Healthcare Procurement and Reimbursement Processes in Sweden

This top level summary of our Deep Dive report for Sweden provides a good understanding of the organization of procurement and reimbursements at regional and national level. The full report includes numerical and written analysis in four main chapters: Economic Outlook (38 Key industry indicators), The Healthcare System (HC system structures),  Reforms (restructuring, re-engineering or austerity efforts), and The Healthcare Market (Capital Equipment, Medical Devices, Disposables and Pharmaceuticals).

Procurement Processes

The procurement of goods used in hospitals and secondary care is managed at regional level, by the corresponding county council, often resulting in price discounts, due to the large amounts purchased.

In the case of primary care, Municipalities are responsible for general procurement. Additionally there are some cases of collaboration between:

  • Sweden’s municipalities
  • Between municipalities and their county councils
  • Joint deals amongst regions and county councils

when procuring for public healthcare supplies.

More complex demands are handled on a smaller scale by local authorities independently to ensure that specific needs in their secondary and primary care are met.

In the Region of Skåne, there are currently several on-going trial cases to learn how to design a healthcare procurement process that will drive innovation and enhance the value chain of supply processes.

Within the context of innovative procurement as practiced and experimented in Sweden, the following are valued:

  • Involving potential procurers at the R&D phase
  • Sharing knowledge and establishing best practices
  • Applying scientific research results
  • Creating stakeholder and/or purchasing groups
  • Setting clear goals and expectations within time frames.

Innovation is a key term in many financial and business discussions; it is a clear trend that more and more industry activity seeks innovative thinking and solutions to ensure sustainable development. Sweden and other European country markets are keen to engage with innovative processes; demonstrating innovation in and stakeholder engagement is a powerful differentiator in the healthcare market and will affect decision making because it is paving the future of procurement processes.

Furthermore, there is an Innovation in the Health Sector through Public Procurement and Regulation program in the Nordic countries, to establish improved public healthcare services by developing a closer relationship between the suppliers and the public buyers and by fostering collaboration and competences.

The public sector is the greatest procurer of healthcare in Sweden. Public procurement is ruled by the Swedish Public Procurement Act (LOU), derived from the EU Directive 2004/18/EC concerning public procurement.

Its intention is to guarantee that contracting authorities apply public funds in the most efficient and effective manner possible by pursuing competitive deals. It strives to achieve the following in procurement:

  • Mutual recognition
  • Proportionality
  • Equal treatment
  • Non-discrimination
  • Transparency

The Swedish Competition Authority provides the guidelines and regulations for procurement, and supervises the execution of its ruling.

The actual procurement process takes place as follows:

  • Each clinic or medical unit forecasts what their care expense will be prior to each fiscal year, or possibly even 2-3 years prior to the expected date of supply delivery.
  • There is the option within this forecast to request additional investment for the renewal of medical equipment.
  • Sometimes companies are invited directly to present innovations to the county council.
  • Tenders or direct contacts are made to seek the best deals, balancing cost and quality indicators.
  • The average length of public procurement healthcare contracts are 4 years, with a possible option of extension.

Decision makers and influencers:

  • The decision/budget maker is most frequently the hospital management.
  • Most county councils create procurement units for the procurement of devices including various types of stakeholders from product users, medical personal to technicians.
  • They will be consulted throughout the period of the procurement process, which can take up to 1-2 years.
  • Clinicians are key decision-makers in the selection of a manufacturer.

Reimbursement

Sweden’s Dental and Pharmaceutical Benefits Board conducts evaluations and decides over the reimbursement of pharmaceuticals. They establish fixed national pharmaceutical retail prices and a medicine’s inclusion into the reimbursement scheme or not. A decision made by the board can be appealed by the pharmaceutical company at a Swedish public court.

Sweden uses DRG coding to aid transparency of the management of hospital services, to have benchmarks for the pricing of medical services, and as a means of performance measurement. It has been noted that the DRG-based reimbursement system in Sweden has increased productivity, provided better information for analysis and performance indicators, and transformed the patient from an expense to a potential revenue source.

Denmark, Finland, Norway, Estonia and Sweden have formed a DRG group which follows the HCFA-DRG version 12, using definitions from ICD-10 and the NOMESCO Classification of Surgical Procedures.

Each nation in the group readjusts the DRGs to suit their country specific conditions.

Sweden has a specific agency, called Vinnova, designed to increase and enhance innovation in procurement and procurement processes.

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For further quantitative information on the Swedish healthcare system and the macroeconomic climate, please look into our Business intelligence platform or order the TforG Deep Dive report for Sweden containing volumes of 620 surgical procedures in 13 specialisms.