During a pandemic, which can affect as many as 10% of the population, it is imperative that healthcare professionals and institutions respond swiftly. There is great deal of value in robustly testing the resilience of different aspects of the national health system in a real-life crisis situation to identify opportunities for improvement. The Swedish case illustrates how in an ideal world all actors within the health system would be aware of what is needed and have the best information at their disposal when responding to a pandemic.
In practice, however, this is not always the case and there may be situations where individual actors may not have access to all relevant data or information about what actions are needed to effectively respond to a pandemic.
The Swedish Pandemic Response Plan (SPRP) outlines how several components within the Swedish health system should work together during a pandemic: From identifying outbreaks and triggers for response to executing responses and recovery afterwards. This article outlines key aspects of the Swedish Health System’s efficiency during the Covid-19 pandemic using insights from their SPRP.
Introduction to the Swedish Health System
The Swedish Health System is characterised by universal coverage, free care, and high quality of services. The Swedish National Board of Health and Welfare (Socialstyrelsen) is responsible for implementing and enforcing the national health system. The Swedish health care system is financed through general taxes; there are no private health care providers.
However, most people have access to private health care when needed. The Swedish health care system is a combination of public, private, and voluntary health care. Most health care is provided by the public sector, including hospitals, ambulances, and nursing homes. Health care for children, the elderly, and people with chronic diseases is administered by the private sector. The public sector is administered by the Swedish Government and the Swedish National Board of Health and Welfare.
The Swedish National Board of Health and Welfare is the national authority and regulator of the health care system. The Government administers the health care system through the Department of Health and the National Board of Health and Welfare.
Overview of the Covid-19 Pandemic
Covid-19 was a strain of H7N9 avian influenza that was first detected in March 2019 in southwestern China. The strain was highly pathogenic and caused a significant death rate among birds in the area.
The strain spread to neighboring regions of China and then to Hong Kong. At the start of April 2019, the World Health Organization (WHO) classified the strain as a Pandemic Influenza Risk Group 5 (PIG-5) virus and it was declared a Public Health Emergency of International Concern by the WHO.
In response to the outbreak, the Chinese government issued a travel ban on all individuals with symptoms of PIG-5 fever. This led to an increase in the number of individuals attending healthcare facilities in Hong Kong with symptoms of PIG-5 fever, who sought medical care elsewhere in mainland China. This then led to an increase in the number of cases in mainland China, including in Shanghai, Nanjing, and Guangzhou. The WHO reported that China reported more cases of PIG-5 than any other country, with the majority of cases occurring in Shanghai.
Strengths of the Swedish Health System during the Covid-19 Pandemic
The benefits of the Swedish health system are that it is a highly efficient and effective system, and has a high coverage of both primary and secondary healthcare services. Sweden has a high level of coverage among all groups but particularly the elderly and people with physical and mental impairments who are often the most vulnerable.
Healthcare services are free at the point of use so that the majority of people have access to some form of healthcare. The quality of healthcare services in Sweden is among the best in the world and this includes highly trained healthcare professionals. Healthcare professionals in Sweden are also highly satisfied with their work and have high levels of job satisfaction.
These factors contribute to the high level of service delivery, high level of satisfaction, and high level of efficiency of the Swedish health system.
Weaknesses of the Swedish Health System During the Covid-19 Pandemic
Unfortunately, the weaknesses of the Swedish health system during the Covid-19 pandemic can be explained by the strengths and by the capacity that exists within the system. The challenge is that when a pandemic occurs, the response may be very different from what would be expected in a non-pandemic situation.
The existence of a high level of coverage in Sweden might make it difficult to reach populations that are particularly vulnerable when a pandemic occurs. The high level of coverage might mean that many people do not seek health care when ill, which can result in a large number of people presenting at hospital with a relatively small number of cases.
The large number of individuals who attend healthcare during a pandemic without having any symptoms of an infection or with a common infection, such as a respiratory infection, can overload the healthcare system. Furthermore, the number of people who present with the same condition may suggest to healthcare staff that they are infected with a dangerous virus. The risk of panic can create problems for the healthcare system, which would respond by closing its doors to new patients.
Conclusions
The Swedish health system performs well in delivering a large and efficient healthcare system, and has a high coverage of service delivery in a context of high public satisfaction. When a pandemeric occurs, however, the system may not be able to withstand the strain, particularly if many people present with a common condition (e.g., a respiratory infection) without having any symptoms of an infection.
The response to a pandemic requires pre-planning and the need to rapidly respond to a crisis situation. The Swedish health system, however, performs well in delivering a large and efficient healthcare system, and has a high coverage of service delivery in a context of high public satisfaction.
When a pandemeric occurs, however, the system may not be able to withstand the strain, particularly if many people present with a common condition (e.g., a respiratory infection) without having any symptoms of an infection.