Priority setting in health policy in Sweden and a comparison with Norway
Introduction
This paper will review priority setting policies during the past 10 years in Sweden, with brief comparisons with Norway. First, the features of both health systems and the general health policy measures that have been undertaken in recent years are introduced. This is followed by a description of the specific National Priority Commissions that were established in Norway and Sweden. Third, actual priority setting activities are discussed; and finally, the impact of the specific approaches taken by the National Priority Commissions in the two countries are evaluated. Due to the author’s nationality, the paper focuses mainly on Sweden.
Section snippets
The health systems
There are many features common to the health systems of Nordic countries. Even though historical and cultural developments within individual countries have led to differences, these are mainly marginal [1]. The Nordic systems have an overwhelmingly public character with regard to both the financing and the delivery of services. Private elements traditionally have been quite firmly integrated into the public management of the systems; for example, doctors practising ‘privately’ do so mostly
The Swedish Parliamentary Commission on Priority Setting
After several waves of public and media discussions during 1988–1991, the Swedish Parliament took the initiative and organised a public hearing focused on the issue of choices in health care. This resulted in a request to the Government to set up a Parliamentary Commission, which in Sweden is a traditional way of formally investigating an important social issue. After deliberations by Government officials, during which time there was a general election and a change in Government from a social
The new National Commission for priority setting
In order to maintain a national monitoring mechanism for priority setting, Parliament also decided to set up a new national body for priorities in health care, the National Priority Commission [6]. With a 3-year mandate, the Commission began its work in mid-1998 and has the following main functions:
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to disseminate information on Parliament’s decision regarding priority setting;
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to develop methods to promote implementation of the decision;
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to monitor and evaluate the effects of the decision; and
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to
Local developments in priority setting within Swedish County Councils
As with most other areas of health services in Sweden, the development of priority setting now occurs within the County Councils. Several County Councils have developed their own local models for priority setting. In some County Councils, the focus is on ethical committees, while in others, more independently based priority committees have the task of developing priority setting methods or increasing general discussion of the issues involved. Local implementation of priority setting schemes
Specific measures influencing priorities
As is evident from the presented information, the Swedish national priority recommendations are very general. Somewhat more detailed directives for action have been developed in certain County Councils. In some areas, national decisions influence this field, even if they are not directly linked to prioritisation. The following areas and activities are the most important:
Public involvement
In summary, so far, the Swedish health services system can be described as a system that has experienced strong economic pressures over a number of years. During the past few years, the emphasis has been on structural reforms and the reallocation of resources. The National Commission on Priorities produced guidelines of a general sort, emphasising an ethical platform and a principal list of priority groups. Implementation and development of more practical tools are left to the local level of
The Priority Commissions in Norway
Norway was the first country in the world to undertake work on the priority setting issue though a National Priority Commission. As early as 1985, a National Parliamentary Commission was set up with the task to analyse and propose guidelines for national and local health policy priorities. The commission was composed of health care experts as well as members of the public; but unlike Sweden, no politicians were included. The commission was chaired by the former rector of the University of Oslo,
Sweden and Norway — some comparative aspects of priority setting
Although Sweden and Norway are quite similar to each other with regard to many aspects of their governing styles and tradition, as well as in the structure of their health care systems, there are several, interesting differences in their handling of priority setting. Norway established a National Commission on Priority Setting very early on. It is worth noting that in Norway, the discussion on priority setting was triggered, paradoxically, by a situation where limits on health care had to be
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