Sweden offers both best practice and room for improvement on value-based healthcare

Value-based healthcare (VBHC) is about achieving the best possible health outcomes at the lowest possible costs. The concept has been a cross-cutting theme in many of the projects I have led since starting to cover global health issues at The Economist Intelligence Unit. Sweden is a fascinating case study for VBHC, both because of how advanced the country is in adopting VBHC principles and in the still large room for improvement. Sweden’s experience with VBHC is subject of a new Economist Intelligence Unit study that I edited, Value-based healthcare in Sweden: Reaching the next level.

The way Sweden considers value in a number of different aspects of healthcare makes it a global leader in VBHC. Sweden’s experience with instituting VBHC underscores a number of key lessons. First, the need to understand what VBHC is and how best to measure it. Then there is the importance of political will and careful consultation with all stakeholders. Moreover, advancements in the use of technology offer great potential in Sweden and beyond. And finally, our study also highlights the need to tread carefully when introducing new payments systems or care pathways.

Highlights from the research:

  • A new report by The Economist Intelligence Unit (EIU) argues that Sweden is a global leader in value-based healthcare (VBHC), helped by its highly developed system of disease registries, outcome-based reimbursement for some specialised care and a decentralised health system encouraging local experimentation.
  • Major challenges in the rollout of VBHC in Sweden persist, notably different information technology systems across regions, data-quality and data-sharing issues, and a backlash against some hospital restructuring programmes.
  • Several initiatives show how Swedish stakeholders can overcome the barriers and limitations, for example improvements in cross-regional co-operation, use of technology, integration of care systems between municipal and county bodies, and stakeholder collaboration using bottom-up approaches.

Sweden is a world leader in value-based healthcare (VBHC) with many lessons for other countries. However, major challenges still need to be overcome to ensure a successful rollout of VBHC principles across the country, according to a new study released today by The Economist Intelligence Unit (EIU). Entitled “Value-based healthcare in Sweden: Reaching the next level”, the study was commissioned by Takeda.

The EIU study found that Sweden benefits from an interconnected system of electronic health records (EHRs), quality health registries, outcome-based reimbursement, and a decentralised health system that encourages experimentation at the local level. There are many examples of international best practice in Sweden, such as different forms of value-based pricing and reimbursement through “bundled care” in Stockholm and parts of western Sweden.

But Sweden is not immune to the challenges facing other systems that take on entrenched interests and ways of doing things, the study also reveals. For example, the value-based pricing models in Sweden’s pilot programmes are still largely driven by process, not patient outcomes. Moreover, each of the country’s 21 regions has a different IT environment, including EHR systems that vary both within and between regions. Data-sharing has been made more difficult because quality registries differ significantly in terms of data availability, completeness and utility. Meanwhile, a backlash against some hospital restructuring programmes has made VBHC the focus of protests despite the success of projects elsewhere in the country.

The study explores a range of approaches to overcome these challenges. Cross-regional co-operation, for example via the Swedish national collaboration for value-based reimbursement and monitoring of healthcare (SVEUS), is improving. Better integration of care systems between municipal and county bodies can also help to break down silos, exemplified by mobile home healthcare in the Västra Götaland region. Stakeholder collaboration is also improving, as seen for example in bottom-up approaches at Uppsala University Hospital. Finally, there are several promising collaboration opportunities that make better use of technology, such as predictive analytics, machine learning and artificial intelligence.

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