Organization and responsibility for the health sector
The systems operate at the state, regional, and municipal levels, with some variation in responsibilities and functions at each level. At the state level, the main responsibilities include health care legislation, supervision, and the development of policies and guidelines.
Responsibility for the organization and provision of health services is decentralized to varying degrees, from the national level to regional and local health authorities. All Nordic countries have highly developed hospital and specialist services, and well-established systems for primary health care. Health services include preventive care for mothers and infants, school health care, vaccination schemes, and dental care for children and young people. Preventive occupational health services are also available in all Nordic countries.
The countries generally have well-developed hospital sectors with highly advanced specialist treatment. Specialist medical treatment is also offered outside hospitals.
Health care services are, to a large extent, publicly financed. However, in some cases user co-payments are required for pharmaceutical products and treatment. Employees are entitled to salary or cash allowances during illness. Self-employed individuals also have the possibility of insuring themselves against loss of income due to illness.
Denmark
State-regional-municipalities responsibility
Responsibility for health services is relatively decentralized. The main principles are as follows: The State is responsible for legislation, supervision and guidelines. The regions are responsible for hospitals, special nursing homes and for financing and planning primary care services provided by self-employed health professionals. The municipalities are responsible for primary health care, home nursing, prevention, rehabilitation after hospitalization, and child and school health services. The regional authorities have operational responsibility for health services.
Population coverage
In principle, primary contact shall always be with a general medical practitioner. Health care during pregnancy is the responsibility of the regions.
Municipalities are responsible for health visiting services for children and families, while preventive child health examinations are carried out by general practitioners.
Contact with the health services: As a main rule, patients may contact general practitioners, dentists, chiropractors, physiotherapists, chiropodists, psychologists, dental hygienists, emergency wards and emergency and ambulance services without referral. However, access to public reimbursement for some services may require referral from a general practitioner.
Free choice of hospital: As a rule, patients are free to choose the hospital where they wish to receive treatment.
Hospital, specialist and care
Public hospitals are owned by the regions.
Practicing specialists: Most practicing specialist physicians work under a contract with the health insurance scheme.
School and occupational health services are regulated by legislation. Municipalities are responsible for school health services, which are provided by health visitors and physicians.
Most dental services are provided by private dentists. Municipalities are responsible for publicly funded dental care for children and adolescents.
Home nursing care is provided by the municipalities and is free of charge after referral by a physician. Ordinary nursing homes are run by the municipalities, but there are many private (independent) nursing homes, which receive residents according to a contract with the municipality in which they are located. Certain specialized nursing homes are run by the regions, for example psychiatric nursing homes.
Pharmacies are organized as private companies, but are subject to government regulation. The state regulates the number and the geographic location of pharmacies, their tasks and the profit margin on pharmaceutical products.
Private sections and areas of health care
The regions have a contract with some private hospitals to provide treatment under the extended free choice of hospital arrangement. A few private hospitals operate independently of the public hospital services. Some specialized hospitals are organized under the hospitals, while others are owned by organizations.
Faroe Islands
State-regional-municipalities responsibility
The Home Government of the Faroe Islands lays down the rules concerning the tasks, benefits and administration of the health service.
The government is responsible for the hospital services, the general practitioner’s (GP's) service and the dentist’s service. Also, the government is responsible for the Health Insurance Scheme (Heilsutrygd).
Rehabilitation after hospitalization for people under the age of 67 is the responsibility of the government. The municipalities are responsible for nursing homes, home care and rehabilitation after hospitalization for citizens above the age of 67.
Population coverage
The main principle is that the primary contact is the GP’s. The GP’s refer patients to hospitals or other specialists if required. In general, there is free choice of hospital to receive treatment. However, patients might be referred to a certain hospital in order to reduce waiting time or due to limitations in services offered by certain hospitals. Also patients might be referred to hospitals abroad - primarily Denmark - offering more specialised treatments for some illnesses.
The midwifery service is provided by hospitals.
Child health care is provided by health visitors and is administered by the government.
The government is also responsible for primary school health services, which are provided by health visitors and physicians.
Dentists may be contacted directly by patients for service. The service is free of charge for children and youngsters until the age of 23. For others, the service is paid for partly by the Health Insurance Scheme and partly by the receiver of the service. Other specialists like physiotherapists, psychologists and chiropractors may be contacted directly by patients without referral from a GP, but no remuneration for the cost will then be granted from the health insurance scheme.
A district psychology service is available as a supplementary to the in-patient treatments at the psychiatric hospital. Also a scheme has been set up as a cooperation between the government and private psychologists. The scheme is for people 15 – 25 of age with mild mental health conditions. A GP referral is required to take contact to the scheme. No user charge applies to the scheme.
Hospital, specialist and care
Three hospitals are in the Faroes: The main hospital is situated in the capital city, one in the northern part of the islands and one in the southern part.
The hospitals are owned by the government.
Self-employed specialists are mainly dentists, psychologists, chiropractors and physiotherapists.
Home nursing care is provided by the municipalities. Ordinary nursing homes are run by the municipalities.
Pharmacies are owned by the government.
Private sections and areas of health care
There are no private hospitals in the Faroe Islands.
Rehabilitation home after hospitalization and rehabilitations homes for addicts are privately owned, but they receive financial support from the government.
Some companies have insurance schemes for employees covering direct access to hospital services from private hospitals in Denmark.
Cross boarder health care
The government has entered into agreements with hospitals overseas, mainly in Denmark, to provide health services not offered in the Faroe Islands. Patients to hospitals overseas are referred by the local hospitals.
Links to relevant legislation/organizations
Heilsutrygd, Health Insurance Scheme – www.heilsutrygd.fo
Law on the Health Care System in the Faroe Islands - https://logir.fo/Lov/316-af-17-05-1995-om-sundhedsvaesenet-pa-Faeroerne
Law on the Hospitals - https://logir.fo/Logtingslog/64-fra-17-05-2005-um-sjukrahusverkid-sum-broytt-vid-logtingslog-nr-141-fra-11-oktober
Greenland
State-regional-municipalities responsibility
Responsibility for health services is relatively centralized. Municipalities are responsible for nursing homes for the elderly. In Greenland, there is no system of private general practitioners. Primary health care is provided through the public health care system. However, a small number of private dental practices do exist.
The primary responsibilities of the health care system are to promote public health, prevent diseases, and examine, treat, and care for individuals with illnesses or illness-like conditions. Health services must be planned in a way that ensures, to the greatest extent possible, equal access to health care services for all citizens, regardless of where they live.
According to Greenland Self-Government Consolidated Act No. 44 of 26 September 2023, persons residing in Greenland are entitled to health care services in accordance with the provisions of the legislation. Pregnant women are offered free preventive prenatal examinations and maternity care (ltf 15 1997).
Section 14 provides that the health care system grants citizens access to a range of health services, including preventive health examinations, medical and hospital treatment, nursing care, medicines, vaccinations, assistive devices, physiotherapy, and medical certificates, when circumstances permit. Pregnancy examinations may be included within the right to preventive health examinations and general health care services.
Persons who are temporarily staying in Greenland are entitled to health care services in accordance with rules established by Naalakkersuisut, either free of charge or subject to payment. Furthermore, following an individual assessment, Naalakkersuisut may consider a stay in Greenland of more than six months' duration as equivalent to registration in the Greenlandic population register, even if the person remains registered in a population register outside Greenland.
Hospital, specialist and care
The Greenlandic health care system is organized at several levels and includes health centres, regional hospitals, nursing stations, and village health services staffed by health care workers authorized to dispense medicines.
Regional hospitals are located in several towns across Greenland, but they mainly provide primary and general medical care as well as basic health services. Nursing stations and village health services ensure access to essential health care in smaller towns and settlements.
Specialist treatment is largely centralized at Queen Ingrid's Hospital in Nuuk. Only a few regional hospitals are equipped to handle childbirth, and pregnant women requiring specialized maternity care or those with high-risk pregnancies are therefore usually referred to Nuuk. Patients from other towns and settlements are therefore often referred to Nuuk for specialist examinations and treatment. If the required treatment cannot be provided in Greenland, patients may be referred to specialized hospitals abroad, particularly in Denmark.
Cross border health care
Persons residing in Greenland are entitled to free physician-prescribed patient transportation to relevant treatment facilities within Greenland and, when necessary, to health care institutions abroad. The health care system also covers necessary expenses for meals and accommodation during transport. Referrals for treatment outside the local health district or outside Greenland are subject to assessment and approval by the Visitation Committee, and treatment abroad may only take place at institutions with which Naalakkersuisut has entered into an agreement. As a general rule, transportation related to dental treatment is not covered, unless the condition constitutes an acute and serious dental disease (for details, please see chapter 7 and 8 in: ltf 15 1997).
Greenland is not a member of EU, has not formally joined the EU Cross-border health care directive, but joins a general treatment obligation.
Links to relevant legislation/organizations
Greenlandic medical Services Act in Greenland (Grønlands sundhedslovgivning): https://naalakkersuisut.gl/da/Naalakkersuisut/Departementer/Sundhed/Sundhedslovgivning
Patients´s Rights in Greenland (Patientrettigheder i Grønland): ltf 06 2001
Ministry of Health in Greenland (Naalakkersuisoq for Sundhed og Personer med Handicap): Naalakkersuisoq for Sundhed og Personer med Handicap
Directorate of Health in Greenland (Sundhedsledelsen i Grønland): Administration og Ledelse
Hospitals and Health Centres in Greenland (Hospitals and Sundhedscentre I Grønland):
https://www.peqqik.gl/Kontakt/Sundhedscentre
Dental Care in Greenland (Tandklinikker i Grønland):
https://www.peqqik.gl/Kontakt/Tandklinikker
Complaints about treatment in the Health Care System in Greenland (Patientklagener i Grønland):
https://nun.gl/emner/borgere/oensker_du_at_klage?sc_lang=da
Health professional notes in Greenland (Sundhedsfaglige notater i Grønland):
https://nun.gl/emner/udgivelser/aarsberetninger?sc_lang=da
Health Statistics in Greenland (Grønlands Statistik «Sundhed»):
https://bank.stat.gl/pxweb/da/Greenland/
Finland
State-regional responsibility
Since 1 January 2023 the wellbeing services counties have been responsible for organising public healthcare, social welfare and rescue services. There are 21 self-governing wellbeing services counties in Finland. In addition, the City of Helsinki and Åland Islands are responsible for organising health, social and rescue services within their own areas. The Health Care Act (1326/2011) together with The Act on Organising Social Welfare Services and Health Care (612/2021) and The Act on its Implementing (616/2021) regulates the health care and nursing services that the regions are responsible.
Population coverage (Adult/Children/Youth, main route for health care contacts, freedom of choice etc.)
The wellbeing services counties are responsible for proving health care. including measures to promote health and welfare, primary care and specialized nursing. More specifically each county has to provide guidance and preventive health care, including children's health, maternal health, sexual and reproductive health, health education, counselling concerning contraceptive measures and health check-ups and screening. Medical treatment, including examination and care, medical rehabilitation and first aid. General medical treatment is provided in health care centres, in-patient wards or as home nursing. Since 1 January 2025, the treatment guarantee for non-urgent care will be 3 months in primary healthcare outpatient care, and 6 months in dental care. For children and young people under 23 years of age, the maximum waiting time is one month for access to primary mental health services from the date when the need for help was established.
The wellbeing services counties provide services for people with mental illness that can reasonably be offered in health centres. Children and young people shall receive mental health care within three months if it is assessed to be necessary.
Citizens can choose whichever health centre in their home county to go to for primary health care services.
A referral is required for specialized health care. Individuals requiring specialised medical care services can choose a treatment provider within their wellbeing services county. The treatment provider is chosen together with the referring doctor. Patients also have the right to choose their own doctor or other health care professional where possible.
Hospital, specialist, and care (dental care, rehabilitation, occupational care, other)
If a patient’s own health centre or hospital cannot provide treatment within the given time, the patient must be offered treatment either in another wellbeing services county or at a private institution, without extra cost. With the exception of emergency cases, patients must be examined and treated within a given period. The time limits are the same as for specialized health services, i.e. six months. The need for treatment must be assessed within three weeks after referral to a hospital. If a physician has examined a patient and has established that treatment is needed, such treatment shall be started within six months.
Wellbeing services counties are responsible for organizing primary health care for their residents. These services are defined by law and they include monitoring the health of the population, health counselling, including health education and contraception advice, maternity and child welfare clinics, school and student health care, screening for specified diseases and vaccinations against infectious diseases, oral health services, mental health care and substance abuse services, appointment with physician or other health care professionals, emergency and treatment for accidents, in-patient care for patients for those patients who require nursing and home care services.
Wellbeing services counties are required to provide ambulance services and to ensure that occupational health services are established. Employers can either organize their own occupational health service, or they can enter into an agreement with a health centre or with others who provide occupational health services. Employers are responsible for preventive health care of their employees. On a voluntary basis, some also provide medical care. Employers may purchase these services from the wellbeing services counties.
Dental treatment that is assessed to be necessary shall be started within a reasonable time and at the latest within six months. Dental care includes advice and prevention, dental examination and treatment. Dental care and treatment paid for by the health insurance scheme is provided for the entire population. Dental care is also provided for adults in health centres, particularly in rural areas. Most dental treatment for adults is provided by dentists in private practices. Young people under the age of 18 are entitled to dental carefree of charge.
Rehabilitation organised by the Social Insurance Institution of Finland (Kela) includes adaptation training, psychotherapy or vocational rehabilitation. Apart from Kela, rehabilitation is organised by public health care, occupational health care, regional social services and associations for the disabled. Occupational rehabilitation is also organised by pension providers. The majority of rehabilitation services are free of charge for the rehabilitee. A client fee or a fixed non-reimbursable payment may be charged from the rehabilitee for some rehabilitation services, such as therapies and care periods at rehabilitation facilities.
Specialised medical care services are provided at hospitals. The majority of the hospitals are public, owned by wellbeing services counties. University hospitals and central hospitals are responsible for the most demanding medical treatment. Furthermore, there are regional hospitals and local hospitals, such as city hospitals. Health centre have inpatient wards, which may also be called hospitals. Private hospitals supplement the public services for example by providing day surgeries.
Wellbeing services counties are responsible for arranging the social and health services that older people require. These services are provided in as integrated health and social welfare services.
Only pharmacies, which are privately own, are entitled to sell medicines and most of over-the-counter products. Some sparsely populated areas have pharmacy service points where a prescription and self-administered medication can be purchased.
Private sections and areas of health care
The private health care sector such as health care companies and non-governmental organisations supplement regional services. Wellbeing services counties may also procure health care services from private service providers.
Cross border health care
Finnish citizens and permanent residents can obtain medically necessary treatment in an EU or EEA country or Switzerland for a corresponding user fee that the local residents pay with a European Health Insurance Card. Treatment in connection with a chronic illness, pregnancy or childbirth is also covered. The European Health Insurance Card is not necessary in the Nordic countries, since treatment can be received by presenting a valid passport or other official identity document. Outside Europe, treatment for a corresponding user fee as that paid by local residents can only be received in the Australian public healthcare system by presenting the KELA card (Social Insurance Travel expenses for care in the EU or EEA countries or Switzerland are reimbursed according to travel costs to the nearest local place of treatment. Travel expenses for care in some other country than an EU or EEA country or Switzerland are not reimbursed, excluding the expenses incurred in Finland.
Links to relevant legislation/organizations
Ministry of Social Affairs and Health: https://stm.fi/en/health-services
Social Insurance Institution of Finland: https://www.kela.fi/medical-care-entitlement-finland
Social Insurance Institution of Finland: https://www.kela.fi/web/en/medical-treatment-in-international-situation…
Åland
State-regional-municipalities responsibility
Åland is a separate region for social and health care in Finland. According to the main rule set out in the Act on the Autonomy of Åland (FFS 1144/1991), legislative authority in the field of health care and medical treatment rests with Åland. However, the State of Finland retains legislative authority in a number of areas, including administrative deprivation of personal liberty, human contagious diseases, castration and sterilisation, abortion, artificial insemination, forensic medical investigations, the qualifications of persons involved in health care and nursing, the pharmacy service, medicines and pharmaceutical products, drugs and the production of poisons and the determination of the uses thereof. Consequently, legislation from both Åland and Finland apply within the health care sector in Åland.
The division of legislative authority and the organization of health services in Åland mean that the State, Åland, and the municipalities are all responsible for different aspects of health and social care. As a result services, governance and supervision may be exercised either by Finnish state authorities or by Åland authorities, depending on the area concerned. However, according to landskapslagen (2011:114) om hälso- och sjukvård (the health care act in Åland) public health care services are provided by Ålands hälso- och sjukvård (ÅHS, the Åland health and medical services authority). ÅHS is a subordinate authority under the Government of Åland and, in practice, provides the vast majority of all public health care services in the region.
Social services are provided by Åland’s 16 municipalities and by Kommunernas socialtjänst k.f. (KST), a muncipal association. The municipalities are also responsible for certain health care services provided within public institutional care.
Population coverage
ÅHS is responsible for all primary and secondary care of the inhabitants. Patients do not have the right to choose the hospital they wish to be referred to outside Åland. However, in accordance with the legislation on patient’s right, they have the right to a second opinion. Patients who need tertiary care are referred to Sweden and Finland. On an average there is one helicopter transport to the neighbouring countries every day.
The health care in the 59 inhabited islands other than the main Åland Island is organized with the help of local health nurses.
Hospital, specialist and care
ÅHS runs a hospital with 110 beds and with most of the main specialities. Because of its unique geographic position the hospital provides a wide-range of emergency services.
Recruiting competent personnel is clearly one of the greatest challenges. Moreover, the language of the islands is exclusively Swedish which restricts the possibilities to recruit from the Finnish universities.
Private sections and areas of health care
There are several private sector actors mainly providing specialists and general practitioner visits. Public dental care differs from most other publicly funded health care services in Åland as access to public dental services is restricted to specific groups. As a result a large share of dental care is provided by private practitioners. Occupational health care services fall within the legislative authority of the State and the overall system in Åland is therefore similar to that in the rest of Finland. However, ÅHS has a more limited role in the provision of occupational health care services than the public health care authorities in the rest of Finland. Consequently, occupational health care services may be provided to a greater extent by private providers.
Cross border health care
As in Finland citizens and permanent residents can obtain medically necessary treatment in an EU or EEA country or Switzerland for a corresponding user fee that the local residents pay with a European Health Insurance Card. Treatment in connection with a chronic illness, pregnancy or childbirth is also covered. The European Health Insurance Card is not necessary in the Nordic countries since treatment can be received by presenting a valid passport or other official identity document.
Links to relevant legislation/organizations
Åland’s public health and medical services act:
Landskapslag (2011:114) om hälso- och sjukvård | Ålands landskapsregering
Åland’s act on private health care:
Landskapslag (2024:29) om privat hälso- och sjukvård | Ålands landskapsregering
The Government of Åland:
Startsida | Ålands landskapsregering
Ålands hälso- och sjukvård (ÅHS):
Välkommen till ÅHS | Ålands hälso- och sjukvård
Ålands miljö- och hälsoskyddsmyndighet (ÅMHM):
Välkommen till Ålands miljö- och hälsoskyddsmyndighet! | Ålands miljö- och hälsoskyddsmyndighet
National Contact Point for Cross-Border Healthcare:
Kontaktpunkt för gränsöverskridande hälso- och sjukvård | Om FPA | FPA
Iceland
State-regional-municipalities responsibility
Health services in Iceland are governed by the Health Service Act No. 40/2007.
Health policy is the responsibility of the Minister of Health, who is also responsible for ensuring access to the best possible health services. Quality of services is monitored by the Directorate of Health.
A policy for Iceland’s health services until 2030 was accepted by parliament in 2019. Following its adoption, , amendments were made to the Health Service Act, including changes to the responsibilities of different types of health institutions.
Health services are organized into primary, secondary and tertiary levels of care. The country is divided into seven health regions. Each region has a public health care facility that provides primary and secondary inpatient and outpatient services at one or more locations. Home nursing services are also provided through primary health care centres. Two main public hospitals, in Reykjavík and Akureyri, in addition to secondary care, provide specialized tertiary health care services. In addition to public health care facilities, health services are provided by privately operating health care professionals and institutions via contracts with Icelandic Health Insurance.
Population coverage
Legal residents in Iceland automatically become members of the Icelandic social insurance system, regardless of nationality. Individuals moving to Iceland generally become insured three months after registering their legal domicile in the National Register, unless otherwise provided for under international agreements. Each resident is registered at a specific primary health care center, either automatically or to the individual’s choice. No referral is required to consult physicians in private practice. However, many specialists in private practice only accept patients with a referral. Children under the age of 18 are exempt from charges for specialist services if they have a referral from their general practitioner.
No referral is required to receive dental care. As for outpatient private practice physiotherapy, occupational therapy and speech therapy, referrals are required to receive state refunds. This is also the case for psychological services for children with special referrals.
Hospital, specialist and care
Publicly funded primary health care centres provide both preventive and general health care services.
Preventive measures include antenatal care, infant health care, school health programmes, immunization, family planning etc.
Inpatient secondary care is provided by public regional health care institutions, as well as by the public hospitals in Akureyri and Reykjavík. Highly specialized services are primarily provided by Landspítali University Hospital in Reykjavík.
Outpatient specialist medical treatment is largely provided by specialists in private practice. The majority of private specialists operate in densely populated areas, especially the capital region. Specialist treatment is also offered in outpatient wards in public hospitals.
Dental care is provided in private dental practices.
Physiotherapy services are provided in health centres, although most services in urban areas are provided by physiotherapists in private practice.
Nursing homes are independent institutions, run by municipalities, voluntary organizations and the like. They are financed partly by user charges, but mainly by health insurance.
According to law, occupational health services are the responsibility of the employers. Larger companies buy these services from practicing physicians, consultancy firms, or from health centres.
Pharmacies are privately operated in accordance with legislation and monitored by The Icelandic Medicines Agency.
Private sections and areas of health care
Privately operated health care facilities almost exclusively have a contract with the state and receive some public funding. This includes detoxification services, nursing homes and rehabilitation centers, physicians in private practice, physiotherapists, and dentists.
Cross-border health care
In accordance with EU directive 2011/24 on patients’ rights in cross-border health care, a patient may travel to another EEA country for treatment under certain conditions. Icelandic Health Insurance is the national contact point for cross-border healthcare.
Citizens of Iceland and other EEA countries who reside and have health insurance in Iceland are also entitled to the European Health Insurance Card.
For certain highly specialized services, contracts are in place with health care facilities in other countries.
Links to relevant legislation/organizations
Ministry of Health: https://www.government.is/ministries/ministry-of-health/
Icelandic Health Insurance: https://island.is/en/o/iceland-health
Directorate of Health: https://island.is/en/o/directorate-of-health
Icelandic Medicines Agency: https://www.ima.is/
The Health Service Act no. 40/2007: https://www.government.is/library/04-Legislation/Health%20Service%20Act%20No%2040%202007%20as%20amended_not%20fully%20translated.pdf
Patients´s Rights Act no. 74/1997: https://www.government.is/library/04-Legislation/Patients%20Rights%20Ac…
Norway
State-regional-municipalities responsibility
Health care in Norway is organized at three main levels; national/state, health regions and municipalities. A few health care responsibilities are held by the counties. The Ministry of Health and Care Services determines national health policy, prepares and oversees legislation, decides on the allocation of funds within the health sector, and delegates implementation of national health policy to different government agencies. Legislation broadly reflects the decentralized nature of the health care system. Responsibility for specialist care lies with the state, administered by four Regional Health Authorities (RHAs) owned by the state. Primary care is organized at the level of the municipalities, and dental care is organized at the level of the counties.
Population coverage
Outpatient specialist care is provided by public hospitals and private specialists. Patients need a referral to acute-care services from a GP. However, in specific cases (e.g., accidents, suspected heart attack), patients can be taken directly to the hospital via ambulance. Patients are free to choose a hospital for elective services, but not for emergency care.
GPs may refer patients either to private psychologists and psychiatrists or to community mental health centres (district psykiatriske sentre, DPS. More advanced specialized services are provided in the inpatient psychiatric wards of general hospitals or in mental health hospitals. Psychological care for children under the age of 18 is fully covered.
All residents have a unique personal identification number, used in primary care and for hospital medical records. Virtually all GPs use electronic health records and transmit prescriptions electronically to pharmacies. Electronic communication systems are used for referrals, for communication with laboratories and radiology services, and for sick leave. Some GP and specialist outpatient offices have electronic booking, while most hospitals do not.
Hospital, specialist and care
General practitioners (GPs) constitute an important link between primary and specialized health services and refer patients to specialized care when necessary. The municipalities are responsible for arranging after-hours emergency primary care. The Regional Health Administrations (Regionale helse administrasjoner, RHAs) are enterprises responsible for providing specialized care in hospital trusts (helseforetak, HF) and a few contracted private facilities. RHAs are also responsible for other specialized medical services, such as laboratory, radiology and ambulatory services, for services to persons with alcohol- or drug addiction and hospital pharmacies.
Hospitals provide outpatient specialist care and emergency care. Hospital inpatient treatment is provided free of charge. Outpatient services are subject to the same cost-sharing as other ambulatory visits.
Municipalities and RHAs are responsible for coordinating rehabilitation services. Rehabilitation is provided at the primary level (physiotherapy, occupational therapy, etc.) and at the secondary level (specialized rehabilitation).
Adults receive dental care from private dentists and pay the full cost of treatment. Public dental care is free of charge for children and young people aged 0–18 years, except for orthodontic treatment. Young people aged 19–20 years pay 25 per cent of the costs.
The municipalities are responsible for providing long-term care and may contract with private providers. The majority of long-term care recipients receive care at home, while 10 per cent live in sheltered or assisted housing facilities. About 20 per cent of recipients live in an institution or a home with personnel available 24 hours a day. Most nursing homes are owned and funded by municipalities; only 10 per cent of all long-term care beds are in private nursing homes.
Private sections and areas of health care
Private treatment centres for addiction (mainly drugs and alcohol) are funded mostly through contracts with RHAs.
Sweden
State-regional-municipalities responsibility
The Swedish health care system is comprehensive and decentralized with responsibilities on the national, regional, and local levels. Several government agencies cover different areas of expertise related to health care, social welfare, and public health.
The National Board of Health and Welfare (Socialstyrelsen) has a wide range of tasks and activities concerning social services, health and medical services, patient safety and epidemiology. The Public Health Agency (Folkhälsomyndigheten) is responsible for public health issues and promotion of public health.
The Health and Medical Services Act (Hälso- och sjukvårdslagen, HSL) lays down the responsibilities for health services based on the principle of equal access to good quality health services. Regional health authorities and to some extent local municipalities have the main responsibility for providing health services. There are 21 regional health authorities and 290 local authorities (municipalities). The organization of health services varies between regions and municipalities; however, the main principles are the same.
Population coverage
Most health services are delivered by regional and local health authorities themselves but both general and specialist health services are also provided by private providers, contracted by the regional authorities.
According to the Health and Medical Services Act, the regional health authorities are obliged to provide timely access to specific health services. If the health care provider is unable to provide care within these limits, patients should be offered options such as alternative providers within the region or elsewhere in the country.
About 660 000 persons had a private healthcare insurance in 2018, that is one in seven employed persons aged 16 to 64 years.
Hospital, specialist and care
Regional authorities have the main responsibility for providing hospital care, specialized ambulatory care and primary care including maternity and child health care, and ambulance transport services. Regional authorities are also responsible for public health surveillance and immunization schemas.
Dental care is provided both by public and private providers.
Occupational health and related preventive services is the responsibility of employers and not provided by the health authorities.
Local authorities are responsible for home help and nursing care in the community and to provide special housing for the elderly and people with disabilities. Medical care in special housing is the responsibility of the regional authorities and is mainly provided by contracted primary care physicians. School health and prevention among children and youth is the responsibility of the local municipalities.
Private sections and areas of health care
The private health care sector, especially in primary health care, is connected to the regions' systems of choice of care and provider, and financed with tax funds according to the same principles as the public providers. The cost for private health care sector providers is about 12 per cent of the total, mainly in accordance with agreements with the regions. Most Swedish hospitals are run by health regions; however, some acute care hospitals are run wholly and partly by private corporations. The focus of private hospitals varies within different specialties. A few private hospitals provide the same range of services as hospitals run by the health regions.
Dental care is provided by all health regions at 880 units. Five regions run the services as public corporations. In addition, there are some
2 000 private dental care providers with approx. 3 550 units. Two thirds of the adult dental care within the government subsidies system is provided by private dentists.
Cross border health care
Citizens of countries in the EU/EES and Switzerland are entitled to health care and cost-coverage for certain health care abroad, in accordance with the patient mobility directive of the European Parliament and Council. The cost of services is covered according to the national health insurance schema of the country providing care, and a European Health Insurance Card is required. The European Health Insurance Card covers emergency medical and dental care by public health care providers, but not transportation costs. For a Swedish citizen to be reimbursed for planned care abroad, only treatments that you would have been able to receive in Sweden are reimbursable. The Swedish Social Insurance Agency is responsible for decisions on reimbursement for care and other payments of benefits in the Swedish Social Security Insurance system.
The National Board of Health and Welfare is the National contact point responsible for providing information regarding the Swedish healthcare system and to provide guidance on cross-border health care.
Links to relevant legislation/organizations
Medical Services Act (Hälso- och sjukvårdslagen) https://www.riksdagen.se/sv/dokument-lagar/dokument/svensk-forfattningssamling/halso--och-sjukvardslag_sfs-2017-30
Hälso- och sjukvårdsförordningen https://www.riksdagen.se/sv/dokument-lagar/dokument/svensk-forfattningssamling/halso--och-sjukvardsforordning-201780_sfs-2017-80
Patient Act (Patientlagen) https://www.riksdagen.se/sv/dokument-lagar/dokument/svensk-forfattningssamling/patientlag-2014821_sfs-2014-821
Patient Safety Act (Patientsäkerhetslagen) https://www.riksdagen.se/sv/dokument-lagar/dokument/svensk-forfattningssamling/patientsakerhetslag-2010659_sfs-2010-659
Dental Care Act (Tandvårdslagen) https://www.riksdagen.se/sv/dokument-lagar/dokument/svensk-forfattningssamling/tandvardslag-1985125_sfs-1985-125
Care guarantee (Vårdgaranti) https://skr.se/vantetiderivarden.46246.html
Cross-border care
https://www.socialstyrelsen.se/en/about-us/healthcare-for-visitors-to-sweden/
https://www.forsakringskassan.se/english/travel-work-study-or-receive-care-abroad/travel-or-receive-medical-or-dental-treatment-abroad