Recent items in some Canadian newspapers have proclaimed the death of the ”Stockholm model” for healthcare reform. Conservative losses in Sweden’s September elections, these opinions say, show that people in Stockholm and other big cities were turning against reform. Market-oriented policies now seem to be tumbling in the face of the new wind.
This is wishful thinking. People in Canada and elsewhere who advocate more of the same rather than fundamental changes in healthcare hail what they percieve as reform failures. But when you look through the smoke screens of the political battle front, you find that the Swedish healthcare reforms are moving ahead, regardless of the elections outcome. The Stockholm revolution is still setting the agenda.
An increasing number of Swedish county councils are implementing purchaser-provider splits in their systems, which means they will replace old-style global budgets by reimbursing providers according to their output. By last year, one-third of the Councils had made this split, and next year half of the rest will join the new camp. The most populated areas are leading the change.
Quite contrary to what you might expect, more and more publicly owned hospitals have been listed for takeover by entrepreneurs. According to the Confederation of County Councils, half a dozen of hospitals are up for grabs, and another ten are being investigated. In a couple of years, the private contractors at the St. Goran and the Simrishamn hospitals will have a lot of company.
The Social Democratic Minister of Health, Lars Engqvist, is now explicitly welcoming more private – even for-profit – players into Swedish healthcare. Fresh proposals from a government committee open the door to for-profit companies. They will be allowed to operate any kind of publicly owned hospital except for the largest ones, like university hospitals. They can even own them.
How come? The Swedish government understands that the future of public healthcare requires improved efficiency, effective access and better management of human resources. Letting private companies into the game brings new concepts and benchmark opportunities. The Swedish experience of the 1990s shows that doctors, nurses and other medical staff appreciate working for private companies, which offer a better working environment and inspiration. This explains why Swedish healthcare unions support change.
During the last ten years many, especially nurses in the Stockholm region, have moved into self-employment and abandoned Council employment to reduce bureucracy and red tape. As a result, 200 successful small and medium-size care companies in Stockholm offer a new labour market to professionals tired of Council administration.
There are no attempts to reverse this reality. In practice, the centre-left majority in control of the Stockholm County Council since last fall seems to have accepted all the essential actions taken by the former centre-right coalition. One Councillor, a Reform-Communist, strongly denies any plans to reduce the number of contracted entrepreneurs or the incentives for private actors.
Instead the new leadership has asked for more speed in the transformation of primary care and in the implementation of priority tools. The most likely outcome will be price reforms, with better compensation to efficient primary care units.
The new majority won the elections on the promise of balancing the Council´s budget, and it quickly noticed that not even a significant tax rise is enough. In reality, they are not able to reduce the big deficit without looking for cost reductions. Tougher medical priorities might be the recipe – and a surprise to many political supporters. Far from dead, the healthcare revolution has become a staple of daily politics in large parts of Sweden.
Today the government is the strongest advocate for a national access guarantee, which mandates any kind of treatment within 90 days. Free choice is already a fact. Patients can go anywhere in Sweden for treatment, and bringing their public funding with them. Just a couple a years ago, these policies were highly controversial, under attack from the Left. Today every politician supports them.
Dead or kicking? You be the judge.