SWEDEN - GENERAL FACTS

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SWEDEN - GENERAL FACTS• Area: 450,000 km2 (174,000 sq mi)

• 9.1 million inhabitants

• Average life expectancy: men 77.5 years, women 82.1 years

• Capital: Stockholm (1,643,000)

• Major cities: Göteborg 789,000, Malmö 518,000

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Population • 71% live in nuclear families (1990 census)• 80% live in urban areas and along the

coast• Post-retirement age (65+) 18%• Very elderly (80+) 4.9%• Sami (Lapp) minority of 17,000 – 20,000

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ORGANIZATION OF THE SWEDISH HEALTH SERVICES

STATECOUNTY

COUNCILS

LOCAL AUTHORITIES

Hospital and heath centers

Housing and care for elderly and disabled

LegislationSupervisionEvaluation

FinanceOrganisationFollow-up

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Local GovernmentTwo types of local government body:• 289 municipalities (kommun) with

responsibility for schools, social services, elder care, care of people with physical or intellectual disabilities, physical planning and building, certain environmental tasks and rescue services

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Local Government• 18 county councils (landsting) + two

health care regions and one municipality. Their main areas of responsibility are:

- health care services at hospitals, outpatient medical care at local health centers

- public dental services

- psychiatric care

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The Financial Circumstances of Swedish Households• Gainfully employed: 62% of adult population.

• Transfer payments to households (27% of GDP): pensions, child allowance, housing allowance, sickness benefit, parental leave etc.

• Universal state pension system

• Social assistance for those below the poverty line

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Housing policy• Allow families with low financial capacity

to be able to acquire accommodation with good standard

• Programs for renewal and maintenance of flats and housing areas

• Housing allowances for those in need

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Taxes• 51% ceiling on mariginal income tax

• Local and state tax on income from employment, real estate, companies, pensions, capital and capital gain

• Taxes on alcohol, tobacco, petrol etc

• VAT on goods and services

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SOCIAL ISSUES• The Swedish welfare state – a social

democratic project that has enjoyed broad support

• Universal welfare system covers everyone regardless of income or occupation. Some benefits are needs-based, however.

• The social insurance system, health care, schools etc are financed mainly via taxes and employer payroll fees

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Social Insurance• Uniform social insurance system providing:

- health care

- parental insurance

- cash benefits during illness

- occupational injury insurance

- unemployment benefits

- pensions

- other support for families with children

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Care of the Elderly• Care of the elderly outside the family is a

public responsibility

• Costs for pensions, housing benefits, institutional care, home-help services etc account for some 16% of GNP

• Local variations in service levels

• An estimated 4 out of 10 elderly people do not receive any form of public assistance

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Care of the Elderly• 10% of care is provided by private

organisations (public funding)

• 7,000 home-help providers for the elderly (often less than 20 hours/week)

• Around 7,000 close relatives receive cash grants for care of the elderly

• The family is the most important care provider

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Health Care System• County councils responsible for health care

• Primary care sector comprises health centres, district nurse clinics, child and maternity health care

• Hospitals, nursing homes and service apartments with 24 hours service a day

• 80 county and district hospitals and 9 regional hospitals

• 1 physician per 340 inhabitants

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Health Care System• Reductions in inpatient care. More outpatient care.

• Freedom to choose health centre, doctor or hospital

• About 8% of Sweden’s employees work in health services

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Distribution of public health care costs

58%

10%

19%

3%10%

Somatic short-term care

Psychiatric care

Primary care

Dental careOther

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Child Care• Municipalities obliged to provide preschool care

and school-age care. Grants provided to non-municipal childcare.

• Preschool care for children aged 1-5 is provided at preschools, family daycare homes and open preschools

• Childcare for children aged 6-12 is provided at leisure-time centres, in family daycare homes and at open leisure-time centres

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Child Care• Almost 75% of all children aged 1-5 are

registered with preschools and 60% of children, aged 6-9, with leisure time centres or family daycare

• Children needing special support are entitled to a place irrespective of whether parents work or not

• Four staff categories: preschool teachers, leisure-time teachers, daycare attendants and childminders in family day-care

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Disability Policies • Disability policies aim at full participation

and equality.

• Organizations for disabled people are run and dominated by people with physical disabilities

• Institutional living replaced by group accommodation, service housing and adapted homes

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Disability Policies• Local authorities have ultimate responsibility for

personal assistance, preschool places, housing, home-help service etc. for the functionally disabled

• The majority of children with disabilities attend ordinary schools

• Rising unemployment has restricted functionally impaired people’s chances of obtaining work

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Housing modification grant• Was introduced in 1959• A complement to building regulations• People with disabilities should be able to live in

ordinary dwellings• Every local authority are by law obliged to provide the

grant• Is provided regardless of financial situation• Cover all costs for adaptation needed• For persons with all types of permanent disabling

conditions

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Housing modification grant• Permanent housing• Permanent structure of the building property• Not finance ordinary building maintenance• For building materials – a standard ordinary

type will be financed by the grant

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A four part assessment• The applicant’s self assessment of her/his problems

and needs• The occupational therapist's assessment of the

applicant’s ability, disability, and handicap, and ways to solve the functional problems

• The engineer’s technical assessments of adaptive solutions to solve the problems of structural barriers

• Examination of legal guidelines about how the grant can be used and what can be financed by the grant

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Home modification

• Automatic door opener • Stair case elevator

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Assistive devices• Based on need• Regardless of the person's age, economic

status, or place of residence

• Free or almost free of charge• Every county council and/or local authority

have their own guidelines for how to provide these services

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Assistive devices• Assistive technology centres• Low vision centres• Hearing centres• Orthopaedic centres• Intrepretation services (non-hearing, non-speaking persons)

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The Swedish Handicap Institute• A national resource centre on assistive

technology and accessibility• Is run by:

– the Ministry of Health and Social Affairs– the Federation of Swedish County

Councils– the Swedish Association of Local

Authorities

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The Swedish Handicap Institute• Improving the quality of assistive technology• Stimulating research• Stimulating development of new assistive

technology• Testing assistive technology products• Improving the provision • National and international co-operation• Information

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Assistive devices• 70 % are prescribed for persons over 65

years of age