Analyzing Sweden's Health System

Introduction

This essay will critically analyse the health system of Sweden against other health systems of other countries using five factors from the eight factors model for providing True Access. These are; Major Health issues, Preventive Strategies, Resources, Structures and Historical. It will then compare Sweden’s health system with those of at least ten other countries. Finally, this essay will provide recommendations to improve the health system. Health system is defined as the combination of an organisation, resources, institution and people whose main purpose is to improve health (Health Systems Global, 2014). World Health Organisation (2018) describes health systems as having six building blocks, which are; leadership/governance, health workforce access to essential medicines, health information services, services delivery and financing (World Health Organisation, 2018). These can contribute to the strengthening of the health system and can be used to monitor the health system (World Health Organisation, 2010). For students seeking additional guidance, resources like healthcare dissertation help can provide valuable support in navigating these complex topics.

Background

Sweden is a Monarchical country with a parliamentary form of government (Anell et al., 2012). It has a population of about 9.4 million inhabitants and the majority (80%) of the population live in the urban areas (Anell et al., 2012). Sweden has three independent government levels including the 290 municipalities; the 21-county council/regions and the national government and it is a decentralised structure (Anell, et al., 2012).

Major Health Issues

The broad social and economic circumstances that together influence health throughout the life course are known as the social determinants of health, a condition in which individuals are born, attain growth, work and get aged (Public Health England, 2017). Although, there is a social gradient across most of these determinants which contribute to health as to why poor people are experiencing worse health outcomes than the wealthy people (Marmot et al., 2010) which lead to life expectancy at birth, one of the major significant demographic indicators which shows the number of years a new born infant would live presuming that death and birth rates will persist at the same level during the whole life time (Public Health England, 2017). According to world Health Organisation (2018), the total life expectancy at birth for Sweden’s population is 81.1 years which is above the life expectancy at birth of the global population as71 years. Individuals with higher education and incomes can expect to live longer in coparison to those earning low income and with less education. For example, in Sweden, working class men in the lowest earning group have more than twice the mortality risk of men in the highest earning group (Torssander and Erikson, 2010). The differences in life expectancy of socio-economic categories have been seen in high income countries like Sweden. Although, the difference in mortality risk assessment involving different social classes with diverging educational levels has become wider during the past (Shkolnikov et al., 2012). However, life expectancy gaps across occupational classes have increased because of increasing income in inequality.

In comparison to Nigeria, life expectancy at birth is 55.2 years (Home Office, 2018). The reason is because of poverty which affects most aspects of the individuals’ conditions and restricts them from meeting their necessity in life such as education, access to quality healthcare etc. (Olowa, pp.12, 2012). It became more apparent from changes in the distribution of income. For example, if higher average income is above the poverty line, individuals’ will be able to pay for their healthcare and education and there will be low poverty which generally affects life expectancy (Olowa, pp.32, 2012). However, in Switzerland, life expectancy at birth is 82.90 (IHME, 2019). In many cases, majority of the population are educated and their education is completed in early adulthood and does not have much change in the future (Spoerri, et l., 2014) which have a huge effect on the individuals` health outcome which could be related to life expectancy (Spoerri, et al., 2014). The ten major health issue of Sweden , Switzerland and Nigeria are listed in Appendix 2. However, concentrating on the top three major health issues will realise that the three major health issues of Sweden’s and Switzerland are non-communicable disease. Although, there are differences in access to resources and distribution such as services, income and education.

In addition, most of the social determinants of health are associated with working life in adult’s life (Toivanen, 2012) since the adverse work environment and employment conditions contribute to social inequalities in health. According to Cesare et al., (2013) non-communicable disease is attributed to environmental, behavioural and dietary risk factors. These conditions are unfairly disseminated across men and women in working populations and occupational classes (Benach et al., 2010). Further, men and women often work in different industrial areas with great variations in their respective work environments. Therefore, the social gradient in stroke morbidity and mortality is higher in low socio-economic groups (Noone, 2009). In Sweden and Switzerland, Stroke is mostly found among men, but women are more affected (Appelros, Stegmayr and Terent, 2009). Additionally, evidence has shown that psychological stress is one of the make risk factors for stroke (O’Donnell et al., 2010). However, for working groups of people, stressors are rooted in the psychosocial work environment which become to be specifically harmful for cardiovascular health (Eller et al., 2009). The psychological work environment involves all areas of the management and design of work and it`s organisational and social context and this has the ability for causing psychical harm amongst employees (Toivanen, 2012). For literacy Sweden, Nigeria and Switzerland see Appendix 1.

The major health issues of Sweden and Switzerland are linked to the major global health risks, for instance, stroke and lung cancer are caused by tobacco use and tobacco use is one of the global health risks which are recognised by the World Health Organisation. World Health Organisation, 2018).

Preventive Strategies in Health System

In Sweden, the general health of the population is good. However, most of the major health diseases are caused by lifestyle of the individuals and the risk factors as mentioned above. The role of the healthcare system in prevention is based on the public health policies by preventing diseases and promoting public health in accordance with the Health and Medical Services Act (The National Board of Health and Welfare, 2013). The health system helps in the prevention of disease and promotion of public health to change patient`s lifestyle (The National Board and Welfare, 2013). Managers’ and staffs’ in Sweden’s health system assist to prevent diseases by providing lifestyle advice about psychical activity, eating habits and about the hazardous use of alcohol and tobacco (Anell et al., 2012). The Swedish National Board of Health and Welfare has set up a national guideline for disease prevention strategies to assist individuals’ who use alcohol hazardously, smoke, have unhealthy eating habits and are not engaging in psychical activities . The purpose is to provide counselling to change the patient`s lifestyle (The National Board and Welfare, 2013).

This is mirrored in China with the top major health issues in Appendix 2. The eradication of these illnesses was at the forefront of the prevention strategies of the Government of China. The government implements disease prevention project- health promotion components and there is community-based oversight which is put in place to raise awareness of people about their own health (Wang et al., 2005). China has a framework convention of tobacco control to provide information on law, tobacco health control in youth education (Yip and Hsiao, 2008). Similarly, to Sweden preventive strategies, the burden of disease is more dominated by non-communicable disease, The Swedish has a national guideline for preventing disease to support with unhealthy behaviour (Anell et al., 2012). This can also be observed in activities of the Chinese government which has set out frameworks, policies to help people to have control over their behavioural lifestyle to improve health condition of Chinese patients (Yip and Hsiao,2008). Although, the government has implemented preventive programmes to help reduce the burden of the diseases but has failed to investigate why people chose to live unhealthy lifestyles for instance, Lung Cancer which is caused because of smoking. In China, the rate of cigarette consumption has massively increased that an estimate of two-thirds of Chinese men now smoke. This is linked to social determinants of health, which reflect the social and economic resources which influence an individual’s access to health promotion, working and living conditions as well as healthy choices (Braveman, et al., 2010). For example, unemployment causes most individuals to smoke to ease off stress due to lack of resources to cope with daily challenges i.e. basic needs for life (Braveman et al., 2010).

However, in Sweden, in 2012, 11% of the population were smokers and it was based educational status that those with low education tend to smoke more that those with higher education (Anell et al., 2012). Studies have confirmed that people with higher education live longer, have less chronic illness, showed healthier behaviour and feel healthier (Anell et al., 2012). In comparison, Russian Government provides a national guideline for the prevention of non-communicable diseases and a Government committee on health protection (Boytsov and Potemkina, 2013). The ministry of health designs a state programme of health development in line with the world health organisation action plan for prevention of NCD (Boytsov and Potemkina, 2013) to lower the mortality rate among Russians, specifically in individuals of working age leading to low life expectancy associated to behavioural factors like smoking.

Health System Resources

True access can be measured using the adequacy and availability of resources within a health system. Resources are a good criterion of how a nation values its patients which allows true access to health services (Masuku, 2019). In Sweden , equipment are publicly and privately purchased. The use and adoption of medical technologies including medical equipments like magnetic resonance imaging (MRI), computed tomography (CT), PET scanners per population is very high (Anell et al., pp.57, 2012). However, there are differences between countries in the supply of these medical equipments. In Japan, the number of CT scanners and MRI units’ scanners per population is 107 per 1 million population higher than Sweden, and the United States of America had the third highest for CT with 41 per one million, and MRI 38 per one million population (Papanicolas, Woside and Jha, 2018). Despite U.S. investment being more on MRI and CT scanners to a large population, however, the population health outcome is still worse (Rapaport, 2018).

The general health outcomes of the U.S. healthcare system are not in a good form regardless of the potentials to provide the best quality of care (Brawley, 2011) and it has a negative impact on most of the population e.g. the uninsured and underinsured cancer patients paying for cancer treatment is a huge problem for lots of cancer patients (Brawley, PP. 67, 2011). Huge health costs endanger the ability of families of the patients who are diagnosed with cancer to afford the necessary care they require because they have troubles affording healthcare costs such as co-pays and insurance premium (Brawley, PP. 67, 2011). In addition, affordability, of care is a major problem for individuals aged 65 years, because of cost which led to delayed health care and further have negative impacts for presenting late diagnosis of the illness, if they have symptoms, the individuals always have greater difficulty getting diagnosed and evaluated and received inadequate treatment (Brawley and Berger, 2008). In contrast, Japan invests less on healthcare equipment than U.S. and Sweden. However, it has a good benefit to patients since the government has less power over the volume of services provided (Yates, PP. 102, 2018). As a result, the healthcare system is used excessively (Yates, PP.102, 2018). Patients can seek information from any healthcare professional, in terms of any symptom (Yates, PP.103, 2018). Also, demand of MRI, CT and PET scanners by the patients is very high as they could require these at all of times.

Amongst the Swedish, the use of and access to Internet and computers is high. According to Anell, et al., (2012), more than 90% of Swedish population have access to the Internet in their residential homes and 100% employers, which help the citizens to also get information’s about their state of health privately and publicly, and about healthcare services available at primary care hospitals and county council health information web pages (Anell et al., 2012) in case the individuals need to seek care concerning their ill health. However, in Japan, the population using the Internet is 82.8% and 99.9% employers have access to their personal computer (Sakamoto, et al., 2018). Japanese individuals can obtain targeted health information systematically through the Internet (Sakamoto, et al.,2018) which makes them to be aware of health information seeking behaviour. In contrast, U.S., citizens started researching for health information earlier on online than the Japanese (Sakai, et al., 2012), the reason is because of the pressure on the health system which led the healthcare providers including the psychians not having much time to discuss in details with the patients’ regarding their health problem whether in an inpatient bed or an exam room (Sakai, et al., 2012). Although, the use of traditional sources for health information seeking like television, doctors, nurses, magazine and books are still very common amongst the U.S. populations.

Structure

The structure of Swedish health system is regional based, decentralised and centralised and it is classified into three parts, the primary healthcare set up by the permanent basis of the system (Shing, et al., 2012). It run specialist care in all geographical areas. The second part is the county council hospitals, although these hospitals provide less specialisation to patients (Shing et al., 2012). The third level is the regional that includes university and regional hospitals. This form of health care has no specialised programme because it is mainly based in rural areas and have few resources to provide the appropriate care to the patients. While the university and regional hospitals are situated in the main cities and have most of resources which provide opportunity to access specialised care. However, this makes it less convenient for individuals living outside the major cities (Shing et al., 2012). This could also be observed in Italian health system which is regionally based, decentralised and the National health service is organised by the ministry of health (Ferre, et al., 2014). At the national level, the ministry of health determines the main benefits which could be provided across the country. The regional government makes sure that access to the benefits of any health package is delivered through population-based networks of the local health authorities (Ferre, et al., 2014).

The structure is designed to provide quality care to its citizens through effective activities for prioritising the delivery of care in a form of clinical appropriateness of patient safety and prescribed services (Jurjus, 2014). On the other hand, Canada health care system is decentralised and centralised and is split into three parts, namely the federal, provincial and territorial (Allin and Rudoler, 2013) to provide health and services for individuals to promote the individuals’ general health, wellbeing and prevention of disease (Allin and Rudoler, 2013 and also to ensure best practice in patient safety. In Sweden, roughly 115,000 registered nurses and 35,000 registered physicians are in services who are working at the three regional levels (Anell, et al., 2012). There are 3.7 doctors per 1000 population and the number of nurses per population is 1000 per 100 000 inhabitants. However, it is higher than the European Union but lower than Norway and Denmark (Anell et al., pp. 77, 2012). Similarly, in Italy the number of doctors to a patient is 37 per 1000 (Ferre, et al., 2014). At Sweden, there are shortages of nurses and doctors based on low salaries for doctors which are $4000 and nurses $2.25 per month. However, the government’s aim is to make health provision for every citizen by setting priorities for the improvement and maintenance of the populations’ health, ensuring that all staffs are held correctly to account for their actions (Anell, et al., 2012). In comparison to Italy, there are shortages of staffs, doctors and nurses as they migrate to other part of Europe countries due to low wages and monthly salaries at Sweden for doctors which is $3,292 and nurses $1,325 (Ferre, et al., pp.68,2014).

Low wages affect employment, retention, job satisfaction and attraction (Tijdens, et al., 2013). This can be mirrored in Canada, which also experienced shortage of doctors and nurses as a result of budget cutting and lower salary and wages which impacted the professional practice of the country development (Allin and Rudoler, 2013). The number of doctors per 1000 population in Canada is 2.5 which is lower compared to Sweden and Italy because of wages and salary. For workforce education Sweden, Italy and Canada see Appendix 3.

Historical

The present universal health care system of Sweden had been initiated in the medieval era in 1600’s, where the nobility and landowners decided to employ physicians to provide public primary basic care to their citizens on a more practical basis of which the people in power were so concerned about the health of their subjects simply because they believed that a healthy person can work much better than a sick person (Anell et al., pp. 20, 2012). In comparison, Germany’s health care system started at the late middle ages, where the guilds made provisions for health support in a form of health insurance based on the idea of solidarity (Busse and Blumel, p.21, 2014). In Sweden, in the year 1752, the first hospital, the Sterafimer Hospital, was established to meet health care needs for the entire citizenry. However, in Ireland, the first hospitals were constructed in 1720s for the individuals with medical problems to be treated outside of the home based and these were constituted on public donations and were maintained by ;public subscriptions (Corbett, 2015).

In Sweden, the county council administrative units were formed in 1864 where healthcare became one of their main responsibilities to provide a good standard of care by levying taxes on their citizens (Anell et al., pp. 21, 2012). Even though in 1849, Germany made health insurance compulsory for some individuals like the miners and community employers and their employees to contribute financially to the provision of quality healthcare to the general citizen (Busse and Blumel, p.21, 2014). In contrast, in Norway, the 1970 Hospital Act formed the state as the major provider of funding (Ringard, et al., 2013). In comparison to Sweden, the steps for universal coverage had taken place through the 1946 National Health insurance Act, after the Second World War and in the hospital organisation, a sufficiently great expansion of the Swedish health sector occurred (Anell, et al., p.22, 2012). This practice has been emulated in Denmark - welfare expansion and medical specialisation increased which led to the strengthening of counties to come together to make plans for hospital development (Byrkjeflot and Neby, 2008). This allowed the improvement of the lives of the citizens by providing quality health care. Amadeo (2018) stated that universal health care is a system that provides quality medical services to all citizens. It creates a healthier labour force because preventive care lowers the chances for expensive usage of emergency rooms. Although, some universal health systems have a long waiting time, the government focuses on providing emergency and basic health care (Amadeo, 2018).

Recommendations

To control the social determinants of health of Sweden the government should strengthen the tobacco control laws and introduce stronger measures such as support for individuals who want to desist from practising of such a habit. The administration in partnership with major stakeholders should develop a strategic plan for addressing the shortage of nurses and doctors by limiting the migration of these professionals out of Sweden. The healthcare system should provide with advanced counselling to patients who smoke and drink hazardously. Pedometer should be provided as a written prescription for physical activity and counselling to patients with unhealthy habits should be performed as an essential step towards the management of the entire undertaking..

Conclusion

This essay has analysed the health systems of most of the countries. By looking at the problems of the health systems and the major health issues discussed in this essay, it has highlighted that patient quality care is a significant concern for the healthcare policy makers and for the governments. However, some recommendations have been given above for policymakers. It has shown that a bad health system can affect patient quality of care which, in turn, reduces the life expectancy. However, governments operating on the health system building blocks will, strengthen the health system of every country.

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