Abstract:

To outside observers, the Swedish health care system is hardly in crisis. By most generally accepted criteria for developed countries, access & quality are high, & expenditures are a relatively modest (& declining) portion of the gross domestic product. Yet, challenges to the state's provision of generous health & welfare benefits to its population include an aging population; relatively high unemployment & low economic growth; caring for increasing numbers of immigrants; & use of health care spending reductions as a means to reduce the national debt. These challenges have led to increasing concern as to whether Sweden can continue to provide the same level of comprehensive services for all or must impose increasing constraints on health services spending & service delivery . Some recent health services policies & programs are viewed in the context of this concern: reduction of health personnel; integration of health & social services for older persons; efforts to introduce competition among providers; cost sharing for patients; dismantling of dental insurance; shift in responsibility from regional government toward local & individual responsibility; priority setting for treatment; & encouragement of the private sector. However, consideration of the rationale, implementation, & apparent effects of these policies & programs raises more questions than answers about their meaning for solidarity & economy.