How Sweden will deal with EU cross border healthcare


Sweden is decentralizing the operation of cross-border healthcare to the regions.

It often tops the world rankings for the best healthcare. The Swedish healthcare system is universal and free for all. It is government funded and decentralised. The problems are few, but for some operations in some regions there are queues for treatment and the relatively high cost of private Swedish healthcare means that patients can choose many EU countries where they could get quicker treatment at prices that would be lower than the local costs; although they would still have to pay for accommodation and healthcare so numbers taking advantage are not expected to be high.

While Swedish counties normally pick up the tab for health care, the central state has administered and paid for health care purchased in other EU countries. But that system is set to change on October 1st, although the state has promised to earmark funds in the autumn budget for the counties to dip into to ease the transition.

Sweden is divided into 290 municipalities and 20 county councils, which include the regions of Gotland, Halland, Västra Götaland and Skåne.There is no hierarchical relation between municipalities, county councils and regions, since all have their own self-governing local authorities with responsibility for different activities. The only exception is Gotland, an island in the Baltic Sea, where the municipality also has the responsibilities and tasks normally associated with a county council.

In theory, patients will get more choice on what treatment to seek abroad, but nobody is sure what the result of transferring the decision-making process to the regional level will be. The regions could be very strict, or if there are local queues, could pay for treatment and other costs too. The decision of who gets what from whom will transfer over to the counties, which will confer in reviewing patient applications with the National Insurance Agency.

Hasse Knutsson of the Swedish Association of Local Authorities and Regions (SALAR) says that while patients can apply retroactively to have their treatment or operation paid for by Swedish authorities, there is never a guarantee that the full cost will be reimbursed, "If replacing a hip costs 55,000 kronor in Sweden, but you get it done in Germany where the price is 70,000, you would only get back 55000.”

In 2012, 3,000 Swedes got money back for health care obtained abroad, but 400 people who applied for coverage were rejected. Swedish patients most commonly seek help with skin conditions and eye problems, but there are signs that ailments that Swedish health care has little capacity to treat are pushing patients over the borders.

Hasse Knutsson of SALAR admits, "It is difficult to speculate about what effects this reform will have, both in terms of the number of people leaving for treatment and people coming here. There may be more patients coming here."



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