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Health Services in Sweden

Health Services in Sweden. Shiv Chandra Mathur Professor of Preventive and Social Medicine and Director State Institute of Health and Family Welfare,Rajasthan,Jaipur India. Sweden. Capital : Stockholm Other large cities : Goteborg,Malmo,Uppsala Area : 449,793 sq kms

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Health Services in Sweden

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  1. Health Services in Sweden Shiv Chandra Mathur Professor of Preventive and Social Medicine and Director State Institute of Health and Family Welfare,Rajasthan,Jaipur India

  2. Sweden • Capital : Stockholm • Other large cities : Goteborg,Malmo,Uppsala • Area : 449,793 sq kms • Population : 9,001,774 • Language : Swedish • Religion : Lutherans Christians (87%) • Life Expectancy : 80.3 years • Currency : Krona ($1=7.79) • Government : Constitutional Monarchy • Prime Minister :Goran Persson Shiv Chandra Mathur

  3. Swedish Government • Four separate constitutional documents • Succession of King/Queen first born regardless of sex • Political power rests with Cabinet • Ministries are small units • Parliament by direct elections • 23 County administration • 286 Municipalities • Fiscal year from July to June • Nine years of compulsory education from 6-7 years of age Shiv Chandra Mathur

  4. Swedish Economy • Forests, Iron ore and water power are the basis • Pulp and Paper, motor vehicles and steel industries* • GDP is around 2000 billion SEK • Labor force(16-64 years) is >half the population • Local gov’t followed by mining/manufacturing is main labor force • Normal statutory week is 40 hours * ABB, Ericsson, Electrolux, Saab, Volvo account for 60% of employment and 80% of exports of manufactured goods. Shiv Chandra Mathur

  5. Health Scenario • IMR is 3.4 per 1000 LB • CV conditions account for half of all deaths • Magnitude of allergic disorders is very high • One-fifth population is 65 and above • Growing proportion of overweight children • Mental Health, psychosomatic problems on increase • One Physicians per 320 inhabitants Shiv Chandra Mathur

  6. Demographic/Social Indicators (Source:SWPR-2005,UNFPA) Shiv Chandra Mathur

  7. Year -Midwife Assisted Delivery - MMR Shiv Chandra Mathur

  8. Sweden IMR 4 Life Expectancy M/F 78.2/82.7 MMR 2 Birth/1000 W 15-19 7 Contraceptive Prevalence 78 HIV Prevalence(15-49)M/F 0.1/0.0 India IMR 64 Life Expectancy M/F 62.4/65.7 MMR 540 Birth/1000 women 15-19 7 Contraceptive Prevalence15-49M/F 78 HIV Prevalence(15-49)M/F 1.2/0.6 ICPD Goals(Source:SWPR-2005,UNFPA) Shiv Chandra Mathur

  9. Family Planning in Sweden • RFSU founded in 1934 • Sex Education compulsory part of school curriculum by 1954 • Absolute ban on abortions lifted in 1938,amended in 1946 and 1963 including socioeconomic distress and fetal disorders for legal abortions. Legal abortions rose from 16000 in 1974 to 30600 in 1974. 93% of abortions are before 12th week of Pregnancy. • Economic growth of sixties led to change in social attitude towards sexuality • 1976 sterilization act; 7’ to 10 ‘000 sterilizations every year • 70% of sexually active couples use contraceptives; ¾ of them use conventional contraceptives Shiv Chandra Mathur

  10. Child Care • Loss of earnings due to childbirth and illnesses are compensated • Free maternity health care throughout pregnancy • Free health and dental care all through school • < 10% children start school before 7 years • Parents are responsible for their children until they are eighteen • 45 % marriages are dissolved but 80% children live with both parents • Custodial parent is guaranteed maintenance advance by other parent Shiv Chandra Mathur

  11. Gender Equality Policy • Equality Affairs is part of Ministry of Labor • Women and Men are equally assiduous voters • Women make up half of the labor force • Economic independence through gainful employment for all • Measures foe women and men to combine jobs with parenthood • >40 % of 349 MP’s are women • Violence against women – a serious offence • National Centre for women victims of battering, rape Shiv Chandra Mathur

  12. Social Insurance in Sweden • National Health Insurance – financed from taxation revenue and contributions from social insurance budget. • National Pension Insurance – elderly and disabled are provided basic/partial pensions • Work Injury Insurance • Unemployment Insurance Shiv Chandra Mathur

  13. Management and Planning Central Government County Councils Local Authority Shiv Chandra Mathur

  14. Central Government • Ministry of Health and Social Affairs • Laws and ordinances for health services (Health and Medical Services Act 1982) • National Board of Health and Welfare • Swedish Council of Technology Assessment in Health Care (SBU) Shiv Chandra Mathur

  15. County Councils • 23 county councils • 60 000 – 1.8 million people • 230 000 people employed in county council health services (7%) • 24 hour casualty department • Freedom for Patient to choose their provider • Referral system is not mandatory • Six Medical Care Regions for highly specialized care • Award financial compensation to patients who have suffered injuries/infections during treatment Shiv Chandra Mathur

  16. Health Care System Primary care system is wide and large • Everyone has the right to choose their own family doctor i.e. GP (Only 20% of Doctors are General Practitioners) • Child clinics • Maternity clinics • Occupational health services • School Health Services 65 Central/District County Hospitals somatic care in a number of specialist fields (deliberate emphasis on outpatient care) 9 Regional Hospitals Neurosurgery, Thoracic Surgery, Plastic Surgery Shiv Chandra Mathur

  17. Finances • Costs for health care services is SEK 178 billion in 2000 • 8.5% of GNP and 80% financed by county councils • Average salary of specialist is 46 000SEK / Nurse is 22000 SEK pm • SEK 80 per day is charged for stay in hospital • Number of Beds for short term care fell from 4.4(1985) to 2.4 per 1000 inhabitants in 2002. Corresponding figure for psychiatric care fell from 2.5 in 1985 to 0.6 in 2001 Shiv Chandra Mathur

  18. Pharmaceutical Preparations • Registration of Medical Products Agency is mandatory • 6000 registered medical preparations • Pharmaceutical Board constituted in 2002 • Costs for drugs rose from 8%(1990) to 15%(2000) proportion • Social Insurance Scheme provides ceiling on cost to be borne by patient • 900 Pharmacies nationwide under Apoteket AB Shiv Chandra Mathur

  19. DOCTORS Universities:Lund,Gothenberg,Linkoping,Stockholm,Uppsala,Umea 1100 students join Medical schools every year 5 1/2 years basic training and 18 months pre-registration houseman ship Specialization after five years service 62 recognized specialist fields NURSES Three years training 30 centers 5500 students join each year Training Shiv Chandra Mathur

  20. Swedish Projectsin India • MAMTA-RFSU collaboration • Create relevant database on key YRSHR issues • Strengthen resource and training base to capacitate stakeholders • Strengthen network of 150 NGO’s to integrate YRSHR in the state policies • Develop effective for a for global partnerships for ensuring YRSHR • LAWYERS COLLECTIVE • Promote awareness of HIV/AIDS related issues in different segments • Enhance capacity of legal community regarding HIV/AIDS • Advocate for change, development of the judicial response • INTEGRATED WATER RESOURCE MANAGEMENT AND POLICY ADVOCACY IN RAJASTHAN Shiv Chandra Mathur

  21. Specific Projects • Injury Prevention (Safe Communities) • Sexual and Reproductive Health Rights Shiv Chandra Mathur

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