FCCA: There are lessons to be learned from Sweden’s experiences when promoting patient freedom of choice

The Finnish Competition and Consumer Authority (FCCA) has assessed the impacts of the system of patient freedom of choice, which Sweden introduced in 2010.  On the basis of the analysis, freedom of choice has improved the availability of services and customer orientation. The service production structure has also become more extensive. Patients are mainly satisfied with the new system. On the other hand, the Swedish system also involves challenges or development needs. Sweden is well aware of these, however, and continuous work is being done to develop solutions.

From the perspective of the debate in Finland, a crucial challenge in the Swedish model lies in its cost development. In Sweden, healthcare expenditure has risen slightly in recent years, although fairly moderately. When the Swedish system was being planned and rolled out, cost savings were not the primary objective. According to international estimates, the Swedish system can still be considered fairly efficient in relation to the results obtained. It also contains elements that, if fine-tuned, would make it possible to increase its cost-effectiveness.

The reasons for cost pressures in Sweden are to a large extent the same as those in Finland: the population is ageing, demand for health and welfare services is growing, and productivity performance in public service provision is weak. Patient freedom of choice and wider use of competitive mechanisms would be one tool for controlling costs. These would stimulate the sector, among other things, to seek new operating models, use technology more efficiently and cross professional boundaries.

Realisation of freedom of choice requires options and comparative information

For patient freedom of choice and the use of competitive mechanisms to function as intended, it must be ensured that certain preconditions for a functioning market are met. It is particularly important that alternatives and comparative information of sufficiently high-quality be made available to patients. At the same time, attention must be paid to the approval procedures for service providers, as well as to providing equal opportunities for private and public service production to operate in the market. In the light of Sweden´s experiences, the development of freedom of choice should be viewed as long-term development work rather than as a search for ready-made models.

Sweden´s experiences and new international research finding suggest that the advantages of wider use of competitive mechanisms initially arise, above all, as an improvement in the availability of services and customer orientation. However, from the perspective of controlling cost development, the effects can probably only be seen in the longer term, mainly due to the introduction of new operating models and technology. Owing to the specific nature of health services, the control of cost development also needs to be supported through numerous other measures.

At times, the public debate on the issue has taken a somewhat simplified and one-sided view of Sweden´s model. In an assessment independently initiated in May 2015, the FCCA endeavoured to provide a more precise and detailed picture of the prerequisites and challenges related to realising patient freedom of choice in the light of Sweden´s experiences. On the basis of the FCCA´s analysis of Sweden´s experiences – including its weaknesses and challenges – it would be well worth taking account of the lessons learned in Sweden when developing the Finnish model.

Further information:

Potilaan valinnanvapaus, Ruotsin malli ja Suomen sote-uudistus – markkinoiden toimivuuden ja taloudellisten vaikutusten näkökulma. Kilpailu- ja kuluttajaviraston selvityksiä 6/2015.