During the period 2011–2019, the costs of Swedish health care increased by SEK 134 billion in fixed prices. They now account for 11% of Sweden’s GDP, a number expected to increase in the future.
So, how is the future health care system to be financed? This issue is becoming more and more urgent as new drugs and treatments are introduced in the health care system. Most of these are good, but far from all, says Mikael Svensson in the SNS report High costs and limited patient benefits – on evaluating interventions in health care.
“There is a tendency to put too much faith in new drugs and treatments. New and very expensive drugs are sometimes introduced even though it is unclear how much benefit they actually offer the patients. This not only results in ineffective treatments, but also that other and more effective alternatives are rejected due to financial considerations,” says Mikael Svensson, health economist at the University of Gothenburg.
The report focuses on drugs, surgery and medical technology and discusses several cases where new treatments have been introduced despite a lack of evidence that they are actually beneficial. This concerns everything from cancer treatments to operations regularly performed even though research has shown that they offer little to no benefit to the patients. For example, more than SEK 100 million per year is spent in Sweden on operations aimed at treating intermittent claudication, pain in the legs due to atherosclerosis, despite the fact that, according to a large study, such operations have a limited effect. These kinds of procedures may even be harmful in a broader context.
“Decision-makers in government agencies and health care regions obviously want what is best for the patients, but there are limited resources. That is why it is not a good idea to focus on interventions that, on the whole, do less for the money spent. This will result in public health declining instead of improving,” says Mikael Svensson.
In order to prevent such problems, he believes that there need to be stronger requirements regarding proven efficacy before new and costly interventions are introduced in the health care system. And when introducing particularly urgent interventions, whose efficacy has not been established, there should be clear requirements regarding following up patient benefits.
The Swedish National Board of Health and Welfare should also to a greater extent use so-called not-to-do lists, thereby providing guidance on which alternatives should be eliminated in the health care system, says Svensson. In addition, he also thinks that there are reasons for changing the limit used when calculating which interventions will have a positive effect on patients at a reasonable cost to society.
High costs and limited patient benefits – on evaluating interventions in health care is published within the framework of the SNS project Organizing and financing health care and elderly care. It examines whether the current procedures for introducing new interventions are sufficient for protecting both patients and the economy. The case descriptions originate from the field of pharmaceuticals, as well as surgery and medical technology.
Mikael Svensson is a professor of applied health economics at Sahlgrenska Academy, University of Gothenburg.
Download a summary of the report High costs and limited patient benefits – on evaluating interventions in health care.
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