Anders Anell

• Professor
• Professor at Lund University

Background Continuity of care is important for patients with chronic conditions. Assigning patients to a named GP may increase continuity. Aim To examine if patients who were registered with a named GP at the onset of their first chronic disease had higher continuity at subsequent visits than patients who were only registered at a practice. Desig...

Reducing socioeconomic health inequalities is a key goal of most health systems. A challenge in this regard is that healthcare providers may have incentives to avoid or undertreat patients who are relatively costly to treat. Due to the socioeconomic gradient in health, individuals with low socioeconomic status (SES) are especially likely to be nega...

Background Digital applications that automatically extract information from electronic medical records and provide comparative visualizations of the data in the form of quality indicators to primary care practices may facilitate local quality improvement (QI). A necessary condition for such QI to work is that practices actively access the data. The...

This Health system summary is based on the Sweden Health System Review published in 2023 in the Health Systems in Transition (HiT) Series. Health system summaries use a concise format to communicate central features of country health systems and analyse available evidence on the organization, financing and delivery of health care. They also provide...

This analysis of the Swedish health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The analysis shows that Swedish life expectancy is very high. There are, however, health gaps across different socioeconomic groups and regional areas. Health c...

The Health Systems in Transition (‎HiT)‎ country reports provide an analytical description of each health system and of reform initiatives in progress or under development. They aim to provide relevant comparative information to support policy-makers and analysts in the development of health systems and reforms in the countries of the WHO European...

Background Primary care in several countries is developing towards team-based and multi-professional care, requiring leadership and management capabilities at the primary care practice level. This article reports findings from a study of primary care managers in Sweden, focusing variation in performance and perceptions of feedback messages and goal...

Reducing socioeconomic health inequalities is a key goal of most health systems. When care providers are paid prospectively, e.g., by a fixed sum per patient, existing inequalities may be sustained by the incentives to undertreat relatively unhealthy patients. To counter this, prospective payments are often risk-adjusted based on observable patient...

Market frictions, such as imperfect information or hassle costs, may reduce benefits from market incentives in healthcare settings. We use data from two randomised policy interventions in a Swedish region, which improved the access to provider information and reduced the switching costs of one percent of the adult population and of a sample of new...

Background This article addresses the role of audit and feedback (A&F) to support change behaviour and quality improvement work in healthcare organisations. It contributes to the sparse literature on primary care centre (PCC) managers´ views on A&F practices, taking into account the broad scope of primary care. The purpose was to explore if and how...

Background High quality primary care is expected to be the basis of many health care systems. Expectations on primary care are rising as societies age and the burden of chronic disease grows. To stimulate adherence to guidelines and quality improvement, audit and feedback to professionals is often used, but the effects vary. Even with carefully des...

Objective: The objective was to examine the association between primary care consultations and a Care Need Index (CNI) used to compensate Swedish primary care practices for the extra workload associated with patients with low socioeconomic status. Design: Observational study combining graphical analysis with linear regressions of cross-sectional...

Consumer choice policies may improve the matching of consumers and providers, and may spur competition over quality dimensions relevant to consumers. However, the gains from choice may fail to materialise in markets characterised by information frictions and switching costs. We use two large-scale randomised field experiments in primary health care...

Background High quality primary care is expected to be the basis of many health care systems. Expectations on primary care are rising as societies age and the burden of chronic disease grows. To stimulate adherence to guidelines and quality improvement, audit and feedback to professionals is often used, but the effects vary. Even with carefully des...

Achieving Person-Centred Health Systems - edited by Ellen Nolte August 2020

Achieving Person-Centred Health Systems - edited by Ellen Nolte August 2020

Achieving Person-Centred Health Systems - edited by Ellen Nolte August 2020

Achieving Person-Centred Health Systems - edited by Ellen Nolte August 2020

Achieving Person-Centred Health Systems - edited by Ellen Nolte August 2020

Achieving Person-Centred Health Systems - edited by Ellen Nolte August 2020

Achieving Person-Centred Health Systems - edited by Ellen Nolte August 2020

Achieving Person-Centred Health Systems - edited by Ellen Nolte August 2020

Background: Countries rely on out-of-pocket (OOP) spending to different degrees and employ varying techniques. The article examines trends in OOP spending in ten high-income countries since 2000, and analyzes their relationship to self-assessed barriers to accessing health care services. The countries are Australia, Canada, France, Germany, the Ne...

Background: Providing equal access to health care is an important objective in most health care systems. It is especially pertinent in systems like the Swedish primary care market, where private providers are free to establish themselves in any part of the country. To improve equity in access to care, 15 out 21 county councils in Sweden have imple...

The Nordic countries are healthcare systems with tax-based financing and ambitions for universal access to comprehensive services. This implies that distribution of healthcare resources should be based on individual needs, not on the ability to pay. Despite this ideological orientation, significant expansion in voluntary private health insurance (V...

Table B.1: Other antibiotics P4P indicators in treated counties Figure C.1: (a) Reproduction of Figure 2 in Section 5 of paper; (b) Same, but shift back regression line cut‐off one year. Figure C.2: (a) Longer regression period; (b) Same, but shift back regression line cut‐off one year. Figure C.3: (a) Unweighted data; (b) Excluding Stockholm count...

Background: Access and continuity are important objectives in primary care. They can be measured through registered process measures or PREMs. These measures do not necessarily converge in terms of outcomes. Patient views are affected by factors not necessarily reflecting quality of services. Results from surveys are often uncertain due to low res...

Objective: A pay for performance programme was introduced in 2009 by a Swedish county with 1.6 million inhabitants. A process measure with payment linked to coding for medication reviews among the elderly was adopted. We assessed the association with inappropriate medication for five years after baseline. Design and setting: Observational study...

Antibiotic resistance is a major threat to public health worldwide. As the healthcare sector's use of antibiotics is an important contributor to the development of resistance, it is crucial that physicians only prescribe antibiotics when needed and that they choose narrow-spectrum antibiotics, which act on fewer bacteria types, when possible. Inapp...

Objective We explore whether standardisation in health care based on evidence on group level and a public health perspective is in conflict with responsiveness towards individual patient’s expectations in Swedish primary care. Methods Using regression analysis, we study the association between patient views about providers’ responsiveness and indi...

Background Mild traumatic brain injury (TBI) is associated with substantial costs due to over-triage of patients to computed tomography (CT) scanning, despite validated decision rules. Serum biomarker S100B has shown promise for safely omitting CT scans but the economic impact from clinical use has never been reported. In 2007, S100B was adapted in...

Objective Comparison of provider performance is commonly used to inform health care decision-making. Little attention has been paid to how data presentations influence decisions. This study analyzes differences in suggested actions by decision-makers informed by league tables or funnel plots. Design Decision-makers were invited to a survey and ran...

Coordination of health care exists at many different levels and in many different forms. We describe the similarities and differences in coordination mechanisms among the Nordic countries. In some respects, the Nordic countries approach coordination problems in similar ways although differences exist. The overall pattern shows that Finland and Swed...

Background: General practice systems in the Nordic countries share certain common features. The sector is based on the Nordic model of a tax-financed supply of services with a political objective of equal access for all. The countries also share the challenges of increased political expectations to deliver primary prevention and increased workload...

The Nordic countries represent an institutional setting with tax-based health care financing and universal access to health care services. Very few health care services are excluded from what are offered within the publically financed health care system. User fees are often non-existing or low and capped. Nevertheless, the markets for voluntary pri...

This article maps current approaches to public reporting on waiting times, patient experience and aggregate measures of quality and safety in 11 high-income countries (Australia, Canada, England, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and the United States). Using a questionnaire-based survey of key national informan...

Objective A pay-for-performance (P4P) programme for primary care was introduced in 2011 by a Swedish county (with 1.6 million inhabitants). Effects on register entry practice and comparability of data for patients with diabetes mellitus were assessed. Design and setting Observational study analysing short-term outcomes before and after introduction...

Health care systems around the globe are facing great challenges. The demand for health care is increasing due to the continuous development of new medical technologies, changing demographics, increasing income levels, and greater expectations from patients. The possibilities and willingness to expand health care resources, however, are limited. Co...

The Swedish health care system is largely the product of past Social Democratic governments, which emphasized equity and reliance on the public sector. But since 1990, more centrist governments have turned to privatization, competition, and greater consumer choice.

A number of reforms have been implemented in Swedish health care to support integrated care for frail older people and to reduce utilization of hospital care by this group. Outcomes and process indicators have been used in pay-for-performance (P4P) schemes by both national and local governments to support developments. To analyse limitations in the...

Purpose and theory: Fragmented services and poor access to primary care physicians are important explanations behind an excessive use of hospital care by elderly patients with multiple chronic conditions. This study analyses the potential of using indicators reflecting utilisation of hospital care to incentivise primary care units to improve qualit...

The organisation of Swedish primary health care has changed following introduction of free choice of provider for the population in combination with freedom of establishment for private primary care providers. Our aim was to investigate changes in individual health care utilisation following choice and privatisation in Swedish primary care from an...

There are variations in quality of life (QoL) and reported risk of chronic pain after inguinal hernia repair. The aim of this study was to investigate the improvement in pain and QoL after open inguinal hernia repair, and the economic impact. Patients undergoing open mesh repair of a primary unilateral inguinal hernia were stratified depending on p...

Life expectancy in Sweden is high and the country performs well in comparisons related to disease-oriented indicators of health service outcomes and quality of care. The Swedish health system is committed to ensuring the health of all citizens and abides by the principles of human dignity, need and solidarity, and cost-effectiveness. The state is r...

This paper explores leadership and governance arrangements in seven developed health systems: Australia, England, Germany, the Netherlands, Norway, Sweden and Switzerland. It presents a cybernetic model of leadership and governance comprising three fundamental functions: priority setting, performance monitoring and accountability arrangements. The...

In 2007, a new wave of local reforms involving choice for the population and privatisation of providers was initiated in Swedish primary care. Important objectives behind reforms were to strengthen the role of primary care and to improve performance in terms of access and responsiveness. The purpose of this article was to compare the characteristic...

Recent reforms in Swedish primary care have involved choice of provider for the population combined with freedom of establishment and privatisation of providers. This study focus to what extent individuals feel they have exercised a choice of provider, why they exercise choice and where they search for information, based on a population survey in t...

OBJECTIVES: To analyse the impact of parallel trade of pharmaceuticals on welfare and innovation in the long run and to estimate the impact of costs for pharmaceuticals in some therapeutic areas in the short run. METHODS: Identify arguments for and against parallel trade by use of literature review and by interviewing agens involved in parallel tra...

To examine which attributes are important when individuals choose between primary care models. In particular, we studied whether individuals that were given a choice preferred individual family physicians (GP) or a primary care team consisting of physicians and nurses (PCT). A questionnaire survey, designed as a discrete choice experiment, was sent...

In Sweden decentralised drug-budgets at health-care facility levels were introduced in 1997 in an attempt to contain increasing pharmaceutical expenditures. This paper reports the findings of a postal survey which investigates whether decentralised drug-budgets according to a so-called primary-care based model in Swedish health care have led to inc...

The pharmacy market in many European countries is characterised by individually owned pharmacies that operate under tight government control regarding barriers to entry, scope of activities and profit margins. Many countries are, however, in the process of introducing pro-competitive policies, including possibilities to own several pharmacies and c...

Introduction of the new Pharmaceutical Benefits Board (LFN; 1 October 2002) has markedly changed the principles of pricing and reimbursement of drugs in Sweden. The Board is required to make decisions based on information on cost-effectiveness, and pharmaceutical companies must submit economic evaluations when relevant as part of their applications...

Swedish health care, run by local governments at both the regional (county) and the municipal levels, has been under pressure during the last 15 years, following increased scrutiny of performance and demand for cost-containment. Health-care expenditures per capita and levels of resource inputs have grown, but more slowly than in other EU countries....

Authorities in a number of countries rely increasingly on cost-effectiveness analysis to determine reimbursement status or clinical guidance for pharmaceuticals. This study compared the use of health economic evidence across five reimbursement committees (Australia, Ontario and British Columbia in Canada, Finland, and France) and one clinical guida...

The pharmacy market in many European countries is characterised by individual, privately-owned pharmacies that operate under tight government control regarding barriers to entry, scope of activities and profit margins. In Iceland, many of these restrictions were relaxed in 1996 in the hope of stimulating competition. Similar changes were introduced...

Our evaluation using postal and interview surveys suggests that the telephone hotline service at the Swedish Poisons Information Centre ('Giftinformationscentralen') may be cost-effective for society. Advice to physicians--which was highly regarded for its speed, competence and applicability--was time-saving and facilitated better treatment. Simila...

Within modern health care, much attention is given to the tasks of identifying patient preferences and then delivering health care services accordingly. Standardised solutions are not always acceptable to patients with divergent needs and preferences, and the growing number of treatment alternatives makes patient participation increasingly importan...

Our evaluation using postal and interview surveys suggests that the telephone hotline service at the Swedish Poisons Information Centre ('Giftinformationscentralen') may be cost-effective for society. Advice to physicians - which was highly regarded for its speed, competence and applicability - was time-saving and facilitated better treatment. Simi...

The most frequently used bases for comparing international health care resources are health care expenditures, measured either as a fraction of gross domestic product (GDP) or per capita. There are several possible reasons for this, including the widespread availability of historic expenditure figures; the attractiveness of collapsing resource data...

Theoretically, the preferred type of health economic evaluation is the cost-benefit approach in which costs as well as benefits are measured in monetary units. This type of analysis is rarely found in practice, however, where cost-effectiveness analysis (CEA), cost-utility analysis (CUA) and other forms of economic evaluations are instead favored....

Swedish formulary committees are expected to influence prescribing practice by establishing and issuing drug lists and clinical practice guidelines, particularly now that financial responsibility for prescription drugs has been transferred from the national to the county council level. The purpose of this exploratory study was to identify the infor...

Since the health care expenditure share of the GNP (gross national product) is a measure difficult to interpret, its use can yield erroneous results in comparing health care sector development in different countries. A complementary measure of health care resources is the size and structure of the health care labour force. Information from Sweden,...

Extending the possibilities for health-service consumers to choose among providers has been an important objective on the political agenda in Sweden and elsewhere. Little is known, however, about individual and group preferences concerning the demand for choices. It is often implicitly assumed that individuals can be treated as a group with similar...

This article reviews recent reforms geared to creating internal markets in the Swedish health-care sector. The main purpose is to describe driving forces behind reforms, and to analyse the limitations of reforms oriented towards internal markets within a monopolistic integrated health-care model. The principal part of the article is devoted to a di...