Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

What Sweden can teach us about primary care

Andreas Mitchell
Policy
March 24, 2014
Share
Tweet
Share

Fulfilling every stereotype, I sat at my grandparents’ house in southern Sweden, sipping elderberry juice out of an IKEA glass and eating meatballs with lingonberry jam. It was Christmas Eve, and I was enjoying a getaway from the rigors of medical school. However, it wasn’t a complete escape, as my grandparents loved talking about medicine and the differences between health care in the United States and Sweden.

In this particular conversation, I was looking up physician density data to make a point about the enormity of the U.S. health care system. To my surprise, I found that Sweden has a substantially higher density of physicians (3.8 vs. 2.4 per 1000 population) as well as nurses and midwives (11.9 vs. 9.8 per 1000). Yet, Sweden spends less than 10 percent of its GDP on health care and achieves better outcomes than the United States. Despite fundamental differences in organization and payment structure, the U.S. can still learn great lessons about primary care and team-based health care delivery from the Swedish system.

As are the residents of many European countries, every Swede is covered by national health insurance. Primary care docs are salaried and work in team-based practices of 4-6 physicians alongside nurses, physiotherapists, psychologists, occupational therapists and social workers. Nurses serve as the first contact with patients and are empowered to do home visits. Patients are legally guaranteed access to immediate contact with the primary care system and an appointment with a doctor within seven days. Although primary care explicitly does not serve a “gatekeeper” role for access to specialty care, it is still considered the frontier of the health system and the main point of entry for patients.

Health care in the U.S. faces a number of challenges with which we are all familiar — high costs, relatively poor quality, and limited access for many. What can we learn from this relatively successful Scandinavian nation to incorporate into our own practice and advocacy efforts?

First, Sweden’s primary care physician density is high. The government is working towards a goal of one primary care physician per 1,000 citizens, and though they aren’t quite there yet, the expectation reflects a high social value placed on primary care. We must bring about a similar cultural attitude in the US. While there is widespread discussion about the U.S. shortage of primary care doctors, Dr. Stephen Schimpff and others have noted that our institutions have not made necessary changes to address the issue. Let’s generate excitement about primary care at our medical schools and advocate for policy changes that make primary care the most attractive career option for talented medical school graduates.

Second, Sweden has demonstrated what can be done with effective team-based care. Although more practices across the country are transitioning into patient-centered medical homes, there is still limited scope of practice for nurse practitioners, little reimbursement for population management, and almost no role for community health workers, despite their widespread achievements globally. We know that primary care physicians can’t do everything alone, and we need to work inter-professionally to advocate for the policies needed to support patients’ health at the highest level and to provide the best possible care.

As we work toward long-term policy change, we have to get creative in our practices immediately. I’m working with an academic primary care practice to investigate what medical student health coaches can do to help patients manage their diabetes. Student volunteers cost nothing, and the literature shows that they can make a significant impact on patients’ HbA1cs and long-term health outcomes. Elsewhere, “hot spotting” programs are taking off, highlighting that intensive team-based care can take care of the sickest patients more cheaply and more effectively than traditional health care.

In the face of great challenges, we can look around the world for inspiration. Sweden has figured out that the key to great health in a sustainable system is a strong, team-based primary care infrastructure. We can get there from here. We must advocate for policies that expand the primary care workforce — not just physicians but also nurses and health coaches and community health workers — so that we can protect the nation’s health without burning out our doctors. While we work on bringing that change to bear, we must pursue innovative ideas that bring team-based primary care to the next level.

Andreas Mitchell is a medical student who blogs at Primary Care Progress.

Prev

Patients do not always arrive with diagnoses

March 24, 2014 Kevin 2
…
Next

Why the days of the stethoscope are numbered

March 24, 2014 Kevin 0
…

Tagged as: Primary Care

Post navigation

< Previous Post
Patients do not always arrive with diagnoses
Next Post >
Why the days of the stethoscope are numbered

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More in Policy

  • Why physician voices matter in the fight against anti-LGBTQ+ laws

    BJ Ferguson
  • The silent toll of ICE raids on U.S. patient care

    Carlin Lockwood
  • What Adam Smith would say about America’s for-profit health care

    M. Bennet Broner, PhD
  • The lab behind the lens: Equity begins with diagnosis

    Michael Misialek, MD
  • Conflicts of interest are eroding trust in U.S. health agencies

    Martha Rosenberg
  • When America sneezes, the world catches a cold: Trump’s freeze on HIV/AIDS funding

    Koketso Masenya
  • Most Popular

  • Past Week

    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • Why so many physicians struggle to feel proud—even when they should

      Jessie Mahoney, MD | Physician
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • Why so many physicians struggle to feel proud—even when they should

      Jessie Mahoney, MD | Physician
    • If I had to choose: Choosing the patient over the protocol

      Patrick Hudson, MD | Physician
    • How a TV drama exposed the hidden grief of doctors

      Lauren Weintraub, MD | Physician
    • Why adults need to rediscover the power of play

      Anthony Fleg, MD | Physician
    • How collaboration across medical disciplines and patient advocacy cured a rare disease [PODCAST]

      The Podcast by KevinMD | Podcast
    • 5 cancer myths that could delay your diagnosis or treatment

      Joseph Alvarnas, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 18 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • Why so many physicians struggle to feel proud—even when they should

      Jessie Mahoney, MD | Physician
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • Why so many physicians struggle to feel proud—even when they should

      Jessie Mahoney, MD | Physician
    • If I had to choose: Choosing the patient over the protocol

      Patrick Hudson, MD | Physician
    • How a TV drama exposed the hidden grief of doctors

      Lauren Weintraub, MD | Physician
    • Why adults need to rediscover the power of play

      Anthony Fleg, MD | Physician
    • How collaboration across medical disciplines and patient advocacy cured a rare disease [PODCAST]

      The Podcast by KevinMD | Podcast
    • 5 cancer myths that could delay your diagnosis or treatment

      Joseph Alvarnas, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

What Sweden can teach us about primary care
18 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...