International Health Care Systems

The Development of Universal Health Care in Sweden

Sweden adopted universal health coverage in 1955.  How did the universal health coverage develop?  A 2004 World Health Organization report provides the answer.

Health insurance in the 19th century mostly occurred through mutual aid organizations, which paid out sickness benefits if their members became ill.  By 1885, about 10% of workers had joined “Friendly Societies.”  In the latter half of the 19th century, employers and unions began to create sickness funds for their workers.  Employers wanted to attract more workers; unions hoped to increase their member’s independence by reducing their reliance on employer-based schemes.  In 1891, the government not only recognized these societies, but began to offer subsidies to help finance their operations.

“Over  the next 40 years, government legislation moved steadily toward realizing the goal of universal effective health insurance coverage.  Early regulations sought to reduce the number  of societies so that they could achieve economies of scale. The government also gradually increased the number and categories of individuals who were required to  have coverage. A gap emerged between professionals with individual contracts and  manual workers with collective contracts, with the former enjoying a higher level of insurance coverage, particularly with regard to sick pay. Sweden almost enacted a universal insurance system in 1935, but the economic crisis in that period forestalled adoption.  The legislation establishing a universal system was finally passed in 1946 and implemented in 1955.”

The CIA World Factbook provides some additional facts on the Swedish healthcare system:

  • Health Spending: 9.9% GDP
  • Taxes: 53% of GDP.
  • Health Revenue derived from county taxes: two-thirds
  • Share of local budget dedicated to health: 85%
  • Life Expectancy: 81.07 years
  • Total Fertility Rate: 1.67

Source: William Savedoff, Tax-Based Financing for Health Systems: Options and Experiences, WHO Discussion Paper, 2004.


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