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Fredriksson M. Universal health coverage and equal access in Sweden: a century-long perspective on macro-level policy. Int J Equity Health 2024; 23:111. [PMID: 38807180 PMCID: PMC11134649 DOI: 10.1186/s12939-024-02193-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/08/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND When today's efforts to achieve universal health coverage are mainly directed towards low-income settings, it is perhaps easy to forget that countries considered to have universal, comprehensive and high-performing health systems have also undergone this journey. In this article, the aim is to provide a century-long perspective to illustrate Sweden's long and ongoing journey towards universal health coverage and equal access to healthcare. METHODS The focus is on macro-level policy. A document analysis is divided into three broad eras (1919-1955; 1955-1989; 1989-) and synthesises seven points in time when policies relevant to overarching goals and regulation of universal health coverage and equal access were proposed and/or implemented. The development is analysed and concluded in relation to two egalitarian goals in the context of health: equality of access and equal treatment for equal need. RESULTS Over the past century, macro-level policy evolved from the concept of creating access for the neediest and those reliant on wages for their survival to a mandatory insurance with equal right to healthcare for all. However, universal health coverage was not achieved until 1955, and individuals had to rely on their personal financial resources to cover the cost at the time of care utilization until the 1970s. It was not until 1983 that legislation explicitly stated that access to healthcare should be equal for the entire population (horizontal equity), while a vertical equity-principle was not added until 1997. Subsequently, ideas of free choice and privatization have gained significance. For instance, they aim to increase service access, addressing the Swedish health system's Achilles' heel in this regard. However, the principle of equal access for all is now being challenged by the emergence of private health insurance, which offers quicker access to services. It can be concluded that there is no perpetual Swedish healthcare model and various dimensions of access have been the focus of policy discussion. The discussion on access barriers has shifted from financial to personal and organizational ones. Today, Sweden still ranks high in terms of affordability and equity in international comparisons: although not as well as a decade ago. Whether this marks the beginning of a new trend intertwined with a decline in Sweden's welfare 'exceptionalism', or is a temporary decline remains to be assessed in the future.
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Affiliation(s)
- Mio Fredriksson
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Box 564, Uppsala, 751 22, Sweden.
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Tekerek B, Günaltay MM, Ozler G, Turgut M. Determinants of COVID-19 cases and deaths in OECD countries. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023:1-12. [PMID: 36721741 PMCID: PMC9880371 DOI: 10.1007/s10389-023-01820-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/03/2023] [Indexed: 01/28/2023]
Abstract
Aim This research aims to examine the effects of variables that can affect COVID-19 deaths and cases in Organisation for Economic Co-operation and Development (OECD) countries during the years 2020 (first wave), 2021 (vaccine available), and 2022 (vaccine available and Omicron variant appeared). Material and method The factors that are thought to affect the case and death rates in 37 OECD countries were examined by multiple linear regression analysis using SPSS 22. The dependent variables were the COVID-19 deaths and cases per 10,000 (in 2020, 2021, and 2022); the independent variables were universal health coverage, physicians, nurses, intensive care beds, hospital beds, non-communicable diseases mortality per 100,000 people, population over 65 years of age, out-of-pocket expenditure, private expenditure, and health expenditure per capita and percent of % GDP. Results It was determined that the non-communicable diseases mortality is the relatively important variable COVID-19 cases and deaths in 2020 and 2021. After controlling for the scores of other variables, according to the ß coefficients, a one-unit increase in the number of physicians variable increases COVID-19 cases by 1.14 units in 2022; a one-unit increase in the universal coverage variable decreases COVID-19 deaths by 0.33 units in 2022. Conclusion The results of this research provide evidence that the effects of the COVID-19 outbreak have changed between 2020, the first wave of the epidemic, 2021, when the vaccine is available, and 2022, when both the vaccine is available and the Omicron variant is seen. With the increase in vaccination in 2022, the impact of non-communicable diseases mortality on the number of COVID-19 cases has decreased.
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Affiliation(s)
- Burak Tekerek
- Department of Health Management, Faculty of Health Sciences, Yüksek Ihtisas University, Ankara, Turkey
| | - Meliha Melis Günaltay
- Department of Health Management, Faculty of Health Sciences, Ankara University, Ankara, Turkey
| | - Gökcen Ozler
- Department of Health Management, Faculty of Health Sciences, Ankara University, Ankara, Turkey
| | - Meryem Turgut
- Department of Health Management, Zübeyde Hanım Faculty of Health Sciences, Nigde Omer Halisdemir University, Ataturk Boulevard, Derbent Campus (Opposite Hayat Hospital), Nigde, Turkey
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Brizzi A, Whittaker C, Servo LMS, Hawryluk I, Prete CA, de Souza WM, Aguiar RS, Araujo LJT, Bastos LS, Blenkinsop A, Buss LF, Candido D, Castro MC, Costa SF, Croda J, de Souza Santos AA, Dye C, Flaxman S, Fonseca PLC, Geddes VEV, Gutierrez B, Lemey P, Levin AS, Mellan T, Bonfim DM, Miscouridou X, Mishra S, Monod M, Moreira FRR, Nelson B, Pereira RHM, Ranzani O, Schnekenberg RP, Semenova E, Sonabend R, Souza RP, Xi X, Sabino EC, Faria NR, Bhatt S, Ratmann O. Spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals. Nat Med 2022; 28:1476-1485. [PMID: 35538260 PMCID: PMC9307484 DOI: 10.1038/s41591-022-01807-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/31/2022] [Indexed: 02/07/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Gamma variant of concern has spread rapidly across Brazil since late 2020, causing substantial infection and death waves. Here we used individual-level patient records after hospitalization with suspected or confirmed coronavirus disease 2019 (COVID-19) between 20 January 2020 and 26 July 2021 to document temporary, sweeping shocks in hospital fatality rates that followed the spread of Gamma across 14 state capitals, during which typically more than half of hospitalized patients aged 70 years and older died. We show that such extensive shocks in COVID-19 in-hospital fatality rates also existed before the detection of Gamma. Using a Bayesian fatality rate model, we found that the geographic and temporal fluctuations in Brazil's COVID-19 in-hospital fatality rates were primarily associated with geographic inequities and shortages in healthcare capacity. We estimate that approximately half of the COVID-19 deaths in hospitals in the 14 cities could have been avoided without pre-pandemic geographic inequities and without pandemic healthcare pressure. Our results suggest that investments in healthcare resources, healthcare optimization and pandemic preparedness are critical to minimize population-wide mortality and morbidity caused by highly transmissible and deadly pathogens such as SARS-CoV-2, especially in low- and middle-income countries.
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Affiliation(s)
- Andrea Brizzi
- Department of Mathematics, Imperial College London, London, UK
| | - Charles Whittaker
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | | | - Iwona Hawryluk
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Carlos A Prete
- Departamento de Engenharia de Sistemas Eletrônicos, Escola Politécnica, Universidade de São Paulo, São Paulo, Brazil
| | - William M de Souza
- World Reference Center for Emerging Viruses and Arboviruses and Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston TX, USA
| | - Renato S Aguiar
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
| | - Leonardo J T Araujo
- Laboratory of Quantitative Pathology, Center of Pathology, Adolfo Lutz Institute, São Paulo, Brazil
| | - Leonardo S Bastos
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Lewis F Buss
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
- Departamento de Moléstias Infecciosas e Parasitárias e Instituto de Medicina Tropical da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Marcia C Castro
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston MA, USA
| | - Silvia F Costa
- Departamento de Moléstias Infecciosas e Parasitárias e Instituto de Medicina Tropical da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Julio Croda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven CT, USA
| | | | | | - Seth Flaxman
- Department of Computer Science, University of Oxford, Oxford, UK
| | - Paula L C Fonseca
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Victor E V Geddes
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Philippe Lemey
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven - University of Leuven, Leuven, Belgium
| | - Anna S Levin
- Departamento de Moléstias Infecciosas e Parasitárias e Instituto de Medicina Tropical da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Thomas Mellan
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Diego M Bonfim
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Swapnil Mishra
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
- Section of Epidemiology, School of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mélodie Monod
- Department of Mathematics, Imperial College London, London, UK
| | - Filipe R R Moreira
- Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruce Nelson
- Environmental Dynamics, INPA, National Institute for Amazon Research, Manaus, Brazil
| | | | - Otavio Ranzani
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
| | | | | | - Raphael Sonabend
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Renan P Souza
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Xiaoyue Xi
- Department of Mathematics, Imperial College London, London, UK
| | - Ester C Sabino
- Departamento de Moléstias Infecciosas e Parasitárias e Instituto de Medicina Tropical da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Nuno R Faria
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK.
- Departamento de Moléstias Infecciosas e Parasitárias e Instituto de Medicina Tropical da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
- Department of Zoology, University of Oxford, Oxford, UK.
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
| | - Samir Bhatt
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK.
- Section of Epidemiology, School of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Oliver Ratmann
- Department of Mathematics, Imperial College London, London, UK.
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