Healthcare coverage in Sweden is universal and covers all legal residents.

The publicly financed healthcare in Sweden covers:

• Close-to-home care (for example primary care clinics, maternity clinics, outpatient psychiatric clinics)
• Emergency care
• Elective care
• Inpatient care
• Outpatient care
• Specialist care
• Dental care

There is no defined benefit package. As the responsibility for organizing and financing healthcare is shared between the county councils/regions and municipalities, services can vary somewhat geographically.  

Emergency coverage is provided to all patients from European Union (EU) and European Economic Area (EEA) countries and to patients from nine other countries with which Sweden has bilateral agreements.

Asylum-seeking children and undocumented children have the right to healthcare services, as do children who are permanent residents. Adult asylum seekers and undocumented adults have the right to receive care that cannot be deferred (for example maternity care).

Three basic principles apply to all healthcare in Sweden:

1. Human dignity: All human beings have an equal entitlement to dignity and have the same rights regardless of their status in the community.
2. Need and solidarity: Those in greatest need take precedence in being treated.
3. Cost-effectiveness: When a choice has to be made, there should be a reasonable balance between costs and benefits, with cost measured in relation to improvement in health and quality of life.

All three levels of Swedish government are involved in the healthcare system.

• At the national level, the Ministry of Health and Social Affairs is responsible for overall health and healthcare policy, working in concert with eight national government agencies
• At the regional level, 12 county councils and nine regional bodies are responsible for financing and delivering health services to citizens.
• At the local level, 290 municipalities are responsible for care of the elderly and the disabled

The local and regional authorities are represented by the Swedish Association of Local Authorities and Regions (SALAR).

Patients are free to choose any public or private provider of primary care in their county.  There are about 1,200 primary care practices in Sweden, of which 40% are privately owned.

For outpatient specialist care referral may be required, particularly if the patient chooses a provider outside of his/her county.

All healthcare for children (up to age 18) is free of charge. In many counties, healthcare is free up to age 20.

For adults, annual out-of-pocket payments for healthcare visits are capped at 1100 SEK per individual.

The county councils set copayment rates, leading to variation across the country (providers cannot charge above the maximum fee).
Primary care visits: 150-300 SEK
Hospital consultation: 200-350 SEK
Hospitalization (per day): 50-100 SEK

Patients normally pay the provider fee up front for primary care and other outpatient visits. In most cases, it is also possible for patients to pay later.

In 2005, Sweden introduced a healthcare guarantee to reduce waiting times for pre-planned care. The guarantee means all patients should be in contact with a community healthcare center the same day they seek help and have a doctor’s appointment within seven days. After an initial examination, no patient should have to wait more than 90 days to see a specialist, and no more than 90 days for an operation or treatment, once it has been determined what care is needed. If the waiting time is exceeded, patients are offered care elsewhere; the cost, including any travel costs, is then paid by their county council.

The majority of the costs to run this system are paid for by county council and municipal taxes, with contributions from the national government to cover specialist treatment, prescriptions, pregnancy and childbirth, and rehabilitation.

About 83% of spending on healthcare is publicly financed, with county councils’ expenditures amounting to almost 57%, municipalities’ to 25%, and the central government’s to almost 2%.

About 16% of all health expenditures were private, of which 97% were out of pocket expenses. Most out-of-pocket spending is for drugs.

Private health insurance, in the form of supplementary coverage, accounts for less than 1% of health expenditures.

The county councils and the municipalities levy proportional income taxes on their populations to help cover healthcare services. In 2015, 69% of the county councils’ total revenues came from local taxes and 17% from subsidies and national government grants financed by national income taxes and indirect taxes. In 2015, 89% of county councils’ total spending was on health care.

General government grants are designed to redistribute resources among municipalities and county councils based on need. Targeted government grants finance specific initiatives, such as reducing waiting times.

The central government dictates health policy, but the system is decentralised, meaning that county councils and municipal governments are responsible for providing services.

An important policy initiative driving structural changes since the 1990s has been the shifting of inpatient care to outpatient and primary care, and the concentration of highly specialized care in academic medical centers.

Public and private physicians (including hospital specialists), nurses, and other categories of health care staff at all levels of care are predominantly salaried employees.

There are seven university hospitals and about 70 hospitals at the county council level. Six of them are private, and three of those are not-for-profit. The rest are public.
Counties are grouped into six healthcare regions to facilitate cooperation and to maintain a high level of advanced medical care. Highly specialized care, often requiring the most advanced technical equipment, is concentrated in university hospitals to achieve higher quality and greater efficiency and to create opportunities for development and research.

Acute-care hospitals (seven university hospitals and two-thirds of the 70 county council hospitals) provide full emergency services.

County councils and municipalities are required by law to set and balance annual budgets for their activities. Because county councils and municipalities own or finance most health care providers, they can undertake a variety of cost-control measures. For example, contracts between county councils and private specialists are usually based on a tendering process in which costs constitute one of the variables used to evaluate providers.
The funding of health services through global budgets, volume caps, capitation formulas, and contracts also contributes to cost control, as providers retain responsibility for meeting costs with funds received through those prospective payment mechanisms. In some county councils, there are local models for value-based pricing for specialized care such as knee replacements.

Only 13% of all employed individuals aged 15 to 74 years in Sweden have private health insurance (2016). Private health insurance is mainly associated with occupational health services, and it is purchased primarily to ensure quick access to an ambulatory care specialist and to avoid waiting lists for elective treatment. Private insurance is not tax deductible.

Prescription drugs for children (up to age 18) are free.

Adults pay the full cost of prescribed medications up to 1100 SEK annually, after which the subsidy gradually increases to 100 percent. The annual ceiling for out-of-pocket payments for prescriptions for adults is 2 200 SEK.

For certain prescription drugs not on the National Drug Benefits Scheme and not subject to reimbursement, patients must pay the full price. Pharmaceutical benefits are determined at the national level.

Children and adolescents (up to age 22) have free access to all dental care.

Adults (above age 23) receive a fixed annual subsidy (300-600 SEK depending on age) for preventive dental care.

For other dental services, adults (above age 23) pay (within a 12-month period)

• the full cost of services up to 3,000 SEK
• 50% of cost for services between 3 000-15 000 SEK
• 15% of costs above 15 000 SEK

Dental benefits are determined at the national level and there is no cap on user charges for dental care.

The National Board of Health and Welfare supervises all health care personnel, disseminates information, develops norms and standards for medical care, and, through data collection and analysis, ensures that those norms and standards are met. The board is the licensing authority for health care staff. The agency also maintains health data registries and official statistics.

The Swedish eHealth Agency promotes information-sharing among health and social care professionals and decision-makers. It stores and transfers electronic prescriptions issued in Sweden and is responsible for transferring electronic prescriptions abroad. The agency is also responsible for statistics on drugs and pharmaceutical sales.

The Health and Social Care Inspectorate is responsible for supervising health care, social services, and activities concerning support and services for people with disabilities. It is also responsible for issuing permits in those areas.

The Swedish Agency for Health and Care Services Analysis analyzes and evaluates health policy and the availability of health care information to citizens and patients. The results of such analyses are published.

The Public Health Agency provides the national government, government agencies, municipalities, and county councils with evidence-based knowledge regarding infectious disease control and public health, including health technology assessment. The Swedish Council on Technology Assessment in Health Care promotes the use of cost-effective health care technologies. The council reviews and evaluates new treatments from medical, economic, ethical, and social points of view. Information from the reviews is disseminated to central and local governments and medical staff for decision-making purposes.

The principal agency for assessing pharmaceuticals is the Dental and Pharmaceutical Benefits Agency. Since 2002, it has had a mandate to decide whether particular drugs should be included in the National Drug Benefit Scheme; prescription drugs are priced in part on the basis of their value. The agency’s mandate also includes dental care.
The Medical Products Agency, meanwhile, is the Swedish national authority responsible for the regulation and surveillance of the development, manufacture, and sale of drugs and other medicinal products.

Swedish Agency for Health Technology Assessment (SBU) evaluates methods used by medical and social services. SBU is an independent national authority, tasked by the government with assessing health care and social service interventions from a broad perspective, covering medical, economic, ethical and social aspects.

Currently, 99% of Swedish prescriptions are e-prescriptions.

The quality of IT systems and their level of use are high in hospitals and in primary care, although the type of systems used vary by care setting and by county council.

Patients increasingly can access their electronic medical records to schedule appointments or view personal health data, although this access varies among county councils.

Responsibility for the financing and organization of long-term care for the elderly and for the support of people with disabilities lies with the municipalities, but the county councils are responsible for those patients’ routine healthcare.

The Social Services Act specifies that adults at all later stages of life have the right to receive public services and assistance, for example home care aids, home help, and meal deliveries. Also included is end-of-life care, either in the individual’s home or in a nursing home or hospice.

Older adults and disabled people have a separate maximum copayment of 2013 SEK per month for services commissioned by the municipalities.