Flying the flag for healthcare

Last week Sweden topped a European index for having the best health outcomes in Europe. CLARE MACCARTHYin Malmö reports on how it achieved this score

WHEN SHARON Pentleton, a young Scottish woman pregnant with her second child, contracted swine flu this summer and lapsed into a coma, her UK doctors exercised their last option to save her life – they picked up the phone and dialled Sweden.

The severity of Pentleton’s condition required an emergency procedure to circulate her blood outside her body and artificially oxygenate it but the only machine in the UK capable of doing this was unavailable.

Luckily for her, Stockholm’s prestigious Karolinska University Hospital had both the willingness and the technology to carry out the highly specialised procedure and a crack team of medics airlifted her out. Several days later Pentleton was understandably shocked to wake up in a Swedish hospital but was delighted to have survived. “I think it really only sank in when I came home and realised how close I was to not being here,” she says.

Dramatic though it is, Pentleton’s story is not unique; Sweden frequently accepts critically ill patients from other countries. More importantly, Swedish hospitals have an enviably high success rate in curing their patients.

For example, almost nine out of 10 women in Sweden who develop breast cancer are likely to beat the disease – a higher rate than most other EU countries. Ursula Tengelin, secretary general of Sweden’s cancer society, says the relatively high survival rates derived from several factors including a widespread and well-functioning mammography programme.

Other factors include state-of-the-art hospital treatment as well as a strong focus on Swedish-based research. “With Swedish research, new knowledge gets out to the healthcare system much faster,” she said.

Indeed, this success is mirrored across the Swedish healthcare system in general. Sweden ranked a respectable eighth in the Euro Health Consumer Index (EHCI) published last week, just a few places above Ireland’s 13th placing.

However, a breakdown of the individual categories making up the overall index score, shows that Sweden made a clean sweep in terms of health outcomes – by many reckonings the most important measure of healthcare quality: results matter. “Sweden has been the European champion in treatment quality since this index was launched in 2005,” said Dr Arne Björnberg, lead author of the report.

Precisely how Sweden manages to cure more ailments than other countries is not easy to pin down. Many factors are at play.

Although Sweden performs dismally in the EHCI in terms of overall accessibility (even Albania scored better on waiting time for treatment), patients do benefit tremendously from the system’s egalitarian nature.

In Sweden, all residents have equal access to healthcare services and the system is government-funded and largely decentralised. Health insurance – the right to treatment – is an automatic right for all legal residents.

Judging from a quick sweep of internet chatrooms for expatriates in Sweden, Britons seem particularly impressed by the service they get compared with their own NHS.

One Briton who suspected she had deep vein thrombosis after a flight to London, waited two days for a doctor’s appointment and got only a handful of Panodil for her efforts. Back in Sweden, her doctor issued an emergency referral to hospital for tests.

Similarly, another compatriot reported that he was on an operating table having a detached retina repaired within hours of first noticing the problem. “In the hospital I had my own room with ensuite and satellite TV and in the lovely room where we ate, the fridge had beer in addition to the usual and you could help yourself at any time to tea, bread, cheese, etc.”

Superior care such as this obviously costs money, and in Sweden, it is the State that picks up the tab.

This tab is itself financed by the tax system (both central government and local taxation). Sweden suffers the world’s second highest tax burden which, at about 48 per cent, is just a tad under neighbouring Denmark.

Remarkably, given the high level of taxation and its sterling health outcome results, Sweden is not the world’s highest spender on healthcare.

According to the OECD, total health spending accounted for 9.1 per cent of GDP in 2007, slightly above the average among developed nations, but well below the United States which allocated 16 per cent of its GDP to health in 2007. That same year (the latest for which figures are available), France, Switzerland and Germany also surpassed 10 per cent while Ireland’s health spending came in at 7.5 per cent of GDP, almost 1.5 percentage points lower than the 8.9 per cent average across OECD countries.

So, if the amount of money that you throw at a healthcare system does not necessarily guarantee the optimum outcome, what does actually work?

Again, there are no easy answers to this question. However, there is much to suggest that Sweden’s tailoring of its healthcare system in recent years to better reflect the needs of its ageing population plays a crucial role.

Swedes have traditionally favoured hospitals rather than the primary care offered by GPs and other community services.

But hospital care is relatively expensive so government policy over the past few years has been to encourage as many patients as possible into local health centres as a first point of contact with the system.

An increased focus on preventative healthcare – as opposed to emergency plumbing in a crisis – has also helped to move resources to the primary care system.

Other reforms introduced by the prime minister Fredrik Reinfeldt’s centre-right government are aimed at expanding choice within the system, allowing patients to choose between the vast public system and the small number of private clinics.

Unlike Ireland, however, there is no two-tier system. Privately run clinics in Sweden are so heavily subsidised that fees are merely nominal.

Leif Pagrotsky, a social democratic MP and former cabinet minister, singles out this freedom of choice as a big advantage in Sweden: “I personally sometimes go to a private clinic, sometimes I go to a public clinic depending on what’s convenient, what’s closest, who has the best opening hours.”

Sweden, he says, compares more than favourably with the US, which spends more but achieves less: “People live longer in my country,” says Pagrotsky.