Gp in Europe

 

Sweden

Sweden has a population of about nine million people. The main responsibility for financing and providing healthcare services in Sweden rests with the 20 County Councils. The County Councils present a political level between the municipal districts and the national government levels. Elections to the County Councils are held on the same day as the general elections to Parliament and to the municipal districts.Traditionally the Swedish healthcare system has been very hospital oriented.A new health political view made its appearance some 20 years ago and at this time we could witness a political thrust on Primary Healthcare as the main basis for the future healthcare delivery system.

Despite the political will, it took several years before the focus on and the resource allocation to the PHC system really gained momentum. As late as ten years ago the number of general practitioners (GP) in Sweden amounted to only 2,000. Today there are about 4,500 GPs. The total number of professionally active doctors in Sweden is approx. 27,500. This means that one doctor out of six is working as a GP, today. The doctor/population ratio for all doctors is 1/320 and the GP/population ratio 1/1,955. 

It is also of interest to note that 39 per cent of the GPs today are women and that 25 per cent of the GPs are working part-time.As mentioned above, primary healthcare has been a major political issue in Sweden in recent years. In 1994, eg, a bill on the introduction of a Family Practitioner system was passed by Parliament. This system was based on the principle that each inhabitant could voluntarily register themselves with a particular GP. The income of the GP was mainly to be based on capitation fees. With the change of government that occurred in the autumn of 1994, this legislation was revoked as of 1 January 1996. The consequence of this is that today the County Councils can decide themselves how to organise the PHC in their areas. If they want to use a list system this is acceptable; if they want to organise the GP services in some other way, this is also possible.As of today there are basically two different modalities for working as a GP. 

One is that the GP is employed by a County Council. This is by far the most common one. More than 80 per cent of Swedish GPs are employed by the County Councils, while just about 1 7 per cent perform their work basically as private practitioners, which is the other option. But in order to work as a private practitioner, an agreement is needed with the County Council concerned, since it is the County Council that will reimburse the private GP for the services rendered. The patients are also charged a fee, but the amounts resulting from the patient's payment are marginal.Private medicine does exist but on a very limited scale. Some 90 per cent of Swedish doctors in total are employed by the County Councils, leaving some seven per cent of all doctors to work in private practice, either as GPs or as specialists in other medical disciplines. Lately though there are indications that the political interest and willingness to consider private alternatives inside the health insurance scheme and also to be openminded about other possible organisational forms for rendering the medical services might be on the rise. It remains to be seen what concrete results this might have on the healthcare system.The most common way for GPs to work today is in group practices, where three to four GPs work closely together with district nurses, physotherapists, occupational therapists, midwives, secretaries, etc.

It should also be noted that Swedish GPs are medical specialists in Family Medicine on the same level as other specialists (surgeons, internists, etc). All Swedish GPs have passed through a specialist training period of at least five years.The training period starts after graduation from medical school and after complete pre-registration training of a minimum of 18 months.After many years of struggle for increased resources for the PHC, we are happy to note that PHC and General Practitioner Services have made substantial progress. But this process must continue in order to obtain a more favourable GP/population ratio than today. The present PHC struggles with many problems some of which are that the reduction of inpatient services has left the PHC and the GPs to care for patients with more complex medical situations than before. An increasingly ageing population staying as long as possible in their own homes or in various types of service or nursing homes also demand more time and help on the part of the GPs. The number of doctors, including GPs, who feel more and more stressed and show various degrees of burn-out symptoms tend to increase. More GPs are clearly needed in the years to come to safeguard both good medical services and acceptable working environments for the heallhc are personnel.

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