Health technology assessment in Sweden

Sweden has a welfare system that is based on the fundamental principle that all citizens are entitled to good health and medical care, regardless of w here they live or what their economic circumstances are. Health and medical care are considered to be public sector responsibilities. However, there i s growing interest in establishing more private alternatives to public care . An important characteristic of the Swedish healthcare system is its decen tralization, with a major role for county councils. County councils are now merging into larger administrative units (region). The whole Swedish syste m is in the process of reform, mainly because of perceptions that it was to o rigid and had insufficient patient orientation. An important factor in th e reforms is that power in the system will be even more decentralized and w ill have greater public input. This change is seen as calling for increased central follow-up and evaluation of matters such as social, ethical, and e conomic aspects. Although the state has decentralized control, it still att empts to control the general direction of the system through regulation, su bsidy, recommendations, and guidelines. An important actor in the system is the Swedish Council an Technology Assessment in Health Care (SBU). SBU beg an in 1987 with assessments of health technologies, but its success has rec ently led policy makers to extend its coverage to dental care. Health techn ology assessment is increasingly visible to policy makers, who find it usef ul in decision making.