Monday, June 11, 2007

Problems with Sweden's Single-Payer System

Sweden is often romanticized by Americans as a model for socialist ideas done correctly. So how does their government-run single-payer system work out in actual practice?

According to this new study by David Hogberg, Ph.D. of the National Center for Public Policy Research, not too well. Like any such system, they control costs by waiting lists and rationing. Here are some excerpts from his paper. (Items in bold are my emphasis):

"Sweden's Single-Payer Health System Provides a Warning to Other Nations", by David Hogberg, Ph.D.

Görann Persson had to wait eight months during 2003 and 2004 for a hip replacement operation. Persson was not considered to be a very pleasant person to begin with, and he became even grumpier due to the pain he endured while waiting for his operation. As a result, Persson walked with a limp, reportedly used strong pain medication and had to reduce his workload.

What made Persson unique was not his wait for hip surgery. Despite the government promise that no one should have to wait more than three months for surgery, 60 percent of hip replacement patients waited longer than three months in 2003 (see Figure 2). Rather, Persson stood out because he was Prime Minister of Sweden at the time. Persson could surely have used his position in the government to gain access to private care, essentially jumping the waiting list. Yet Persson stated that he planned on waiting for his surgery like everyone else.

Whether Prime Minister Persson did this out of benevolent motives is an open question. His party, the Social Democrats, have used the phrase "equal access to health care" to attack the center-right parties on the issue of health care for many years. Persson would have greatly undermined the effectiveness of that attack had he jumped the waiting list.

...While rationing may permit the government to save on costs and thereby restrain health care budgets, putting patients on waiting lists is not cost-free. One study that examined over 1,400 Swedes on a waiting list for cataract surgery found that 5.2 million kronas were spent on hospital stays and home health care for patients waiting for surgery. That was the equivalent of what it would have cost to give 800 patients cataract surgery.

A recent study that examined over 5,800 Swedish patients on a wait list for heart surgery found that the long wait has consequences far worse than pain, anxiety or monetary cost. In this study, the median wait time was found to be 55 days. While on the waiting list, 77 patients died. The authors' statistical analysis led them to conclude that the "risk of death increases significantly with waiting time." Another study found a mean wait time of 55 days for heart surgery in Sweden and a similar rate of mortality for those on the waiting list. Finally, a study in the Swedish medical journal Lakartidningen found that reducing waiting times reduced the heart surgery mortality rate from seven percent to just under three percent.

Sweden is one of several nations whose practices offer proof that single-payer health care systems lead to the proliferation of waiting lists. It also shows that waiting lists have adverse and sometimes tragic consequences for patients.


While Sweden is a first world country, its health care system - at least in regards to access - is closer to the third world. Because the health care system is heavily-funded and operated by the government, the system is plagued with waiting lists for surgery. Those waiting lists increase patients' anxiety, pain and risk of death.

Sweden's health care system offers two lessons for the policymakers of the United States. The first is that a single-payer system is not the answer to the problems faced as Americans. Sweden's system does not hold down costs and results in rationing of care. The second lesson is that market-oriented reforms must permit the market to work. Specifically, government should not protect health care providers that fail to provide patients with a quality service from going out of business.

When the United States chooses to reform its health care system, reform should lead to improvement. Reforming along the lines of Sweden would only make our system worse.