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THL Vaikuttajaseminaari 3.-4.10.2013, Göran Stiernstedt
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The renewal of the Swedish healthcare system
Göran StiernstedtHelsinki 3rd of October 2013
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Why renewal?
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Local self-government
• Municipalities and county councils/regions are responsible for much of the public services
• Strong local self-government
• Right to levy taxes on incomes and charge users for their services
• Municipal/county/regional councils elected every four years
Regional and local authorities
• 20 county councils/regions – population between 126 000 and 2 091 000 inhabitants
• 290 municipalities – population between 2 400 and 864 000 inhabitants
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Problems
Efficiency Access Equality Integration Structure
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Problems
Efficiency
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Open comparisons
Started 2006 Annual Open – media and public 169 indicators 2012
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Overall indicators
Mortality, avoidable hospitalisation Drug therapy Confidence and Patient experience Availibility Costs
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Indicators
Pregnancy, Childbirth
and Neonatal Gynaecological Musculoskeletal Diabetes Cardiac Stroke
Kidney Cancer Psychiatry Surgical
interventions Intensive care Other
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Open comparisons – the paradigm shift
”This is the first time my boss has asked me about anything else but money”
Analysis of success factors
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HbA1c>73 mmol/molPercent
Not För Jämtland, Värmland och Västerbotten föreligger sannolikt metodproblem för HbA1c . * Andel patienter med har ett blodtryck över 150/80 mm Hg Källa: Nationella Diabetesregistret Årsrapport 2013, Health Navigator-analys
Blood pressure >150 mm Hg*Percent
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18161514130
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1917
Halland
Jämtland
Jönköping
KalmarKronoberg
NorrbottenSLL
Sörmland
Uppsala
Värmland
Västerbotten
Västernorrland Västmanland
VGR
Örebro
Skåne
Blekinge
Dalarna
Gotland
Gävleborg
Östergötland
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Success factors
Focus on target values Differentiate follow-up. Focus on patients
with problems Diabetes always on the agenda Careful follow-up and feedback Work with improvement within the
organisation
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Access – wait, queues
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Legislation – max. waiting time
< 1 day primary care telephone
< 7 days primary care visit < 90 days specialist care <90 days for operation
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Access
Agreement between government and county councils since 2008
110 mill euro/year County councils reimburshed
according to performance
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Agreement
>70% <60 days for vistit to specialist care
>70% <60 days for operation
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Waiting time guarantee - receiving treatment < 90 days
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Queue Billion - receiving treatment
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Waiting time guarantee - consulting a specialist< 90 days
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Queue Billion - consulting a specialist
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Integration
Integrated care for elderly Health care from 21 county councils Supportive care from 290
municipalities 3-4% of population Approx 50% of resources
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Integrated care
Agreement between government and county councils since 2010
130 mill euro/year County councils and municipalities
reimburshed according to performance
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Agreement - reimbursement
Use of quality registers Indicator for avoidable hospitalisation
(>65 y) Indicator rehospitalisation <30 days
(>65y) Indicator for use of drugs – improper dugs
(>75y), antpsychotic drugs (>65y), antiinfammatory drugs, NSAID (>75y)
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2010 2012 07 01 – 2013 06 30
Täckningsgradsutveckling Palliativregistret >=65 år
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No. Of registrations in BPSD
Den 19/8-13: 8 810 personer registrerade
17 732 registreringar
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
2010 dec
2011 dec
2012 dec
2013 jan
2013 feb
2013 mars
2013 april
2013 maj
2013 juni
2013 juli
Antal patienter
Antal registreringar
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Unsuitable drugs for elderly
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Antipsychotic drugs
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Antiinflammatory drugs
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Structure
Centralisation Decentralisation – integrated
care
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Structure Peniscancer - 80 cases/yr 30 hospitals 5 hospitals >4 patients/yr
Oesophagus cancer – 650 cases/yr 250 – operated for cure 19 hospitals 8 hospitals <4patients/yr 2 hospitals >10 patients/yr
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Structure
Colonca Today - 40-50 hospitals Tomorrow – 10-20 hospitals
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Structure
Increasing demand on national co-ordination
Coordination of information technology
Coordination of treatment strategies Insufficent equality of outcome Insuffficent cost-effectiveness Overload of political input?
Regional and local authorities
• 20 county councils/regions – population between 126 000 and 2 091 000 inhabitants
• 290 municipalities – population between 2 400 and 864 000 inhabitants
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Structure
Regional reform like in Denmark or Norway?
Do we need county councils? Committee on the subjects above?
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Thank you!