How to improve health care delivery and manage health care costs are central themes in public policy debate in Canada today. It is not only Canada that faces these challenges however and we need not only look to ourselves for solutions. In AIMS latest commentary series we look at Swedish Health Care in Transition. The author, Johan Hjertqvist, is a senior advisor to the Greater Stockholm Council on health care reform. Mr. Hjertqvist is also director of “Health in transition”, a four-year pilot project whose objective is to describe and analyse the operation of a competitive market within the public system.

User Fees for Health Care in Sweden. In this, AIMS’ sixth commentary on Swedish Health Care in Transition, author Johan Hjertqvist discusses the utility and effects of user fees in the Swedish health care system. The investigation explores several different aspects of health care including: general practitioners, dental services, elderly care and pharmaceuticals. Hjertqvist demonstrates how a co-payment system – whereby the public pays for a small percentage of the care they receive – has become instrumental in ensuring better health care in Sweden and not, as many Canadians fear, created a two-tier system. Click here to read this full report on the success of user fees in health care. (Requires Adobe Acrobat Reader)

Canada could follow Britain’s example on improving Health Care – Learn from Sweden. Health care is becoming more and more of a political issue in Britain. Long waiting lists, poor response and low standards have led to rising popular discontent. The Government is now taking radical steps to transform the National Health System (NHS). Just as in Sweden, “more money” has for many years been counted on as the recipe for putting things right. But the Blair administration has gradually come to see that pouring new millions into a malfunctioning system only serves to perpetuate the problems. And so now the NHS is to be reformed, from monopoly and bureaucracy to decentralisation and a consumer focus. In this piece, Johan Hjertqvist, AIMS’ commentator on Swedish health care reform, discusses how New Labour has derived most of the inspiration for its reform from the Stockholm County Council. He concludes that the efforts of Britain’s Labour Party offer a glimpse of what can be achieved when you move past ideology and focus on the more practical question of what actually works. To read “Blair repeats the Stockholm sea change” click here.

In Sweden, employees are taking over health care. In AIMS fifth commentary on Swedish Health Care in Transition, author Johan Hjertqvist discusses the surge of employee ownership in Sweden’s health system. This new model is being adopted by some private sector health care providers as part of the logical evolution in the delivery structure for medical services – moving from the traditional public monopoly to diversity of producers. Citing stories such as a youth psychiatry unit in Stockholm, Hjertqvist explores the transformation of health care providers from an unfocused bureaucracy to a highly motivated entrepreneurial culture where employees have a greater share in the clinic’s success. To read “When Employees Take Over”, click here (Requires Adobe Acrobat Reader).

Competition in Emergency Healthcare. The AIMS commentary series on Swedish Health Care in Transition continues as author Johan Hjertqvist explores the rapid transition in the style and format of health care being experienced in the Stockholm metropolitan area. The new, competition-based model of public healthcare is about to hit the emergency rooms and operating theatres in that city. Seven emergency hospitals in the Stockholm region serve close to two million people. Since 1999, one of them has been privately owned. Last year, two hospitals turned themselves into publicly owned companies with formal business structures, financial statements, and a board of directors. At least two of the remaining ones plan to do the same in 2002. To consider the possible impacts of this transition read “Competition in Emergency Healthcare“. (Requires Adobe Acrobat Reader)

This series of newsletters on Swedish Health Care in Transition is a joint project of AIMS, Atlantic Canada’s public policy think tank, and the Frontier Centre for Public Policy (

The Purchaser Provider Split. In this, AIMS third commentary on Swedish Health Care in Transition, author Johan Hjertqvist explores the shift from public monopolies to market services. The success in Sweden of public policy experiments that have embraced the principles of competition and choice are driving a fundamental shift in opinion towards free choice, competition and diversity. Citing examples like competitive contracting of ambulance services that saw improved service across the board and a cost savings of 15%, Hjertqvist demonstrates how success breeds continued innovation and further experimentation. To read “The Purchaser Provider Split”, click here. (Requires Adobe Acrobat Reader)

The Internet Empowers Swedish Healthcare Consumers. In this, AIMS second commentary on Swedish Health Care in Transition, author Johan Hjertqvist explores the concepts of choice, competition and accountability to the consumer. The internet is being used as a tool in Sweden to maximize the return from the competitive supply of health services. More and better information, readily available to a broad audience, ensures that a well-informed and educated public can make their own choices about the health care available to them. To read “The Internet Empowers Swedish Healthcare Consumers.”, click here. (Requires Adobe Acrobat Reader)

Markets and Competition Here to Stay. In this, his first commentary, Hjertqvist explores the debate over private sector provision of health services in Sweden. He highlights the positive developments in primary care contracting and the continued shift to entrepreneurs over employees in the search for doctors and nurses. Hjertqvist explores the benefits of private sector market driven health care delivery for patients and practitioners alike and concludes that market forces are here to stay. To read “Sale of Public Hospitals Under Fire”, click here. (Requires Adobe Acrobat Reader)