Sweden’s health and elderly care systems are deservedly regarded as among the best in the world, but an aging population with growing chronic conditions is testing their ability to continue delivering high-quality care, a new report warns.

The quality of healthcare in Sweden is generally good, says the study, from the Organisation for Economic Cooperation and Development (OECD). Rates of avoidable hospitalisation for chronic conditions, at 22.2 per 1000,000 population, are among the OECD’s lowest (average 45.8), and the nation’s quality registers, which track the quality of care that patients receive and outcomes for several conditions, are among the most-developed across the OECD, it finds.

But Sweden’s coordination of care for patients with complex needs is less good, it warns. Fewer than half of patients with type 1 diabetes, for example, have their blood pressure adequately controlled, varying from 26% to 68% across the nation’s counties. 

And only one in six patients has had contact with a physician or specialist nurse after discharge from hospital for stroke, again with substantial variation across counties.

Sweden has a larger share of elderly people than most OECD nations, with 5.2% now aged over 80 compared to the average of 4.2%, and its hospitalisation rate for uncontrolled diabetes for the over-80s is among the OECD’s highest - around 1.5 times higher than in Denmark.

Moreover, while the average length of hospital stay after a heart attack in Sweden is less than five days – among the lowest in the OECD and a sign of efficiency – the municipalities are often not adequately equipped to manage patients being discharged so soon. Only around 20% of primary care doctors say they receive the information necessary to manage a patient within 48 hours after discharge, compared to almost 70% in Germany.

Coordination of care between hospitals, primary carers and local authorities is becoming the biggest challenge to the continued excellence of Sweden’s health and social care system, the report warns. It calls on central government to set out responsibilities very clearly, by developing standards, building the evidence base and sharing knowledge; for example, central authorities should be given a more defined role in assuring the quality of services by setting out national quality standards, it says.

Among other recommendations, the OECD emphasises that recent choice and competition reforms in the primary care and elderly care sectors must not fragment services for patients with complex needs