Sweden to offer free primary healthcare over the internet
People living in Sweden will have access to free primary healthcare over the internet after an online medical practitioner set up a clinic in the Södermanland county, where primary care is free.
The development reflects a growing breakthrough for digital health services, says the Swedish Association of Local Authorities and Regions (Sveriges Kommuner och Landsting, SKL).
Yesterday, on January 1st 2018, Doktor.se took over a health centre in the Vingåker municipality, after which both physical and digital consultations will be offered to patients throughout the country.
The entitlement of patients in Sweden to choose where they receive treatment under the country’s public healthcare system means the service will be available regardless of where they live in Sweden.
Partnership with Doktor.se
With primary care free of patient fees in Södermanland county, and the patient fee for digital care visits determined by the county in which the operating company is located, Doktor.se can offer digital consultations without charge.
“When Sörmland [an alternative name for Södermanland, ed.] took the decision to offer free primary care, it was not based on the expectation that digital services would appear,” said economist Annika Wallenskog of SKL.
Doktor.se’s CEO Martin Lindman confirmed to that the heathcare firm would offer services to patients throughout the country.
Prior to receiving a digital visit, patients will consult a nurse who will assess their needs. Those not suitable for digital consultations will be advised to seek physical primary care.
Competitors to Doktor.se in counties where patients pay a fee receive smaller payments from county councils for providing healthcare. For example, the Min Doktor and Kry companies are based in Jönköping, where patients pay a 250 kronor consultation fee. That means that regional authorities must pay 400 kronor to the providing companies for each digital consultation. In Södermanland, the county must pay the full 650 kronor.
Wallenskog said she had expected an online service to be established in a county with free primary care. An SKL task group will now look into the expected financial consequences of the development before county council directors meet to discuss the issue in a few weeks’ time.
Health care in Sweden is the responsibility of regional governments (counties). There are 21 regions in Sweden that fund inpatient and outpatient care by means of general taxes, state grants, and user fees, the rates and levels of which vary across the regions. The most common way of obtaining primary care is to make an office visit to a primary care clinic (in Swedish Vårdcentral).
There are around 1150 such clinics throughout the country. On average, two-thirds are run by the regional health authorities directly and one-third are privately owned practices that contract with the regional authority. The primary care clinics differ in many ways from those in some other countries where such types of clinics are owned and run by single or multiple general practitioners (GPs).
Most primary care clinics in Sweden are staffed by several different types of providers, including GPs (between four and six per clinic), nurses, and physiotherapists. About 14.5 million primary care visits take place annually in Sweden, equivalent to 1.4 per person. The total spending on primary care was around SEK28 billion (US$9 billion) in 2015. Over past years, per capita spending on primary care has been increasing in constant terms, suggesting an underlying issue with cost pressure.In addition, there is broad public and political concern over inadequate access to medical services, including primary care.
Over the past decade or so, a number of reviews have pointed at issues with access to services, both with respect to unequal access across socioeconomic groups and across geographic areas. Recent reforms have aimed at improving the general public’s access to health care by, among other things, introducing enhanced patient choice and free provider establishment of primary care practices.
One underlying problem facing the Swedish primary care system, and one that it shares with most if not all other countries, is a shortage of human resources for health. The national government has set a target of around 1500 inhabitants per GP. However, the current number is over 2000, making it difficult for policy makers to reach set goals of access to services. Determining the extent to which digital models of care can contribute to solving the challenges of access to health care services in Sweden and elsewhere will require further studies of their impacts, including those on costs.