Last update: August 15, 1996

Interview with Silas Olsson MSc, Project Leader, Swedish Institute for Health Services Development (SPRI), Stockholm on 19 February 1996.

Sweden Sweden has an area of 450,000 km 2 and half its land is covered with forest. Less than 10% is farmland. Nearly 100,000 lakes dot the countryside, which is relatively flat with the exception of a long mountain chain in the north-west which reaches heights of up to 2,111 m. There are thousands of islands along the jagged coastline. The Gulf Stream gives Sweden a milder climate than other areas equally far north; Stockholm, for example, is almost the same latitude as southern Greenland, but has an average temperature of about +18C in July. Of the 8.8 million population, 85% live in the southern part of the country. Since the 1940s, immigration, mostly from neighbouring Scandinavian countries, has accounted for over 40% of the population growth. About 4.3 million people make up the workforce, more than

75% of women aged 16 to 64 are gainfully employed; the unemployment rate is about 10%. In the past 100 years Sweden has evolved from a largely agrarian country to one where less than 3% of the workforce is employed in agriculture. Big increases in farm productivity have kept Sweden more than 80% self-sufficient in food. During the second half of the 1980s, the economy experienced excessive domestic demand, leading to a tight economic policy, however, an export-led recovery was initiated in 1994. Forestry products play a major role in the economy and the engineering industry accounts for nearly half of manufacturing. SPRI Spri, which employs about 100 staff, was founded in 1968 and is financed jointly by the Swedish Government and the Swedish County Councils.

Its mission is to guide and improve health services in Sweden, within agreed budgets, always keeping in mind the best interests of the patients. The Institute focuses on three main areas of research and development work, namely, quality improvement, health economics and healthcare informatics. It serves as a forum for healthcare professionals, and its research oriented library gathers and disseminates information about developments in Sweden and internationally. There are about 65 in-house projects running, at present, and Spri is involved, also, in the Health Telematics Fourth Framework Programme projects. This level of commitment to the EC programme indicates Sweden's desire to learn about what is happening elsewhere, and to be able to share its own experiences and expertise, e.g. in telemedicine.

Spri sees, clearly, that there are opportunities offered by information technology and healthcare informatics for improvements in the efficiency and quality of healthcare. Silas Olsson, who has worked for SPRI since 1982, is the Project Leader for research and development projects in healthcare planning and technology assessment within the diagnostic sector, including telemedicine. He is a member of several national steering committees including the Swedish National Board of Technology Development (NUTEK), also, he chairs the Swedish National Standardisation Committee for medical imaging. Silas is active on the EU scene as a member of CEN TC251/WG4 and its expert group PT006, concerned with standards for medical imaging. He is no stranger to Brussels and the European Commission, having spent eight months in

1994 on a mission to gain an insight into the R&D programme for healthcare projects within the EU/EEA sector. Silas represents Sweden as a member of DG XIII's planning panel for research and development in healthcare telematics. Strong links have been forged with Japan and Silas is the Secretary General of the Scandinavian Branch of the Japan - Scandinavian PACS (Picture Archiving and Communication System) Symposium Steering Committee. His publications include about 60 articles published in Swedish medical journals, some 15 conference papers and 10 Scandinavian/international publications. Healthcare Healthcare and social welfare services are regarded as very important parts of the Swedish welfare system. Both are seen as public sector responsibilities which are supported by a national social insurance system. It is a tenet that the people should be offered

health and medical services of good quality which are provided on equal terms and easily accessible to all. Sweden's costs for health and medical services amounted to SEK 108.8 billion (Å 13 billion ECU) in 1992 - 7.5% of GNP. Responsibility for healthcare, both in-patient and out-patient, is shared by 23 county councils and 3 large municipalities. By international standards, health in Sweden is relatively good. Infant mortality amounts to 4.8 deaths per 1,000 in the first year of life. Of the predominant diseases, cardiovascular conditions account for half of all deaths. The average life expectancy for men is 75.5 years and 80.8 for women. The number of elderly people has increased substantially and this trend will continue to the end of the century - with the greatest rise in the age group 85 years and above. Sweden is seen as having one of the world's oldest population with 18% aged 65 or older. cont ...

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