¹Department of Social Medicine, Karolinska Institute, Stockholm 171 77, Sweden. E-mail: peter.allebeck@ki.se

Abstract

In spite of good health indicators and an overall good coverage of health services and universal insurance coverage, a number of problems have challenged Swedish health policy in recent years: demographic shift towards an elderly population, increased occurrence of minor mental illness, increased long-term sickness absence. As responsibility for these problems are shared by several sectors in society, increased efforts of collaboration between sectors and authorities have been made. The paper reviews some of these efforts: the reform of the care of the elderly, the mental healthcare reform and various reforms involving health services, social services and social insurance. Some of the reforms have had a major impact in shifting service utilization and increasing awareness within municipalities on groups in need of care and rehabilitation. It is more difficult to find effects on patient outcome. Also, while shared responsibilities may have overall positive effects, some groups risk falling between the stools. Thus, while housing and home care have been improved for large groups, critics have pointed out lack of medical attention and long waiting lists to health services. In addition to financial incentives and organizational changes, major efforts in training, leadership and capacity building are needed to achieve efficient and cost-effective health and social services while maintaining high quality and social equity.