Swedish National Centre for Priorities in Health

About us

The Swedish National Centre for Priorities in Health works with priority setting within health and social care. We conduct research on priority setting and offer support to state agencies, county councils, municipalities, and other care providers in the health services regarding priorities.

Our vision is that all decision making that affect access to health care in Sweden should be based on shared priority setting principles. To guide priority setting in the health services, the Swedish parliament has decided to include three ethical principles in the Health and Medical Services Act. Decision making regarding health care should be based on these three ethical principles and be evidence based. Decisions should also be made in a transparent process.
 
The centre has the following objectives:

  • Collaborate with a broad range of stakeholders in developing methods that can be used to support open priority setting
  • Stimulate awareness and debate on open priority setting
  • Conduct research on priorities in health
  • Contribute to the exchange of knowledge between research and health care systems
  • Contribute with knowledge-based support to state agencies and care providers
  • Arrange a biannual national conference on priority setting within health and social care
  • Develop and offer courses and consultancy services

Organisation

The Swedish National Centre for Priorities in Health was established in 2001 as a national centre focusing on priority setting in health and social care. Initially, the centre was commissioned by the Ministry of Health and Social Affairs, and the Swedish Association of Local Authorities and Regions. Today the main sponsors are the Ministry of Health and Social Affairs, Östergötland Region and Linköping University. The Swedish National Centre for Priorities in Health has an advisory board consisting of representatives from our funders and state agencies. In 2010 the centre became part of Linköping University and is today part of the Unit of Health Care Analysis at the Department of Health, Medicine and Caring Sciences (HMV), Linköping University.

Nordic Network for priorities in health

In September 2018 a Nordic network for priorities in health was established at the Priorities 2018 conference in Linköping, Sweden. A pre-conference meeting gathered participants from Norway, Finland and Sweden who gave presentations on ongoing research and policy work within the different countries. The meeting gave rise to a number of cooperative efforts from the participants. An informal Nordic network on priorities in health was established, administered by the Swedish National Centre for Priorities in Health. To join the Nordic Network, sign up for PrioNord News.

Our research

A central objective of The Swedish National Centre for Priorities in Health is to conduct research on priorities in health. To find published research articles by researches at the centre, search for the author's name in the research database DiVA.  You can also find more information about the work of the Swedish National Centre for Priorities in Health and our national conference on our Swedish website (click Svenska in the menu to reach it).

Priority setting in Sweden and the ethical platform

The human dignity principle

The term human dignity occupies a central role in the ethical debate. The idea is that all people have a human dignity simply by being human, it is not determined by what they do or have. All humans have the same right to care regardless of talent, social standing, income, age, ethnicity or any other factor. It is only the overall assessment of the patient’s needs that determines the administration of care. The principle primarily states what health care managers should not take into account when making decisions on resource allocation, or in care and treatment. The human dignity principle, which states that all people have equal rights and equal value, is not alone sufficient as a basis for priority setting in health care. Read more about the other principles below.

The needs and solidarity principle

The needs and solidarity principle stipulates that resources should be allocated to the patients who are in the greatest need. How great the need is, is assessed based on the severity and duration of the health problem, and the potential health improvement that would be brought about by a health care intervention. According to the principle, the needs of weaker groups and groups who have difficulty in making their voices heard, should be afforded special consideration. Included in these groups are for instance children, elderly with dementia, unconscious persons and others who for different reasons have difficulties in communicating with their surroundings. To consider the needs of these groups also entails a responsibility to investigate where the unresolved needs are.

The cost-effectiveness principle

The cost-effectiveness principle stipulates that health care has a duty to utilise its resources as effectively as possible. This principle is, however, subordinate to the two other principles above. This means that serious illness and fundamental quality-of-life deterioration are prioritised before minor ailments, even if the care of the severe conditions comes at a higher price. It was emphasised in the Government Proposal that it is the collective and long-term effects and costs that must be considered. According to the Priority Setting Commission and the Government Proposal, the effects of different initiatives are hard to compare fairly. The Commission suggested that the cost-effectiveness principle should only be applied when comparing methods of treatment for the same illness.

Background - priority setting in Sweden

In Sweden the population benefits from universal coverage in a tax-financed national health services type of system, with a regionalised structure. Within directly elected regional units (county councils or regions) politicians are formally accountable to the population for the distribution between service areas. They have the responsibility to meet, as best they can with limited funding, the health needs of a pre-defined population. As resources – in one way or another – are always scarce, it is necessary to make choices about what to fund and what not to fund. Patients who do not have their needs met in accordance with their wishes naturally find this upsetting.

In 1992 the Swedish government appointed a parliamentary commission to consider the need for ethical principles for priority setting in health care. The background was that the cost of care tended to increase faster than the available resources. The gap between needs and resources became ever greater. In 1995 the commission presented its findings in Vårdens svåra val (SOU 1995:5), [Difficult choices in healthcare]. The commission’s recommendations led to a government proposal (prop. 1996/97:60). In 1997 the proposal that included ethical principles and general guidelines on priority setting in health care were ratified by the Swedish Parliament. The ethical principles have been operationalised into a National model for transparent prioritisation in Swedish health care.

Three ethical principles guide priority setting

The Swedish parliament has decided to include three ethical principles in the Health and Medical Services Act. Read more about the principles and when they were ratified.

International Society for Priorities in Health

Priorities 2018
The international conference Priorities 2018 in Linköping, Sweden. Photographer: Emma Busk Winquist

The International Society for Priorities in Health (ISPH) was formed in 1996 to strengthen the theory and practice of priority setting in health care. It is the leading international forum for health researchers, clinicians, policy makers and managers involved in priority setting to exchange ideas and experiences. ISPH hosts a biannual international conference on priority setting. The next conference will be held in Germany in 2026. In 2018 the ISPH conference was hosted by the Swedish National Centre for Priorities in Health in Linköping. Read more about ISPH. ISPH has a Covid-19 database with literature, visualization tools, and other resources relevant to Covid-19 priority setting. Visit ISPH's Covid-19 database.

Contact Address to the Swedish National Centre for Priorities in Health 

Address

Linköping University
Department of Health, medicine and Caring Sciences (HMV)
Swedish National Centre for Priorities in Health
581 83 Linköping
Sweden

Visiting adress

Building 511, entrance 76 or 78, floor 13, Campus US, Linköping

Contacts at the centre

Co-workers at the centre

Organisation