How will the Swedish healthcare system and industry be affected by the new county division system?

It is a well-known fact that many countries have an ageing population. Sweden is no exception, and consequently the national healthcare system is being faced with new challenges. Today’s county division system in Sweden derives from the 17th century and its review and modification have long been under discussion. Finally, last summer, the government gave a committee the task of presenting a proposal for a new county division system, with the aim of reducing the number of counties to fewer than the current twenty-one. The committee’s main consideration has been the citizens’ need of healthcare and thus an appropriate division with an efficient organization. The committee’s proposal was presented on 9 March 2016 and involves a new division system made up of only six counties. This new system is so far merely an initial proposal, and in 2017 the government will submit a bill to the parliament with the aim of the new county division system becoming effective as of 1 January 2019. However; concerns have already been raised about how the proposal will affect the quality of the healthcare system and how the industry will be affected.

In the proposal the new counties, known as ‘great regions’, have been created based on equal population sizes to  enable a tax base high enough in each county to offer specialist care of high quality. According to the proposal, efficient healthcare requires a higher volume of patients than many counties have today. The Minister for Public Administration Ardalan Shekarabi (Social Democrats) has said that the counties today do not have enough patients to be able to make efficient investments or to offer research and healthcare of the highest quality, and thus the recruitment of expertise is suffering. Furthermore, the committee considers that the large variation in county populations may lead to unequal conditions for good, secure healthcare and therefore the proposal aims to reduce administrative borders. From a healthcare perspective the committee can only see positive effects; the risk is instead that the new counties will be considerably larger geographically, which may be challenging from a democratic viewpoint since the politicians will be further away from the citizens. The advantage is considered to be that the counties will be responsible for their own healthcare system, and that the healthcare regions of today can be abolished. The new division system is also expected to reduce bureaucracy and thus lead to better healthcare, mainly since healthcare will continue to be one of the counties’ main responsibilities.

An issue which, however, has not been discussed is how the proposal will affect the healthcare industry, especially since not all affected parties have commented on the proposal yet. The government nevertheless considers the proposal to be characterised by dialogue, humility and transparency. Many healthcare partnerships across county boundaries are already in place, and several coincide with the proposed new boundaries. Another fear is that citizens will not feel any connection to the new counties due to their previous regional identity. Doubts have also been raised that a centralised organization will lead to deterioration in healthcare, and some even pose the question whether it is not better to nationalise healthcare. Another concern is that the regional hospitals will lose their customers from other counties. The county of Uppsala can be used as an example. If the new division system is implemented, Uppsala could lose SEK 130 million annually since this is the income generated from specialist care in the county of Värmland each year. After the division Värmland will be transferred to a great region in the western part of Sweden, with Sahlgrenska University Hospital in Gothenburg as its regional hospital. What also might be problematic is the fact that some labour market regions will be divided in order to achieve an equal tax base between the counties – for example, Stockholm and Uppsala.

To summarize, the new county division raises many questions about how patients will be affected, and some fear that the government is rushing forward with the proposal and that the proposal could be an ineffective measure that will not improve the quality of healthcare but rather create a democratic deficit whereby elected representatives become distanced from citizens. The proposal will most likely be revised before it is adopted, and Setterwalls will continue to follow how the healthcare system and industry will be affected by such a new proposal.