Assessment of Healthcare outcomes in term of Cost, Access and Quality Health outcomes Health Outcomes include a number of aspects that help in assessing the health care system of any country. Parameters like cost of care, quality of care, access to care, morbidity, mortality and use of specified services are indicative of how well the health care system is performing. Healthcare outcomes motivate practitioners to compare their performances and improve from each other. It highlights value enhancing outcomes which leads to reduction of overall cost.
Results based payment rather than volume based payments becomes prevalent. Measuring outcomes is of significance as it gives us an indication of how well the system is functioning. Cost, Access and Quality are few important outcomes that needs to be measured. [https://hbr. org/2015/09/better-value-in-health-carerequires-focusing-on-outcomes,] Cost Fig 2: Public Health spending as % of GDP. http:// www. economicshelp. org/blog/6220/economics/global-healthcare-costs/ Sweden’s health care expenditure as a percentage of GDP( Gross domestic product) was 7. 5% in 2012.
Healthcare in Sweden is tax-financed and is regarded as the responsibility of the public. County Council and municipal taxes form the bulk of the health and medical costs. National government also contributes to the cost and are the other source of funding. Public expenditure account for 80% whereas the public expenditure accounts for only 20% of the total health care expenditures. A very small percentage of health costs are paid by the patients. The figure 2 shows the comparison between different countries in terms of their spending on health per capita.
As seen from the graph, USA spends more than $8000 which is the most on health per capita and slovenia spends the least around $2500 whereas sweden stands in the middle by spending approximately $ 3900. [https://sweden. se/society/ health-care-in-sweden/]. Fig 2: Public Health spending as % of GDP. http://www. economicshelp. org/blog/6220/economics/ global-health-care-costs/ County council and regions design and structure activities based on the conditions and this is the principle of local self government. They generate income through various state grants and also patient charges.
The provider payment mechanism vary among county councils. Different payments methods can be used based on global budget and case or performance based payment. Capitation is the most common payment method to primary care providers for patients who are registered and this is also complemented with fee-for-service and performance based payments. Salaried employees are employed both publicly and privately and include physicians, nurses and other staff. There are flat rate payments the patients have to pay as user charges for health care visits in both primary and specialist care.
In Sweden, the individual never pays more than 155$ for health care visits within 12 months. Also, Patients under the age of 20 years are exempt from user charges and all the inpatient drug costs are paid by the county council. Reimbursed prescription drugs have a cost sharing aspect where the user pays a part of the cost according to the scheme and remaining is paid by the county council using government grants. There is also a maximum cost ($310) the users pay within 12 months. country-has-worlds-best-healthcare-system-this-is-the-nhs] [http://www. helocal. se/20130327/46910] Access Sweden health care system is highly integrated. There has been shift from inpatient care to primary and outpatient care due to the important policies since 1990. County councils fixed all the provider fees and this has caused variation across the sweden. All the service providers like physicians, nurses and othe are salaried employee either by public or private setting. They are allowed to provide services outside their workplace increasing access to care for patients.
According to the Swedish Medical Association, 20% of all health expenditures accounts for primary care and 16% physicians provide primary care services. Gatekeeping is not present in primary care. Primary care is team based. District nurses in the municipalities participate in home care and helps the elderly. No registration is required for practice. 40% of around 1100 primary care practices are privately owned. Payments to these practices are through reimbursements, fee for service and also performance related payment.
This ensures quality targets are achieved in patient satisfaction and patient have access to primary care. People also have access to outpatient care present at universities, hospitals or private clinics. Patients can choose a specialist. Patients only pay the provider fee upfront or later. Care is also provided after hours based on the accrediation in each county council. 24 hours services are provided in 7 universities and 50 hospitals. Counties are grouped into six regions to promote cooperation and maintain high level of medical care. Full emergency services are provided in acute care.
People with minor mental health problems are referred to primary care but patients with worse mental health conditions are admitted to mental care centers. Elderly and people with disabilities are cared and provided services with the financing by the municipalities and also county councils. Home health care services are also provided by nurses and other caregivers. Sweden’s healthcare system is very accessible. Quality Sweden’s population is increasingly living longer. 83. 7 and 80. 1 years are the average lifespan for women and men respectively. Mortality rate from heart attacks and strokes have reduced. Sweden has a 19. 4% of elderly population along with increasing number of children population. Quality of life in sweden is very high. It has one of the highest survival rate from cancer. Premature death is the lowest in sweden as compared to all oecd countries.
The country also has a very high influenza immunization rate. They showcase positive results on quality due to their strict guidelines and regulations. Quality of care is guaranteed and developed continuously and systematically under the Health and Medical Services Act (1982:763). The Act is directed at provider and it sets obligations on them to provide high quality care and it does not confer any rights on the patient. The National Board of Health and Welfare (NBHW) revised the sets of regulations on quality assurance in 2005.
These regulations state that in sweden, all the health services must include a target oriented quality improvement and continuous system. This regulation embodies a new approach to monitoring, quality improvement along with the main focus of patient experience. There are many agencies and Act that work on monitoring the quality and establishes strict guidelines to ensure quality control. Health Care providers are accredited by the County councils and they are responsible for following up on conditions for accreditation.
They assess quality targets associated with pay for performance schemes or requirements for continued accreditation. Patient surveys, patient registries, clinical audits and quality registries are some criteria based on which providers are accredited. Systemic reviews of evidences and development of guidance for establishing priorities to support disease management programs are conducted by the National Board of Health and Social Welfare along with the National Institute for Public Health and Dental and Pharmaceutical Benefits Agency.
Unnecessary variation in clinical practice are avoided by developing regional guidelines to inform priority settings. Regional Cancer Centres were formed in 2011 after the establishment of the National Cancer strategy in 2009. Their role is contributing to regional and national collaborations that are more safe, equitable and have effective cancer care. More than 90 national quality registries are used to monitor and evaluate quality among providers and for assessing clinical practice and treatment options. Data on diagnosis, treatment and treatment outcomes are present in the registries.
An executive committee funded by the central government and county council and managed by the specialist organizations monitor the registries annually. Using the data from various sources the government published annual performance comparison and ranking of health care services. It started in 2006 and the 2012 publications includes 169 indicators which are categorized into different groups. Patient experience and waiting time statistics are also made available through the internet. http://www. keepeek. com/Digital-Asset-Management/oecd/ social-issues-migration-health/oecd-reviews-of-health-carequality-sweden-2013_9789264204799-en#page88. ttps:// sweden. se/society/health-care-in-sweden/ http://www. commonwealthfund. org/~/media/files/publications/ fund-report/2016/jan/1857_mossialos_intl_profiles_2015_v7. pdf What can US healthcare system learn from Swedish Healthcare System
1. Choices for the middle class in the towns have diminished since the 1950s. One cannot get into a private clinic except in Stockholm and Gothenburg, and it is only the very well-to-do patients who can afford private hospital care. Patients have little consumer choice.
2. Productivity in hospitals has fallen sharply since the 1970s, when doctors began receiving fixed salaries and not a fee per patient. 3. Productivity in hospitals has increased recently only as a result of diminishing financial resources. The productivity of district doctors can be extremely low-it is not unusual for a doctor to treat an average of only six to 12 patients a day. 4. Long-term care reform has increased the number of available beds, but the quality of care for elderly patients is not satisfactory.
5. A worker with a wage of US$20,000 pays about US$3,000 a year in taxes for health care. A scientist at Astra with a salary of US$50,000 has to pay more than US$7,000 in taxes for health care, plus a fee of at least US$22 for prescription medicine or consultation with a doctor. 6. When Sweden was a rich country in the 1970s, there were few restrictions on the introduction of new medical methods, new pharmaceuticals, etc. Now the environment is different, and there is a tendency to block or restrict the availability of specialized care in order to save money. Some new medical procedures are introduced as standard later than they are in other countries. For example, while bypass operations were standard (with overcapacity) in Switzerland in 1983, patients in Sweden had to wait more than a year for bypass operations. If the United States had Sweden’s distribution of births by gestational age, nearly 8,000 infant deaths would be averted each year and the U. S. infant mortality rate would be one-third lower.
7. Waiting lists have become a big problem. “Care guarantees” have reduced the waiting list problem temporarily in the past, but these problems began reappearing during the last few months of 1995. [http://oldfraser. lexi. net/publications/ books/health_reform/sweden. html]