emergency room visit: 300 kr (US$38)

Average cost of a doctor’s visit: 200 kr (US$25)

(Money in Sweden is denominated in Swedish krona which can be written as currency code SEK in global trading markets, or simply as kr on signs within the country.)

Number of pharmacies: 1,400

Number of hospitals: 79 

Population % covered by health insurance: 100%

At the time of writing, these are the very approximate figures you can expect to find:

1000 kr = £100
1000 kr = €105
1000 kr = US$125
1000 kr = AU$160

Is healthcare free in Sweden?
All residents, including expats, have access to publicly-financed healthcare services. Employees and employers pay into the public fund. While healthcare is widely available and funded by taxes, there will be small fees associated with many services (unless you're younger than 16 or qualify as a vulnerable person). The county councils determine the prices for care in their region. Here are some expected fees for healthcare services in Sweden:

Medical Item Cost in Sweden
One-day hospital stay 100 kr
Primary care visit 100- 300 kr
Specialist visit 400 kr
12 months of prescriptions (maximum) 2,200 kr

The Swedish public healthcare system
The central government dictates health policy, but the system is decentralized, meaning that county councils and municipal governments are responsible for providing services. The majority of the costs to run this system are paid for by county council and municipal taxes, with contributions from the national government to cover specialist treatment, prescriptions, pregnancy and childbirth, and rehabilitation. The biggest challenges to the public system include access, quality, efficiency and funding.

While coverage is extensive, there are small fees paid by patients, capped at 1,100 kr per year. A Swedish resident doesn’t have to pay more than 300 kr for each doctor visit, whether it’s a private doctor or a doctor at a local health center. All hospital entrance fees are covered, as are specialist visits that a doctor deems necessary.

Prescription drugs 
Prescription drugs aren’t free but fees are capped at 2,200 kr each year. The government covers expenses that exceed this amount. Pharmacies are connected through a centralized system so once a patient’s medical history is stored in the system, it's available for all pharmacies.

Pregnancy and Childbirth
The public maternal healthcare system is particularly strong in Sweden. Maternal mortality rates are some of the lowest in the world, fewer than 3/1,000 babies and 4/100,000 women die during childbirth. Swedish maternal care is looked at as a role model for the rest of the world. Sweden has a high percentage of midwives administering maternity care, who also take care of delivery.

The Swedish private healthcare system
Private healthcare isn't commonly used in Sweden, but as of 2010 it's available. Private insurance premiums and treatment are more expensive, but many citizens and expats prefer to pay in order to ensure that all of their medical needs are met and to avoid longer waits for the public service. About 1 in 10 people have private healthcare. Within the past couple of decades, the use of private healthcare has been increasing.

In case of an emergency in Sweden
In case of emergency, the number to dial is 112. Emergency care is available for everyone including those without state health insurance or without a GP, such as tourists. However, once you're recovered, they’ll want proof of your travel or international insurance. Emergency rooms are available 24/7, and you can use them with or without a referral from a primary doctor. Emergency cases are treated immediately. Some counties may charge a fee for ambulance or helicopter service, but this is capped at 1,100 kr. You can also phone 1177, which is designated as a 24/7 advice line for non-emergency health issues.

Hospitals in Sweden
The standard of care in Swedish hospitals is high. If you qualify for care under Sweden’s universal healthcare system you can use any public hospital. 

Patients can be admitted to the hospital through the emergency department or by a referral from their doctor. There’s a high ratio of in-patient beds and hospitals tend to be very large to accommodate many people. By law, hospitalization fees can’t exceed 100 kr a day, no matter which hospital you’re treated at.

Private hospitals also exist, and there are no waiting lists for them. Private clinics are funded by insurance companies and are independent organizations. Sometimes, doctors and specialists choose to set up their own privately-run health centers. They’re only used by a limited number of people.

Sickness Pay
Another service incorporated into the social welfare system is sickness pay. When a physician declares a patient to be ill (by signing a certificate of illness/unfitness), the patient is paid a percentage of their normal daily wage from the second day. For the first 14 days, the employer is required to pay this wage, and after that the state pays the wage until the patient is declared fit. The state also reimburses patients for travel costs to and from the clinic or hospital.

If you're visiting from an English speaking country
Sweden is one of the best non-native English speaking countries in the world. It should be easy to find an English-speaking doctor in Sweden. However, if you have trouble, you're entitled to help from an interpreter, free of charge, when you go for medical or dental care. You need to mention up front that you need an interpreter when you make your appointment.

Specialists in Sweden
Primary care doctors, or GPs, will refer a patient to see a specialist or consultant if necessary. Consultants are senior doctors that have a higher level of training in one area than a GP does.

Seeing a specialist may have a higher fee than a regular doctor visit. Patients needing to see a specialist shouldn’t have to wait longer than 90 days for the appointment. However, if the 90-day period is exceeded, you'll be offered care elsewhere and the cost, including any travel costs, will be paid by the county council. Recently, the OECD found that the mean wait time from a GP referral to seeing a specialist is around 12 days.

Health insurance in Sweden: Cost and plans
Most people living in Sweden use the national healthcare system, which is paid for through taxes. Public healthcare is the cheapest option for residents. What’s covered under the public system is up to the municipality, so there’s some variety. However, care is divided into 7 categories:

Close-to-home (primary care clinics, maternity clinics, outpatient psychiatric clinics)
Emergency care
Elective care
Inpatient care
Outpatient care
Specialist care
Dental care

If you don’t choose the public option, there are private plans available and some individuals choose to purchase private insurance to cover their deductibles of the public coverage. Many private practitioners have higher treatment fees, but going private means you'll likely speed up waiting times for appointments. Costs for private plans will vary, but expect to pay approximately 4,000 kr per year.

Temporary health insurance for tourists
If you’re visiting Sweden temporarily, you can get medical treatment at any of the public facilities. If you're a visitor from a country in the EU or EEA, you can access healthcare in Sweden using your European Health Insurance Card (EHIC). Tourists from non-EU/EEA countries don’t have an automatic right to free or reduced-cost healthcare; you'll need to show proof of insurance from your country or comprehensive travel insurance. 

With world class healthcare available to expats and temporary tourists, Sweden is a great choice for those looking for a new adventure abroad. You’ll find a welcoming healthcare system that's regulated to ensure that costs never get too expensive. You always have the option of private healthcare if you want to skip the wait, but the social safety net in Scandinavia is almost impeccable, which is why most citizens take advantage of it. 

Compiled by Guiomar Goransson, Nursing Outtakes