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The Evolving Role of Health Sector Research in Sweden

Richard B. Saltman Ph.DEmory University

European Observatory on health Systems and Policies

Brussels

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Initial Caveats

This presentation: • An outsider’s view through the keyhole: - partial - episodic - thematic• Focussing on health services and health policy research broadly defined

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The Broad Picture I

• Health Sector Research in Sweden has developed considerable international respect:

third or fourth best-known across Europe: - UK/England - Netherlands - ? Sweden - ? Finland (recently Spain?)

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The Broad Picture II

Several key reasons: - Good academic base - Publishing in English - Interesting topics often tied to tax-funded health system (lots of international interest in those days)

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The Broad Picture IIIStarted relatively small: - relatively small number of researchers in 1980s and 1990s (Uppsala, Lund/IHE, Handelshogskolan, Linkoping, a few others) - mostly limited focus on Swedish domestic issues (tax-funded health system) - mostly permanently salaried posts for academics (discourages self-exploitation ) - limited funding sources: - Academic Research Council (national funds) - County council funded/focussed - SPRI - Landstingforbundet

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The Broad Picture IV

Recent expansions of resources/personnel in 2000s: - MMC at Karolinska/Stockholm - Jonkoping Academy (quality, IHI)- New Growth in Universities (Lund, Gothenburg, Linkoping, Uppsala, others)- Vardanalyse (Ministry)- Vinnova projects/grants (State)- Open Comparisons data (Ministry)

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The New Research Challenge I

How to focus this new, larger set of health sector research resources:- Domestic or comparative/international?- HSR or broader policy issues?- “System linked” (existing institutions and issues) or “System developing” (new/emerging institutions and issues)?

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What Would be Interesting Internationally I

Greater focus on how tax-funded system is changing:• Diversity of providers in primary/home care - New not-for-profit private actors (including Praktikertjanst) - New for-profit private actors (small vs. large /stock-issuing vs risk-capital)• Dynamism in the delivery system - new roles for innovation and entrepreneurialism (in public as well as private sector) - overcoming the health/social interface (chronically ill elderly) - stimulating greater patient co-production/ co-responsibility for services (new technologies/public sector fiscal pressures)

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What Would be Interesting Internationally II

Greater focus on how tax-funded systems aren’t changing:- Stability or Stasis in the public sector?- Stability or Stasis in the personnel union sector?- Stability or Stasis in the professional sector (physicians, nurses)?- Rapidity of adoption of (rapidly increasing) international standard of care (new technology, new procedures)- Medical Tourism (Swedes going to EU/Thailand)

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What Would be Interesting Internationally III

Assessing key questions looking forward:• Implications for public finance of slowing national economy (eg John Appleby’s 2013 England study)• Understanding the resilience of the county councils • How to better incorporate patient/choice in health decision-making• Can health personnel unions become engines for reform/new models?• Fiscal and staffing impact of genetics and personalized medicine?• Likely policy outcomes of re-distributing democratic authority among three levels of government (including possible new role for the State/Ministry (more centralization vs targeted regulation?)

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What Would be Interesting Internationally IV

Applying both economic and social dimensions to existing and proposed policy strategies - stretching across academic disciplines - presenting a more comprehensive picture - providing an academic baseline from which to assess the work of political “think tanks” (eg Timbro, Arena, LO)

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Overall Objective: Do More!

• Broaden the remit on topics and policies • Focus projects on where Swedish health

system will likely head in near future: A more diverse, complex, but also more innovative and dynamic set of institutions and policies