How long do people wait for care, and how good is it?

Healthcare in the Nordic countries

Sources: OECD (spending) and Eurostat (hospital beds, doctors and deaths before age 75 from conditions that can be treated by healthcare, age-standardised). Countries count hospital beds differently, and Norway's share of GDP swings with oil and gas revenue. Iceland's figure for doctors covers professionally active doctors, not only those treating patients.

1. Does it matter to have the same doctor?

   It seems so. In Norway, people who had had the same GP for more than 15 years had about 25 percent lower risk of dying, 28 percent lower risk of acute hospital admission and 30 percent lower risk of using out-of-hours care than those who had had their GP for only one year. The longer the relationship, the larger the difference. This is an association in register data, not proven cause.

   Sandvik, Hetlevik, Blinkenberg and Hunskaar (2022), British Journal of General Practice.

2. Are overcrowded hospitals dangerous?

   Most evidence suggests so. In Danish medical wards from 1995 to 2012, mortality was about 9 percent higher when the ward was very full. The study shows an association, not necessarily the cause.

   Madsen, Ladelund and Linneberg (2014), Health Affairs.

3. Does the number of nurses matter?

   It seems so. In 300 hospitals in nine European countries, including Sweden, Norway and Finland, each additional patient per nurse was associated with a 7 percent higher risk of dying in hospital within 30 days of admission for common surgery. More nurses with a university degree were associated with lower risk.

   Aiken et al. (2014), The Lancet.

4. Did patient choice reform improve care?

   A little. Many new health centres opened and patients became somewhat more satisfied, but there was no clear effect on avoidable hospital admissions and no sign of lower quality. The Swedish National Audit Office found that new health centres more often opened in areas with lower care needs and that the extra visits in Skåne and Västra Götaland went mainly to patients with lower needs.

   Dietrichson, Ellegård and Kjellsson (2020), Health Economics. Swedish National Audit Office, RiR 2014:22, government communication.

5. Does money for shorter queues help?

   Only briefly. Waiting times fell in the first year of the queue billion and then stood still. The Swedish National Audit Office concludes that the care guarantee, the queue billion and standardised care pathways have in many ways not been effective at shortening queues, and that the care guarantee and the care pathways risk crowding out sicker patients.

   Swedish National Audit Office (2023), I väntan på vård, RiR 2023:12, government communication 2023/24:48.

6. Why are queues long when care is good?

   Sweden is below the average in the comparison on continuity, on getting an appointment quickly and on care in the evenings and at weekends. On the other hand, few Swedes go without care because of the cost, and digital services are widely used.

   Swedish Agency for Health and Care Services Analysis (2024), Care from the population's perspective, IHP 2023.

7. Have online doctors eased the load on health centres?

   Partly. Visits to the national online doctors grew from around 20,000 in 2016 to 2.3 million in 2020. Some replace physical visits, but some are new care, and they led to more follow-up visits in the short term. Among those who used them, many went from using little care to using a lot.

   Swedish Agency for Health and Care Services Analysis (2022), Besök via nätet (Visits via the internet).