It is currently popular to point out that the productivity and efficiency of healthcare needs to increase. Last year, a productivity commission was appointed, and earlier this spring the government introduced a new function that will review the regions’ resource utilization, cost effectiveness and efficiency potential.
Those of us who have an overview of both financial and operational issues know that there are major challenges in healthcare. But the image that healthcare is characterized by low productivity and rampant costs is misleading. When we weigh in the quality, and the progress made during the 21st century, it becomes clear that Swedish healthcare ranks among the top countries in the world.
Modern healthcare costs. But Sweden does not stand out next to comparable countries. Norway, for example, ranks higher. In 2022, the Swedish health care costs – including care for the elderly – corresponded to 10.5 percent of GDP. That share has hardly changed at all during the 2000s (adjusted for changes in definitions in 2011, when elderly care and disability care were added, and for pandemic-related additions in 2020–2021). The image that the resources for care have increased like an avalanche is thus a myth.
The basic problem in the discussion about productivity is that we do not use the same way of measuring in healthcare as in business. There, quality improvements are taken into account, but this is not done in healthcare.
In the National Accounts (NR), which, among other things, is used to calculate GDP, the volume method is used to measure productivity in healthcare, for example cost per day of care. As the number of care days decreases, often as a result of better treatment methods, at the same time as costs increase, this measurement method results in progressively decreasing productivity.
It is a greatly simplified way of measuring and derives from joint guidelines from Eurostat, OECD and WHO, with the aim that the statistics should be comparable between countries.
As the number of care days decreases, often as a result of better treatment methods, at the same time as costs increase, this measurement method results in progressively decreasing productivity.
But this measurement method does not take into account how the development in healthcare has been in recent decades. It does not see that a condition that previously required hospital care can now be treated in outpatient care or at home, or that a patient receives help with several care needs from different professions at the same visit. It also does not measure the actual outcome of care.
Let’s give three concrete examples of how the quality of healthcare increases:
● The number of hospitalizations for different types of circulatory diseases (for example heart attack) has decreased by 22 percent in ten years. This despite the fact that the population has increased, more are older and the number of people with these diagnoses has increased. Mortality in circulatory diseases has decreased by 56 percent in the last 25 years, in heart attacks by 70 percent and in strokes by 66 percent.
● In the field of cancer, we see completely new treatment methods which is carried out in outpatient care, with a reduced number of inpatient admissions and major quality improvements as a result. Today, the patient can receive significantly gentler treatment without being hospitalized, while the so-called lethality (the percentage of deaths in a certain diagnosis within a period of time) has decreased by 15 percent in ten years.
● In Sweden, the number of avoidable deaths decreased in care from 78 to 60 cases per 100,000 inhabitants during the period 2011–2019. In Europe, only Iceland, Norway and Switzerland have lower healthcare-related mortality.
We get simply put “significantly more value for money” in the Swedish healthcare system today compared to 20 years ago. We will deepen this in the Economic Report that Sweden’s Municipalities and Regions (SKR) publishes in mid-May.
When the quality improvements are taken into account, productivity in healthcare is higher than in, for example, the manufacturing industry.
The challenges of measuring healthcare productivity are not unique to Sweden. In an article published by the Bureau of Economic Analysis in the United States, a research group has developed a way to better measure productivity in healthcare, where quality is taken into account. According to their calculations, productivity in the healthcare sector in the United States is underestimated by 3.1 percent per year. When the quality improvements are taken into account, productivity in healthcare is higher than in, for example, the manufacturing industry.
Also including quality gives a more accurate picture of healthcare, while existing measures can be used as help in the regions’ absolutely necessary and ongoing work to streamline and improve.
We should be proud of the development that took place at the same time as we need to get better at learning from each other, and spreading successful working methods, within and between the regions. Every tax kroner must be useful where it is used, and the regions’ financial management needs to be constantly developed.
Over the past ten years, with the exception of the pandemic years 2021 and 2022, the state’s share of healthcare funding has gradually decreased – regardless of government.
There is also a need for better and more predictable government governance, where the focus is on national goals about what the operation should achieve, and on stable funding. Not on review functions that increase bureaucracy. Over the past ten years, with the exception of the pandemic years 2021 and 2022, the state’s share of healthcare funding has gradually decreased – regardless of government.
The general state grants’ share of health care funding has decreased from 16 to 11.5 percent between 2010 and 2022. This is completely at odds with various governments’ recurring descriptions of historic care investments in recent years.
Health care is facing big challenges. Waiting times need to be reduced and access to personnel with the right skills increased. At the same time, year after year we see a positive quality development, with better diagnostics, gentler treatment methods, increased survival and better health. If we start from the whole picture, we can focus on the right measures that make a real difference for patients and employees.
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Tags: myth healthcare efficient
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