The research project “Health care in the 21st century” has focused on how to secure the supply of skilled employees and how to benefit from the potential of technological developments.

The project was launched in 2018 and ended in January 2022. The point of departure has been the changing conditions for the health care system in the form of an aging population, an increased demand for care services and significant recruitment needs. SNS has tied 11 well-qualified researchers in business administration, law, medicine, psychology and economics to the project, as well as a broad reference group, which has resulted in 8 reports and 21 seminars and workshops. These are available to read, watch or listen to further below on this page.


Research director: Gabriella Chirico Willstedt,

Reference group and funding

The following actors have been included in the reference group: Apoteket, AstraZeneca, Attendo, Bräcke diakoni, Frisq, Inera, Kry, MedLearn, Min Doktor, Praktikertjänst, Region Stockholm, Region Västra Götaland, Swedish Association of Health Professionals, Swedish Association of Local Authorities and Regions, Swedish Dental and Pharmaceutical Benefits Agency, Swedish Heart and Lung Association, Swedish Medical Association, Swedish Ministry of Health and Social Affairs, Sophiahemmet, SOS Alarm and Vinnova.

The project in brief

Read more about the researchers’ recommendations, lessons learned and insights made throughout the project.

Lessons concerning the supply of skilled employees

  1. Without qualified and motivated employees, it is not possible to address the challenges facing the health care system.
  2. The work environment in elderly care must be prioritized at the highest management level.
  3. Medical training needs to be adapted to technological developments, and the further education of specialists needs to be regulated.

The researchers’ recommendations concerning digitalization

  1. Develop test environments and let a legal perspective play a proactive role in the digitalization of healthcare.
  2. Separate people’s choice of care providers into a digital and a physical level to promote both digitalization and a person-centered approach.
  3. Reduce micromanagement in the reimbursement systems related to health care to improve the conditions for innovation and digital development.

The researchers’ recommendations concerning governance and organization

  1. Give the state greater responsibility for the transformation, long-term financing and allocation of resources for the health care system.
  2. Focus regional governance on learning and innovation based on professional driving forces.
  3. Clarify who is responsible for the supply of hospital beds and the capacity of emergency departments.
  4. Strengthen the link between upper management and the people working directly in elderly care.

Eight reports focusing on digitalization, the supply of skilled employees, organization and governance


Digital innovation platforms in health care

Essén | The Swedish Rheumatology Registry (SRQ) is one of more than a hundred national quality registries in Sweden. The registry was initially used to a limited extent, but has gradually been expanded by researchers, pharmaceutical companies, and, not least, the patients themselves, which has led to it now serving as a shared resource for all relevant actors. Hence, the registry is an innovation continuously being developed during the implementation process, frequently in an unpredictable and decentralized manner, thus highlighting success factors in a successful digital healthcare initiative. Learn more.

Reimbursement models and e-health

Lindgren | Digitalization is often highlighted as a way of increasing efficiency in health care. Misguided incentives in reimbursement systems may be one of the reasons why the development of e-health solutions is still quite limited. Reimbursement models that do not micromanage caregivers toward engaging in certain activities offer better conditions for innovation and the use of new solutions. Learn more.

E-health as apps

Magnusson Sjöberg | The number of digital health services has exploded in the past decade. This development is moving quickly, but Swedish legislation fails to keep up. That is why existing and future regulations need to be adapted to IT technologies. There is a need for test environments where a legal perspective plays a proactive role in creating legitimate IT solutions. If Sweden is to be best in class in e-health by 2025, we need to include a legal perspective already at the development stage of health apps. Learn more.

Supply of skilled employees

How is patient safety affected by crowding?

af Ugglas | Emergency care in Sweden is experiencing a long-term trend with longer waiting and treatment times in emergency departments. The occupancy rates in hospitals are increasing at the same time as our population is getting older and older. There are many warning signs in the form of work environment problems and deviations from established care practices, but powerful measures to address the current situation are yet to be seen. One reason may be that it is difficult to quantify and highlight patient safety risks in the current system. The report focuses on crowding in emergency departments and how this is linked to increased mortality. The report reviews causes, measurement methods and the consequences of crowding in emergency departments, while also presenting new research where the link between crowding and an increased mortality risk is analyzed based on data from Swedish emergency departments. Learn more.

Medical training for future health care

Bergenfelz, Felländer-Tsai & Östman Wernerson | Medical training is lagging behind in terms of the possibilities of using artificial intelligence and visualization and simulation technologies in health care. Sweden is one of only a few countries in Europe not having a regulated further education of specialists, despite the existing high risks in health care. Formal further education requirements could contribute to a safe and efficient use of new technologies. Learn more.

Constant changes in elderly care

Westerberg & Nordin | Despite several initiatives related to elderly care, a number of shortcomings in this sector are repeatedly highlighted, Major changes in society during the past three decades, in particular the economic crisis in the 1990s, the transfer of responsibility for elderly care from regions (at the time referred to as county councils) to municipalities in 1993 and an increased adjustment to market conditions in the governance of public services have led to work environment issues being neglected. A prerequisite for addressing the problems facing Swedish elderly care concerns improving the work environment. Learn more.

Organization and governance

The future governance of Swedish healthcare

Anell | Swedish health care is world-class in terms of public health and medical results, at the same time as long waiting times, low level of continuity, lack of collaboration and weak person-centeredness represent recurring problems. The report shows that the state needs take greater responsibility for the transformation of the health care system in terms of increased person-centeredness, increased digitalization and strengthened primary care. Learn more.

The volume-outcome relationship in healthcare

Avdic | Several studies have shown relationships between a high patient volume and the quality of care, whereas there are few studies indicating that increased volumes lead to better quality. This report shows such a causal relationship with significant positive effects arising from more patients being treated at the same hospital. This leads to higher survival rates, fewer complications and fewer operations that need to be repeated. The main reason for this is that surgeons have more opportunities to operate, thereby gaining more practical experience. Learn more.

Media impact

The reports and seminars related to the project have had a great impact in media and the public conversation. Below is a selection of articles and news reports.

September 22, 2021, “Forskare: Överbelastning på akuten leder till fler döda: ansvaret måste bli tydligare” (Researcher: Overcrowding in emergency care results in more deaths: Who is responsible must be made clearer), Dagens Nyheter 

September 20, 2021, “När vården belastas för hårt ökar överdödligheten” (Too much pressure on the health care system increases excess mortality), Dagens Nyheter

June 8, 2021, “Så vill Anders Anell förändra sjukvårdens styrning” (This is how Anders Anell wants to change the governance of health care), Sjukhusläkaren

May 21, 2021, “SNS-rapport om äldreomsorgen: Obalans mellan krav och resurser i arbetsmiljön” (SNS report on elderly care: Imbalance between demands and resources in the work environment), Altinget

September 1, 2020, “Rapport föreslår mer ansvar för nätläkare” (Report suggests introducing more responsibility for online physicians), Dagens Medicin

August 31, 2020, “Dela upp vårdvalet i två nivåer” (Separate people’s choice of care providers into two levels), Svenska Dagbladet

June 9, 2020, “Lagstiftningen behöver it-anpassas” (Legislation needs to be adapted to IT technologies), Dagens Samhälle

December 17, 2019, “Fördelaktigt att samla ihop avancerad vård” (Beneficial to gather advanced care in fewer locations), Svenska Dagbladet

September 5, 2019, “Så banar vi väg för lyckad digital innovation” (This is how we pave the way for successful digital innovations), Dagens Samhälle

March 20, 2019, “E-hälsoinnovationer stjälps av styrmodeller” (E-health innovations hampered by governance models), Dagens Medicin

Seminars and workshops

September 21, 2021 – How is patient safety affected by overcrowded emergency departments?

June 17, 2021 – How to ensure skilled workers in elderly care?

May 21, 2021 – Organization, leadership and work environment in elderly care

March 17, 2021 – Vaccinating against covid-19

December 16, 2020 – The Corona Commission presents its report on elderly care

September 8, 2020 – Lena Hellberg on knowledge management in health care

September 1, 2020 – The governance of health care

June 9, 2020 – Legal and governance challenges of e-health

May 5, 2020 – The Government’s official investigation of assistive technology in elderly care

December 18, 2019 – Effects of concentrating parts of Swedish health care in fewer locations

October 3, 2019 – Göran Stiernstedt presents suggestions for governing health care

September 9, 2019 – Key factors for successful digital innovations in health care

June 26, 2019 – Good and local health care – seminar with Anna Nergårdh

May 7, 2019 – Education and training for future physicians

April 11, 2019 – The patient as a resource – on patient participation in health care

March 20, 2019 – How do reimbursement systems affect the development of e-health?

February 19, 2019 – Welfare technology in elderly care

February 4, 2019 – The governmental Pharmaceutical Study is presented at SNS

November 28, 2018 – How to solve the shortage of specialist nurses?

August 30, 2018 – How do we ensure the quality of digital health care?

June 26, 2018 – Governance for more equal health care

March 21, 2018 – Round table discussion on the elderly care of the future

November 9, 2017 – Breakfast discussion. How does Sweden become best in class in e-health?

July 2, 2017 – SNS at Almedalen. Health care in the 21st century