Håkan Tenelius, Commercial Policy Director, The Association of Private Care Providers, ALMEGA. Changes in Scandinavian healthcare sector - oppportunities for Finnish companies. Finpro seminar materials 19.4.2012.

1. Private health care sector in
Sweden – a matter of choice
Håkan Tenelius, head of public affairs,
The Association of Private Care Providers

2. The Association of Private Care Providers (Vårdföretagarna) is
an employer and industry association for private providers of
care regardless of management method
• works for increased freedom of choice and diversity in the
healthcare sector
• suggests a national tool for quality measurement of all care
– public and private provided
• emphasizes the importance of private healthcare as a mean
to develop welfare.

3. Vårdföretagarna is a part of Almega and a member of the
Confederation of Swedish Enterprise.
• More than 2000 member companies
• 80 000 employees within the member companies – rapidly
increasing
• All members have collective agreements

4. The private health care in Sweden
• 12 % of all health care is provided by private providers
• 26 % of all primary care is provided by private providers
• 99 % of all health care is publicly financed
• Every third swede has visited a private care provider
• The competition within health care was started by a
liberal/moderate government and continued under a social
democratic government

5. Two competing models
Two principal models for exposing publicly financed activities to
competition:
• The contract model involves activities undertaken by actors
being purchased in accordance with the provisions of the
Public Procurement Act.
• The choice system may be used when exposing individual
services to competition.
The choice system means that competition takes place in the
market, as opposed to competition over the market.

6. The Koppardalen Health Center
– Jag satte ned foten och sa till mina kollegor; nu
struntar vi i det här och öppnar eget.

7. The choice system
Many advantages:
• Providers compete on quality, not price
• Free choice systems have resulted in a diversity of
providers and increased accessibility
• The best, most popular providers will survive
• In the long run, competition could lead to reduced costs
• Promotes innovation
• Operations can be focused on a certain segment
7

8. The choice system
But…
• Several local governments use the model to reduce
costs
• Several of the county councils that have been forced to
introduce the free choice model have adopted the model
reluctantly.
• Often, stable, long-term conditions are lacking, and
competitive neutrality is deficient.
• Suspicion from some politicians and civil servants
towards private care providers, and vice versa.
8

9. The results – elderly care
558 new units in home help, + 530 %
85 % of the enterprises have a woman as a CEO or owner
Almost half of Sweden’s elderly live in a municipality that
has a private provider to choose from in the home help-
service sector.
Most of the enterprises are small.
9

10. The results – primary care
233 new units in primary care, + 23 % (November 2010)
2/3 of the units are small with less than 50 employees.
Accessibility has improved.
Opening hours are longer, both in private and public units.
The needs of the patients are treated in a better and more
satisfying way.
A diversity of providers, rather than a few large providers.
10

11. The next step: Specialist care
Ortho center,
Stockholm

12. How important is it for you to be able to choose your primary care provider?
90%
80%
80% 78% 78% 78% 77%
75% 74% 74% 73% 73% Important or very important
73% 72%
71% 71% 70% 70%
70% 69%
65% 64%
62% 61% 61%
60%
50%
40%
30%
20%
10%
0%
12

14. Effects of the Carema Care Case
• People in general and some politicians started to
question private care
• Focus on owners and their ambition to pay taxes
• New focus on non profit providers
• Focus on quality and quality measurement

15. Why a success for the choice system?
• Long-term conditions
• Freedom of establishment
• Active listing
• Differentiated compensation
• Medical follow-up

16. What has to be improved?
• Improved patient information
• Competitive neutrality
• Established dialogue with politicians and civil servants
• Separate customer and provider roles
• Avoid detailed regulation

17. Håkan Tenelius,
hakan.tenelius@almega.se