Björn Almér, Chief Business Officer at Skåne Care, outlines four lessons from the Nordic transition to value-based healthcare
Healthcare systems increasingly recognise that providing more activity does not necessarily produce better health outcomes. With chronic disease placing sustained pressure on services and budgets, value-based healthcare aims to organise care and funding around the outcomes achieved for patients.
The more difficult question is how to put that principle into practice. Sweden’s experience suggests that payment reform alone is not enough. Its transition points to four foundations for lasting change: strong primary care, meaningful outcome measurement, responsibility for population health and incentives aligned across the system.
Sweden is not presented as a perfect model. Its healthcare system continues to face waiting-time and workforce pressures, while reforms have produced successes and unintended consequences. Its relevance lies in the experience gained over several decades of trying to improve outcomes within a publicly governed healthcare system.
Skåne Care is a publicly owned organisation operating within the Swedish region of Skåne. It works with international governments and public bodies to share the region’s healthcare experience and adapt relevant knowledge to different systems and population needs.
Primary care first
Value-based healthcare begins before a patient reaches hospital. Prevention and effective management of chronic conditions depend on accessible primary care that can follow patients over time and coordinate support from different services.
Patients living with conditions such as heart disease or respiratory illness rarely require a single intervention. Their outcomes are shaped by the care they receive over many years, including regular monitoring and treatment adjustments to reduce the risk of complications.
A system built primarily around hospitals will tend to intervene once illness has become more serious. Strong primary care can identify risks earlier and manage more care in community settings, helping patients avoid preventable deterioration.
This approach does not reduce the importance of hospitals or specialist expertise. It places them within a connected pathway in which primary care holds a continuing view of the patient and helps ensure specialist intervention takes place at the right point.
Primary care therefore needs more than additional funding. It requires the authority, workforce, information and organisational capacity to coordinate care. Linking every resident to a primary care network can provide the foundation for this relationship and make accountability clearer.
Meaningful outcomes
Traditional performance measures tend to show how much activity has taken place, such as the number of consultations or hospital admissions delivered. Although these measures are important for assessing capacity and access, they do not reveal whether patients experienced better outcomes.
Sweden’s national quality registries demonstrate how systematic measurement can support improvement. Developed over several decades, the registries collect clinical and patient-reported information across major diseases and treatments. They allow clinicians and policymakers to follow outcomes, identify variations in care and understand where services can be strengthened.
The Swedish Hip Arthroplasty Register, established in 1979, follows hip replacement procedures and outcomes across the country. Continued analysis has supported improvements in surgical techniques and prosthesis selection. The Swedish National Diabetes Register similarly brings together information from primary and specialist care, allowing clinicians to monitor long-term outcomes and variations in diabetes management.
The value of these registries lies not simply in collecting data, but in returning useful information to clinical teams. Providers can compare performance with their peers and learn from organisations achieving stronger results. Measurement becomes part of continuing clinical improvement rather than an administrative exercise.
Population health
Some of the greatest improvements in health come from preventing illness or detecting it earlier. Yet prevention can be difficult to fund because its benefits may emerge over many years or be realised in another part of the healthcare system.
An insurer or provider may invest in prevention, only for the patient to move to another organisation before the financial benefit becomes visible. Investment in primary care may reduce future hospital admissions, but the resulting savings may not return to the service that made the investment.
Population-based responsibility offers one way to address this problem. When a provider network is accountable for the health outcomes of a defined population over several years, it has a stronger reason to invest in prevention and coordinated chronic disease management.
Longer-term contracting can give organisations sufficient time to develop new models of care and demonstrate results. Shared outcome measures are equally important. Primary care, hospitals, payers and regulators must understand how their separate contributions affect the same population.
Aligned incentives
Sweden’s experience also shows that payment reform must reinforce the wider design of the healthcare system. Diagnosis-Related Group reimbursement improved hospital financing and transparency, but the model was designed to classify and reimburse episodes of care, not to improve population health or encourage prevention.
Improving the efficiency of each hospital episode does not necessarily reduce the number of episodes or improve a patient’s longer-term health. Sweden has therefore continued to refine its funding arrangements, combining activity-based elements with population-based and outcome-oriented components.
The lesson is not that activity payments should be abandoned. Different services require different forms of reimbursement, and providers must still be paid for necessary clinical work. The aim should be blended models in which payment for activity is balanced by incentives for access, quality, prevention and longer-term outcomes.
KPIs, regulation, data systems and provider benchmarking should support the same objectives. If payment rewards prevention while performance targets continue to prioritise activity, organisations receive conflicting signals.
Lessons for healthcare systems
Every healthcare system has its own funding arrangements, institutional structure and population needs, so the Nordic model cannot simply be transferred from one country to another. Its underlying principles can, however, be adapted to different national and regional contexts.
Reform requires clear strategic direction, agreed outcome measures and primary care networks with the authority and resources to coordinate prevention and continuing care. Payment changes should be introduced gradually and supported by appropriate data sharing, transparent benchmarking and KPIs aligned around common health objectives.
Skåne Care’s role is not to export a standard Nordic system, but to help international partners apply relevant experience to their own priorities, healthcare structures and population needs.
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