Telemedicine in Sweden

Sweden’s health and care system organisation

The Swedish government is responsible overall for health care policies and for quality control via the National Board of Health and Welfare. The country councils are responsible for organising the healthcare of all inhabitants. Municipalities are responsible for social care (elderly care, and care of persons with physical or mental disabilities). There are nine regional hospitals, 70 county council hospitals and around 1,000 general practitioners’ offices.

Swedish citizens have at least two different types of guarantees from the healthcare providers and the government. One is that the patient can choose whichever primary care facility he or she prefers. Another is that the patient is guaranteed to have his/her need for specialised healthcare fulfilled by a chosen healthcare provider within a three-month time limit. If the provider does not have the resources to keep to that time limit, the patient will be reimbursed for choosing a healthcare provider who can perform the specialised care within the three months.

Sweden’s health and care system financing

All public-financed health care and social care is mainly tax-financed, which gives all inhabitants the right to health care. There are also privately-financed healthcare and social facilities and, according to recent figures, six per cent of the population has some kind of private health care insurance. In a political debate held in Almedalen in early July 2013, it was announced that more than 500,000 Swedish people have some kind of healthcare insurance.

Work is being done to reach political decisions for a financing model suitable for eHealth and telemedicine solutions, because today only actual patient contacts are supported financially.

Sweden’s telemedicine strategy and legislation

Sweden’s health IT strategy (pdf, 2.5MB, in Swedish) was adopted by all relevant stakeholder launched in 2006 and further revised in 2010. The focus of the latest revision has moved from a focus on technology to patient benefits, participatory medicine, and usability for all end users.

Participatory medicine has been a focus of interest in Sweden. Patients are increasingly acting as “consumers” and are driving change. Many solutions are currently being piloted at the moment.

In 2013 a new national plan is expected based on the eHealth strategy.

The country has legislation that clarifies the issue of liability in telemedicine. However, there are privacy provisions that complicate the access of more than one care giver to a specific patient’s medical history, which can be a problem for the design of eHealth services.

Every patient has the right to have access to their information online, and also to block unwanted healthcare providers from accessing their electronic health record (EHR).

On the potential difficulties in creating telemedicine services and sharing information between different actors apart from the patient: the problems with administering a patient’s consent will be dramatically lessened if the patient is actually the active participant who manages the service in question. So, the solution is to put the tools in the hands of the patients. This is definitely the way in which Swedish national services are developing at the moment.