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Sweden
- from Europe
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- By Helena Silfverhielm, National Board of Health and Welfare (Socialstyrelsen), Claes Göran Stefansson, National Board of Health and Welfare (Socialstyrelsen), Stockholm, Sweden
- Edited by Hamid Ghodse
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- Book:
- International Perspectives on Mental Health
- Published online:
- 02 January 2018
- Print publication:
- 01 June 2011, pp 405-411
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- Chapter
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Summary
With an area of 450 000 km2, Sweden is one of the largest countries in Western Europe. It is 1500 km from north to south. It has nearly 9 million inhabitants (20 per km2). It is a constitutional, hereditary monarchy with a parliamentary government. Sweden is highly dependent on international trade to maintain its high productivity and good living standards. Many public services are provided by Sweden's 289 municipalities and 21 county councils. Municipal responsibilities include schools, child care and care of the elderly, as well as social support for people with a chronic mental illness. The county councils are mainly responsible for healthcare, including psychiatric care, and public transport at the regional level. Sweden is characterised by an even distribution of incomes and wealth. This is partly a result of the comparatively large role of the public sector.
The healthcare system
Sweden's healthcare system is governed through the three levels of government – central, county and municipality. Central government is responsible for legislation within the healthcare system, higher education (universities), research funding, the health insurance system, and general and directed subsidies to the counties and municipalities to help them carry out different public service measures. The 21 counties are responsible for specialised healthcare activities, which include hospitals and primary healthcare (general practitioners) and the medical professionals working there. The 290 municipalities are responsible for social services for elderly persons and those with a disability, including a mental disability. This includes not only social support but also medical nursing.
The public healthcare system is financed by taxes raised at all three levels of government. A minor part of healthcare is carried out on a private basis (mostly short-term treatment). Private care is most common in the big cities and is rare in rural regions. The management of the care and social services provided for people with mental disorders is handled by the counties and the municipalities.
In 2001 the total expenditure on medical care in Sweden was a19.1 billion, which represented 8.0% of gross domestic product (GDP). After allowing for income from patient fees and so on, the net cost to government was a12.1 billion.
Sweden
- Part of
- Helena Silfverhielm, Claes Göran Stefansson
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- Journal:
- International Psychiatry / Volume 3 / Issue 1 / January 2006
- Published online by Cambridge University Press:
- 02 January 2018, pp. 9-12
- Print publication:
- January 2006
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- Article
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- You have access Access
- Open access
- Export citation
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With an area of 450 000 km2, Sweden is one of the largest countries in Western Europe. It is 1500 km from north to south. It has nearly 9 million inhabitants (20 per km2). It is a constitutional, hereditary monarchy with a parliamentary government. Sweden is highly dependent on international trade to maintain its high productivity and good living standards. Many public services are provided by Sweden's 289 municipalities and 21 county councils. Municipal responsibilities include schools, child care and care of the elderly, as well as social support for people with a chronic mental illness. The county councils are mainly responsible for healthcare, including psychiatric care, and public transport at the regional level. Sweden is characterised by an even distribution of incomes and wealth. This is partly a result of the comparatively large role of the public sector.
7 - Psychiatric evaluation as a process of quality assurance
- from Part II - COMPREHENSIVE SERVICE EVALUATION PROJECTS
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- By Claes-Göran Stefansson, Karolinska Institute
- Edited by Helle Charlotte Knudsen, University of Copenhagen, Graham Thornicroft, Institute of Psychiatry, London
- Foreword by Norman Sartorius
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- Book:
- Mental Health Service Evaluation
- Published online:
- 05 August 2016
- Print publication:
- 14 March 1996, pp 96-118
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Summary
The Nacka Project revisited
Ten years after the introduction of the Community Health Services system in the United States, a study by the National Board of Health and Welfare in Sweden recommended that adult psychiatric services should be reconstructed so as to provide more open forms of care managed by multiprofessional teams and based on a total care responsibility for a defined catchment area. One of the first clinics in Sweden to be organised according to these principles was located in a Stockholm suburb. The Nacka Project (NP), as it was called, was to be run as a pilot scheme for 2 years (1975-76) whilst undergoing continual evaluation.
The aim of the present study is to describe how the evaluation of this organisational change was carried out, as well as some of the effects of the change. A further aim is to give an account of how continual evaluation in close association with clinical practice can be used to monitor and guide the enterprise towards targeted goals and/or improved efficiency. Discussions about the quality of care often start with Donabedian's concepts - structure, process and effect quality-from the patient's perspective (Donabedian, 1966). The present study adopts instead a perspective by which the care organisation in its entirety, as well as its relationship to the catchment area population, is focused upon. It is an attempt which can be characterised as population-focused quality assurance.
Study area and method
The study population consisted of all persons aged 18 years and above in two outer suburbs of Stockholm who had sought psychiatric care in the catchment area at any time during 1972-3 (the old organisation) and 1975-6 (the new organisation, i.e. the NP). Data from these patients was included in a psychiatric case register for these periods. A new patient register was set up during the period 1981-5, containing the same type of information for the area. Patient and treatment characteristics could thus be compared over three periods of time, thereby reflecting organisational changes.
In 1975, the inhabitants of the catchment area numbered 71 400, of whom 51 300 were aged 18 and above. Ten per cent of the population lived in rural, sparsely populated areas.