Original Editor - Mardone Tan.
- 1 Patient Access to Physiotherapy or Physical Therapy Services / Entry Point
- 2 Therapist Preparation
- 3 Professional Associations
- 4 Information about the Patient Community
- 5 Social/Cultural Influences
- 6 Delivery of Care
- 7 Type of Health System
- 8 Payment System
- 9 Resources
- 10 References
Patient Access to Physiotherapy or Physical Therapy Services / Entry Point
- In Sweden, physiotherapists are experts on movement and have an independent responsibility to prevent, investigate and treat disabilities and to evaluate the effects of treatment. They also develop methodology and quality assurance. Physiotherapists take a holistic view of patients’ health, personal situations, personalities and individual circumstances in order to recommend the right preventive or rehabilitative measures.
- Patients can access physiotherapy in various areas such as hospitals, primary care centers, home based health care and company health care. They can also access physiotherapy through private clinics. Physiotherapists often work in close contact with people, from children to the elderly, in everything from acute care to preventive health. The work is conducted in close contact with other health care professions. They can also choose to work on health prevention, developmental work, education or research.
- Patients normally see physicians by appointment, although if patients need urgent attention, it is possible for them to see a physician without an appointment at some health centers during certain hours of the day. General practitioners provide treatment, advice and prevention. Others directly employed at this level include physiotherapist.
- There are about 7 physiotherapy schools in Sweden, graduating about 550 students per year.
- To become a physiotherapist in Sweden, a university education is needed, Bachelor of Science in Physiotherapy (Bsc), based on upper secondary school education. It lasts 3 years and is based on upper secondary school education. When graduating the physiotherapist obtains a University Diploma in Physiotherapy. The diploma entitles the graduate to the registration issued by the Swedish National Board of Health and Welfare. Physiotherapists can enroll educational programs which lead to a postgraduate degree: 
- Master of Science in Physiotherapy (MSc)
- Doctor of Medical Science (PhD)
- The Professional Title of Registered Physical Therapist is protected by the state, but the professional activity is not. The rules of professional conduct are determined directly by the state through national legislation. The physical therapist must be state registered and obtain a license to practice. The national authority responsible for the physiotherapy profession in Sweden is "The National Board of Health and Welfare" .
- After the three-year program, which leads to both a Bachelors degree and a professional physiotherapist qualification, you can continue your training in one of the physiotherapy specialist areas as specified by the Swedish National Board of Health and Welfare (Socialstyrelsen). Physiotherapists can specialize in these areas:
- patients with pain, injuries and/or diseases in the musculoskeletal system,
- patients with diseases in or damage to the respiratory organs or circulatory systems,
- patients with diseases in or damage to the nervous system,
- patients with mental ill-health or psychosomatic problems,
- children and young people with disabilities or disease,
- older persons with physical or mental disabilities
- Sweden has a population of 9 million and there are about 13,000 Physiotherapist, 10,000 of them belong to the Swedish association of registered physical therapist (Legitimerade Sjukgymnasters Riksförbund – LSR) which is the union and professional association for Swedish physiotherapists. Its mission is to make physiotherapists a more visible and valued professional group in society. The association holds 6 executive meetings per year and furthers liaisons with other health care professions and authorities. To be accepted as a member you must be a qualified physiotherapist an1d be licensed by the Swedish National Board of Health and Welfare. Those studying on courses that lead to a qualification as a physiotherapist can become student members.
- Physiotherapist can also join the European Region-World Confederation for Physical Therapist, which was established in September 1998, through the merger of the Standing Liaison Committee of Physiotherapists of the EU (SLCP), and the WCPT Europe (the Regional organization of the World Confederation for Physical Therapy). It is the single representative organization and the voice of the physiotherapy profession in Europe. There are 33 national organizations members of the ER-WCPT that all together work on education, professional issues and EU Matters.
Information about the Patient Community
- Sweden is situated on the Scandinavian peninsula, in the northern part of Europe (see Fig. 1 and 2). The population is 8.9 million (1999) and Stockholm, the capital, is the largest city, with 1.1 million habitants. Swedes are the predominant ethnic group (about 90% of the population). Other residents include immigrants from Finland, South America, the Middle East, Asia and the Balkans. Sweden has two minority groups of native inhabitants in the north: the Finnish-speaking people of the northeast and the Sami (Lapp) population. The educational system reaches the entire population and the literacy rate is 99%. Female participation in the workforce is also high, constituting 48% of the labor force in 1998.
Fig 1. Map of Sweden
Fig 2. Flag of Sweden
- Sweden has a low birth rate, 1.5 per woman in reproductive age and has among the longest life expectancy at birth: 77.5 for men and 81.1 for women (2000). Today Sweden has the world’s oldest population, with almost every fifth person aged 65 years or older (see table 1). This ageing process has important social and political implications, as fewer persons of productive age will support increasing demands on the health care system.
- Furthermore, mortality due to cardiovascular diseases (CVD) has declined, although CVD accounted for approximately 50% of all deaths in 1998. The second largest cause of death was tumors, which amounted to 25% for men and 22% for women (1998). Deaths due to mental diseases and diseases in the nervous system, eyes and ears increased between 1987 and 1997.
Table 1. Age structure of the Swedish population, as of % of the total population, 1970–2050a
- Swedish family policy is based on the dual-earner family and asserts the same rights and obligations regarding family and labor market work for both women and men. The common and expected life cycle pattern of young men and women in Sweden today is to first become established in the labor market and then have children. Most women keep their position in the labor market when they start childbearing and after a period of parental leave both women and men return to the labor force. It is thus unusual for women to end their employment when they start a family.
- A large proportion of the Swedish population is unmarried. The reason is that cohabitation without marriage is wide-spread and is the dominant form of union among young people.
- While many countries have had a declining fertility trend during the 1960s and onwards, this is not the case for Sweden. The Total Fertility Rate of Sweden has instead been called roller coaster fertility and has sometimes been seen as the success story of a generous family policy. Furthermore, Sweden has kept a strong two-child norm that seems unthreatened so far.
Delivery of Care
- Swedish healthcare has an internationally high standard, but is often criticized from a patient perspective owing to access problems to primary and specialist care. The waiting time to get in touch or get an appointment with a doctor, nurse, or physiotherapist is often too long. Access problems also create stress for employees when there are too few appointments to offer. In addition, too much time gets spent on the administration of long waiting lists, which adds no value to patients.
- The basic principle of Swedish care of the elderly is that everyone who would like to remain at home in spite of illness or diminished capacity should be offered support and care in order to do so. Great efforts have been made to make it possible for the elderly and disabled to be cared for at home, and home assistance services are offered 24 hours a day.
Type of Health System
- Health policy in Sweden is a national-level responsibility with universal coverage. Over the past 20 years Sweden has an average reinvestment of some 9.2% of its GDP annually on healthcare. However, around 70 percent of healthcare services are funded through local government taxes. In fact, Sweden's health care system is highly decentralized. Its 21 county councils are responsible for hospitals and GPs, while its 290 municipalities provide municipal care. In Sweden, the county councils and municipalities are also the main providers of healthcare, with only about 10% of all health services delivered by private providers.
- Three main principles apply to health services: equal access, care based on need, and cost effectiveness. Free choice of provider. Referral is required in some cases, particularly if the patient chooses a provider outside of his/her own county council.
- Most of the public financing comes from county council taxes (proportional income tax). This accounts for just over 70% of the healthcare costs. Health services for the elderly and disabled provided at home or in special residential settings are financed mainly by municipal (local) taxes.
- National subsidies cover approximately 20% of the costs.
- Though on the rise, in 2007 private insurance still only covered less than 3% of the Swedish population and accounted for around two thousands of total financing. However, private insurance has risen by 50% from 2004 to 2007 as Swedish hospitals are now permitted to operate at a profit and Swedish companies begin to offer employees private health insurance policies.
- The Swedish Association of Registered Physiotherapists - LSR. Available from: http://www.saco.se/templates/Association.aspx?id=5740&epslanguage=EN.
- Karolinska Institutet. Study Program in Physiotherapy 2008/2009. Available from: http://ki.se/ki/jsp/polopoly.jsp?d=19148&l=en.
- European Observatory on Healthcare Systems. Healthcare systems in transition: Sweden. Available from: http://www.saglik.gov.tr/EN/dosya/2-1001/h/sweden.pdf
- ER-WCPT. Members. Available from: http://www.physio-europe.org/index.php?action=15&subaction=details&member=44
- Swedish Association of Registered Physiotherapists. Available from: http://www.sjukgymnastforbundet.se/omforbundet/Sidor/aboutlsr.aspx
- ER-WCPT. About ER-WCPT. Available from: http://www.physio-europe.org/index.php?action=6
- ER-WCPT. Info tool for physiotherapy associations. Available from: http://www.physio-europe.org/index.php?action=158
- Family Policy in Sweden 2008. Available from: http://www.forsakringskassan.se/irj/go/km/docs/fk_publishing/Dokument/Rapporter/socialforsakringsrapporter/socialforsakringsrapport_2008_15.pdf
- Strindhall M, Henriks G. How improved access to healthcare was successfully spread across Sweden. Q Manage Health Care. 2007; 16(1): 16–24.
- Swedish Health Care. Available from: http://www.swedishhealthcare.se/swedenshealthcaresystem.html