Sweden Considering Private Care for Some Health Needs

Like Britain’s National Health Service, Sweden’s medical system has long been regarded as a model of socialized health care. But now officials here also are looking to private care to help meet some of the health needs of the nation’s 8.4 million people.

The government for the first time has agreed to contract with private hospitals in Stockholm and Goteborg to do cataract, heart bypass and hip replacement operations in order to reduce the waiting time in government hospitals.

But unlike Britain, where the private health sector already has a bigger foot in the door and could move in on the nationalized health system in a major way, the Swedes plan to hold the private sector in check.

Medical care here is thoroughly socialized and almost totally tax-financed. Sweden has only a handful of private hospitals and the government says there is little chance more will be built or that the nation’s private health insurance industry will grow much beyond the current 10,000 subscribers.

Nevertheless, the departure from tradition to pay a private hospital to do some of the government system’s work is seen by some Swedes as a welcome crack in the socialist wall.

High Swedish Taxes

“Swedes have paid a lot of taxes for health all their lives,” said Dr. Rolf Sundblad, medical director of Sophia Hospital, which has the Stockholm contract. “Now they find that when they need a coronary bypass they are told they must wait a year or longer. So they are beginning to demand more, and the government sees Sophia as a way out of a big problem.”

In an interview, Sundblad and Dr. Bjorn Nordenvall, Sophia’s administrator, said they doubt that the for-profit U.S. hospital chains that have invaded Britain and other European countries will be allowed in Sweden because “the government is very sensitive to making a profit on the sick.”

Sundblad said all profits from Sophia’s operation will be reinvested as hospital improvements.

One reason waiting lists for coronary bypasses exist in Sweden’s health system, which is regarded as one of the world’s finest, is that doctors recently broadened the criteria for doing the operation, according to Anders Lonnberg, a Ministry of Health official.

This meant that the country’s highly planned hospital system was not prepared to handle the increased load that resulted.

Private Weekend Work

In an effort to reduce waiting lists for eye surgery, the government recently began allowing government doctors to do private work on weekends in government hospital operating rooms, which normally go unused at that time. The program has had mixed results.

At the 1,200-bed Huddinge University Hospital, Lars-Ake Flood, director of the local government branch that pays for much of the care, said the hospital tried out the weekend plan but has no plans to continue.

“It was the doctors who proposed the idea, but it’s too complicated to have a doctor who on Friday works for the government but on Saturday works for a company on the same patient.”

One reason the government is confident that private care will not spread is that it, in effect, controls the number of doctors who do private work on the side--about 2,000 of the 22,000 total. According to Lonnberg, only about 150 doctors are in private practice exclusively.

The reason for the small private practice, he said, is because the vast majority of Swedes are content with the government’s system.

“We have much higher taxes but, unlike California, we have no tax revolt,” Lonnberg said.

Decreased Health Share

Unlike the United States and most developed countries, Sweden has recently decreased the percentage of its gross national product devoted to health--from 9.8% in 1983 to 9.5% in 1987, said Lonnberg, who is the political adviser to the Health Ministry.

This was accomplished, he said, by de-emphasizing in-patient hospital care and by moving many elderly patients out of hospital beds into less expensive community care. Sweden still has one of the world’s highest per capita number of hospital beds.

But a recent commission recommendation to strengthen primary and preventive care in community clinics is meeting strong opposition from hospital officials who see the move as a threat against their budgets.

At Danderyd Hospital, which delivers more babies than any other in Stockholm, officials complain that doctors have lost the incentive to work, nurses are quitting and there is not enough money to replace obsolete incubators.

The hope is that prevention will decrease the number of people who will need hospitalization. But, said one Swedish doctor, “Politicians won’t dare to take from the already sick to treat the possibly sick.”