News article
Key pieces missing in the transition to person-centered care
The transition to person-centered care (“god och nära vård”) was initiated by the Swedish government in 2018. Despite high ambitions, progress has been slow, and the effects remain limited. Research highlights several crucial measures for success: strengthening the role of primary care, increasing collaboration between different actors, ensuring access to skilled staff, and making more effective use of digital tools.
A reform with high ambitions – but limited results
Seven years later, the promised changes have not materialized in practice. The Swedish National Board of Health and Welfare’s latest follow-up shows that goals related to accessibility, patient participation, and continuity have been met only to a very limited extent. For example, in 2024, only three out of ten Swedes reported having a regular doctor – the same proportion as in 2020. This figure is also low compared with other similar countries, where eight out of ten reported having a regular doctor.
Politicians agree that the transition to person-centered care should happen. But why is progress so slow?
The wrong focus in measuring progress
Anders Anell, professor at the School of Economics and Management, Lund University, has followed developments in Swedish healthcare for several decades. He questions whether the indicators used to measure reform progress really capture the complex challenges that primary care faces.
– The fact that we haven’t reached the targets isn’t necessarily the problem – perhaps we should be measuring other things instead. Goals like accessibility and continuity are important, but they can be measured in different ways. If we don’t address fundamental structural issues, such as the lack of staff and ineffective working methods, we won’t reach these goals.
He points out that much of the problem stems from the widespread shortage of general practitioners, making it difficult to staff health centers and provide the continuity that citizens need.
– We don’t have enough general practitioners to adequately staff primary care. At the same time, we must reshape primary care working methods to make it more flexible and efficient based on patients’ needs, he says.
I would like to see more research on how we can strengthen the role of primary care, improve collaboration between municipalities and regions, and create long-term continuity in healthcare.
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Anders Anell
Professor of Business Administration at the School of Economics and Management, Lund University. Photo: Kennet Ruona
Low status slows development
Another crucial aspect concerns the status of primary care compared with specialist hospital care. Historically, general practitioners and primary care have ranked lower than specialists and hospital care.
– This affects both the allocation of resources and the attention primary care receives, which in turn hinders long-term change. It’s not just about resources – primary care also needs a clearer organizational role in the healthcare system and strong public trust.
Anders stresses the importance of long-term commitment, noting that despite slow progress, there is now broad consensus on strengthening primary care – something that wasn’t the case 25 years ago.
– Financial incentives alone aren’t a solution to drive change. Transition requires long-term decisions about tasks and resources. But incentives can support the achievement of long-term goals and thus contribute to meaningful reform, he says.
In the coming years, Forte has been tasked with expanding its focus: in addition to the healthcare research it already funds, it will prioritize research on person-centered care. This year’s investment of SEK 10 million will gradually increase to SEK 30 million by 2028.
Anders emphasizes the urgent need for research to create the right conditions for primary care to evolve and meet future demands and challenges.
– I’d like to see more research on how we can strengthen primary care’s role, improve collaboration between municipalities and regions, and build long-term continuity in healthcare. That is essential for creating a sustainable and equitable system, he says.
A complex reform in a giant sector
Another key reason for the slow progress is that the transition involves Sweden’s entire health and social care system, including all actors in the country’s regions and municipalities. Healthcare and social care also make up Sweden’s largest sector, employing nearly 900,000 people – more than one in six of the entire workforce.
Ann-Marie Wennberg Larkö, physician and former chair of the National Healthcare Competence Council (Nationella vårdkompetensrådet), now chair of the organization Research!Sweden, argues that too much of the transition has been conducted at the strategic level – without real impact in practice. She believes frontline services have not been given better conditions.
– A key part of the transition is ensuring sufficient competence both now and in the future – and in the Competence Council, on assignment from the government, we are working to propose measures, she says.
Staff shortages threaten person-centered care
Qualified staff are necessary to work in a “person-centered” way – a key concept in the reform. Instead of focusing only on diseases or diagnoses, healthcare staff must also have time to see the individual, including their unique needs, circumstances, and care preferences.
But how is this possible when Sweden lacks more than 4,000 general practitioners, and nurses continue leaving their jobs with no sign of stopping?
– It’s serious that so many are leaving. We have examined this specifically and proposed measures to encourage nurses and other licensed professionals to return, says Ann-Marie.
The Competence Council’s report on healthcare staffing includes 25 concrete proposals to secure personnel supply. The focus is on offering high-quality education and creating conditions that encourage staff to stay in the profession. Proposals include improving the work environment, enabling professional development during working hours, and clarifying career paths – especially for nurses.
– Nurses need to see that there are career opportunities, for example through the new role of advanced practice nurse, she says.
She also highlights the importance of medical competence within municipal healthcare, where advanced practice nurses can play a crucial role.
It is serious that so many are leaving. We have put forward proposals on how to encourage nurses and other licensed professions to return.
Ann-Marie Wennberg Larkö
Physician and former Chair of the National Healthcare Competence Council, now Chair of Forska!Sverige. Photo: Melker Dahlstrand
Digital tools can free up time for patients
What role can digital tools and training initiatives play in the transition to a more person-centered care model?
– A good digital work environment with user-friendly tools reduces duplication and eases staff workload. Today, a lot of work time goes into administration. If we can cut that time, we free up resources to give more time to patients, she explains.
At the same time, Ann-Marie recognizes that proposals must be implemented in practice.
– We’re good at developing reports and describing what needs to be done, but we’re less good at actually getting the boat into the water, she says thoughtfully.
Maja Lundbäck & Michelle Bornestad (English translation by Forte)
