Policy responses for Sweden - HSRM

Sweden


Policy responses for Sweden

4. Paying for services

Adequate funding for health is important to manage the excess demands on the health system. This section considers how countries are PAYING FOR COVID-19 SERVICES. Health financing describes how much is spent on health and the distribution of health spending across different service areas. The section also describes who is covered for COVID-19 testing and treatment, whether there are any notable gaps (in population coverage and service coverage), and how much people pay (if at all) for those services out-of-pocket.

4.1 Health financing

The health budget of 2021 (SEK 341.5 billion) is a bit smaller than that of 2020 (SEK 367.9 billion) and is significantly larger than that of 2019 (SEK 309.3 billion). However, the total budget for 2021 is not finalized as yet. More money is budgeted for education and university research (SEK 82.9 up to 92.1 billion), a lot less for businesses (from SEK 81.8 down to 15.4 billion), less for financial security in case of illness and disability (from SEK 127.7 down to 98.4 billion).

Around 14%, SEK 54 billion of government spending on COVID-19 is budgeted under the health ministry. Over half of the government spending is budgeted under the ministry of finance. Coronavirus related measures during 2020 until February 2021 amounts to SEK 374 billion.

As of December 16th 2020, SEK 100 million will be allocated annually (over a four year period) for establishing a new 10-year national science program wish a focusing on researching viruses and pandemics. The Swedish Research Council is responsible for establishing the program.
As of December 10th 2020, the temporary provision to allow caregivers on the national tariff to receive compensation for digital health care contacts was extended until the end of 2021.

Sources (used for authors’ own calculations):
https://www.regeringen.se/sveriges-regering/finansdepartementet/statens-budget/statens-budget-i-siffror/
https://www.regeringen.se/sveriges-regering/socialdepartementet/socialdepartementets-delar-i-statens-budget/
https://www.ekonomifakta.se/Fakta/Offentlig-ekonomi/Statsbudget/stodatgarder-coronakrisen/
https://www.regeringen.se/pressmeddelanden/2020/12/starkt-forskning-inom-halsa-och-valfard-rustar-sverige-for-framtiden/
https://www.regeringen.se/pressmeddelanden/2020/12/ersattning-for-digital-vard-inom-nationella-taxan-forlangs/

At a press conference on March 11th, the government announced that all extra costs in health and social care associated with COVID-19 will be covered by the state budget. They stated that a lack of money will not stand in the way of a successful fight against the infection.

On April 15th, the government's budget bill was presented. Subsidies of SEK 3 billion in targeted funds to regions (2 billion of these) and municipalities (1 billion) were provided for the extra costs in health and social care as a result of COVID-19. In addition, SEK 1 billion has been allocated for increased testing costs. However, it was not specified how further additional resources would be provided if needed. Then at a press conference on April 17th, the Prime Minister announced that the state is responsible for all extraordinary health and social care costs associated with COVID-19, regardless of the cost. Therefore, compensation on an ongoing basis applies to any additional costs for regions and municipalities that are directly associated with the management of COVID-19.

In addition to directly allocated funds for the health and social care management of COVID-19, the state has also incurred other costs that are indirectly intended to reduce the spread of the infection.
• Sickness benefit will be paid from the first day of illness, corresponding to a cost of SEK 1.7 billion. Before that, employees received no compensation for the first day.
• The requirement for medical certificates during a sick pay period has been temporarily abolished. A personal allowance is paid to people who can work but are suspected to be infected so that they can be compensated while staying home. This corresponds to a cost of SEK 350 million.
•The resources for the carrier's allowance have been increased corresponding to a cost of SEK 500 million.
•The state will temporarily reimburse employers' sick pay costs and the equivalent for self-employed persons through payment of sickness benefits during days 1 to 14 corresponding to a cost of SEK 6.65 billion.

A further measure with financial impact on the regions is the temporary removal of the performance requirements related to the waiting time guarantee, where SEK 1 billion has been allocated to the regions. These funds will instead be paid to the regions on a per capita basis.

Within in the work related to the COVID-19 pandemic, funds should be seen as general such that managers in health and social care can select their own priority areas based on need. This additional funding comes from increasing the state's spending framework by SEK 350 billion in 2020. This type of unique decision has not occurred since the introduction of a new budgetary framework for government finances, which was introduced in the late 1990s.

The spring budget also announced that the state authorities participating in curbing the outbreak should have the resources they need. The Public Health Agency of Sweden, the National Board of Health and Welfare and the Swedish Medical Products Agency have therefore received increased grants. The National Board of Health and Welfare's loan framework for emergency investments has been increased to enable them to purchase, among other things, testing, protection and intensive care equipment.

To increase public awareness of the virus outbreak, the government has commissioned the Swedish Civil Contingencies Agency, in cooperation with other relevant authorities, to quickly produce national information material and disseminate this information to as many people as possible at a cost of SEK 75 million.

The government also proposes increased funding to the Swedish Research Council to fund more research aimed at combating the virus and preventing future pandemics corresponding to a cost of SEK 100 million.

In addition, the spring budget announced reinforcements to the general government contribution to municipalities and regions due increasing needs, including for the care of older people. In 2020, SEK 20 billion will be allocated, of which SEK 12.5 billion will be a permanent increase. The resource supplements are intended to contribute to good access to high quality health and social care, education and public transport. The municipalities and regions are responsible for how they allocate the government allocations.
May 22nd. The government has decided to temporarily allow caregivers on the national tariff to receive compensation for digital health care contacts. The purpose is to reduce the number of unnecessary physical care visits, thereby reducing the risk of spreading COVID-19.

Sources:
https://www.youtube.com/watch?v=QxmsRfQxXCc&list=PLw2eBi2rSx3bo5OxqM8y6qbecq7_MwOlt&index=18&t=370s  
https://www.regeringen.se/496e43/contentassets/efd855d8a5d249b59d491eb221e1cfe3/2020-ars-ekonomiska-varproposition-prop.-201920100.pdf   
https://www.dn.se/debatt/vart-reformarbete-fortsatter-vid-sidan-av-krisatgarderna/
https://www.regeringen.se/pressmeddelanden/2020/05/ersattning-for-digital-vard-inom-nationella-taxan/