This report is the fourth of a new series of publications reviewing the quality of health care across selected OECD countries. As health costs continue to climb, policy makers increasingly face the challenge of ensuring that substantial spending on health is delivering value for money. At the same time, concerns about patients occasionally receiving poor quality health care have led to demands for greater transparency and accountability. Despite this, there is still considerable uncertainty over which policies work best in delivering health care that is safe, effective and provides a good patient experience, and which quality-improvement strategies can help deliver the best care at the least cost. OECD Reviews of Health Care Quality seek to highlight and support the development of better policies to improve quality in health care, to help ensure that the substantial resources devoted to health are being used effectively in supporting people to live healthier lives.

This report reviews the quality of health care in Sweden. It begins by providing an overview of the range of policies and practices aimed at supporting quality of care in Sweden (Chapter 1). It then focuses on three key areas particularly relevant to elderly populations: strengthening primary care in Sweden (Chapter 2), better assurance for quality in long-term care (Chapter 3), and improving care after hip fracture and stroke (Chapter 4). In examining these areas, this report seeks to highlight best practices and provides recommendations to improve the quality of care in Sweden.

Sweden’s generous health and long-term care systems are regarded across the OECD as models to be emulated. Several of the indicators of health outcomes and quality of care are better than the OECD average and citizens enjoy good access to care, while health expenditure is only slightly above the OECD average of 9.3% in 2011. However, the combination of an ageing population alongside increasing expectations of service users for seamless care within and across the health and long-term care sectors, are testing whether these systems can continue to deliver effective, safe and patient-centered care. Long-standing emphasis on local governance and reforms since the 1990s seeking to drive up performance in Sweden´s health and long-term care systems through patient choice and provider competition have resulted in a “light touch” governance model, these approaches must now be balanced against the need to deliver quality in a consistent and transparent manner and assure whole pathways of care.

This chapter summarises the many policies and activities that are in place in Sweden to assure and improve quality of care. After describing the quality governance structure and the roles of central government, its agencies, county-councils/regions and municipalities, the chapter focuses on the assurance of the quality of professionals, pharmaceuticals and devices and health care organisations. The development and use of national guidelines and the Swedish data infrastructure is described, including the important role of registries and systematic measurement of patient experiences. Specific attention is given to measurement and improvement activities related to patient safety.

Indicators of health, health care quality and long-term care for the elderly in Sweden are among the best internationally. The Swedish health care system now faces the challenge of delivering high quality, user-centered and well-co-ordinated services, while coping with the pressures common to most developing countries of an ageing population, growing prevalence of chronic disease and budgetary constraints. Primary care’s role in preventing and managing the burden of chronic disease, and in co-ordinating care across services and providers, will be critical to meeting this challenge.

The Swedish long-term care (LTC) system for frail and dependent old people is comprehensive in many respects. It offers good financial protection and covers a broad range of services; is mainly funded through public sources; and is staffed with a large number of care workers by OECD standards. Long-term care services are organised at local level, with municipalities purchasing care from both public and private providers, and many LTC recipients have the possibility of choosing across competing providers. There has been limited measurement, however, of the effectiveness and safety of care, and few mechanisms for guaranteeing standards of quality of the services of the type found in health care.

The degree to which a health system routinely provides high quality health care after a stroke or hip fracture directly reflects its capacity to provide a complex and tailored array of health and social care services in the face of sudden and unexpected disability.