For long the Swedish welfare system has been known as “the middle road”. Pensions, education, healthcare and elderly care have been collectively funded, the systems regulated by authorities and the distribution of services managed in an egalitarian way by local governments. For long this was part of the “Swedish model” between left and right.
Since the early 1990´s there has been a growing criticism of this model being more to the left than right, hardly meeting the expectations from increasingly individualistic citizens. So, the last 20 years there has been a “Sturm und Drang” to “welfare market solutions”, causing an also internationally remarkable redesign of the provision of services.
Vouchers for choice
The main character of reform has been voucher systems, permitting the individual to make a publicly funded choice among providers. The most radical change has happened in education where anybody could start a charter school and hope that you attracted enough many pupils to run the school, financed by the nationally standardized, tax funded voucher awarded every child and teenager. A consequence, there are today large many charter schools, often run by big for-profit companies, but also many small schools in remote areas of Sweden, schools otherwise destined to be closed down under the old education regime.
Healthcare buy outs
Also in healthcare and elderly care large many private for-profit players emerged, contracted by health care regions and local municipalities. Fee-for-service systems were widely introduced even in publicly owned and managed hospitals. In parts of Sweden public employees have been supported to buy out primary care or maternal care units on most favourable conditions, to start their own business on public funding.
The upside has been higher productivity, shorter waiting and far more user-friendly design of services in those parts of the country where such “market approach” has been implemented. Compared to the old, homogeneous Sweden, with a strong Social Democrat brand, there are today huge variations between how to deliver and account for healthcare and long term care services.
The downside, now provoking political reaction, you find in high profits among big companies in schooling and long term care. Some of these companies are owned by international venture capitalists, based in tax havens. A number of irregularities, such as maltreatment of old people in nursery homes (run by municipalities as well as contractors), healthcare units maximising reimbursement by perverting DRG systems and charter schools going bankrupt (after having sent profits abroad), have been associated with the market introduction.
Improved healthcare performance
According to Health Consumer Powerhouse measurements Swedish healthcare anyhow has continued to improve during this period. As stated by the Euro Health Consumer Index, Sweden is the treatment outcomes champion, but still weak on access (though waiting times have been reduced; http://healthpowerhouse.com/index.php?option=com_content&view=category&layout=blog&id=36&Itemid=55).
Since a few months you can notice a remarkable gathering in the political centre, as the present national government (in charge since 2006) is in full retreat under heavy fire from the parliamentary opposition (Social Democrats, Green Party, Reformed Communists). The Moderates, the main non-Socialist force, who have been mastering the market reforms, are losing ground in every poll and now tries to re-position themselves in front of the general elections next year.
A rush to the centre
My prediction is that in a few months time we will meet a new political landscape, with a broad majority declaring that good intensions have been perverted and that a new mainstream consensus will be established, with stricter authority supervision, the end of buy outs, low tolerance of excess profits and revival of public provision. Regardless of the election outcomes there will be tougher conditions for private providers – though charter schools and private contractors as such most likely will survive.
The pendulum swings back again, to what presently is regarded feasible. Compared to old, uniform policy from the nanny state heydays in the 1970´s also this new mainstream compromise is far to the right, but at the same time a significant correction of the last ten year reality.
See you again at another website!
With this column, we end our publicity through MyNewsdesk and welcome our readers to follow our columns and reporting at www.healthpowerhouse.com and the new www.eihi.org . For publication during 2013 HCP presently works on the Euro Health Consumer Index, the Euro Pancreas Cancer Index and the Euro Vision Scorecard. We will provide information about the project progress and much more, so why don´t you tune in to these websites instead!
See you there,