1. Healthcare

Welcome to Örebro County Council
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Where to find us
Finland
Norway
Denmark
Sweden
Örebro County is
situated in the centre
of Sweden. Örebro lies
between Stockholm,
the capital of Sweden
(200 km away) and the
major city of Gothenburg
(300 km away).
Facts and figures
Number of inhabitants in Örebro County: 275,000
Area of Örebro County: 9,301 square km
Area of Sweden: 450,000 square km
Örebro County is made
up of 12 municipalities.
Örebro County Council
is represented and works
in all 12.
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Örebro County Council
Örebro County Council works to develop the county
and improve the quality of life of all its residents. This
is to be achieved in the areas of health care, dental care,
research, culture, education and regional growth. The
Council’s principal responsibility is to organise and
provide health care.
The County Council’s vision:
Örebro County Council will bring about health
and vitality through security, quality and sustainable
development.
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The Council’s principal responsibility is health care
Good health care – a universal right
Medical advances
Swedish health services strive to achieve good health and
medical care on equal terms for the entire population. All
county inhabitants are entitled to expect good health care
that meets their specific needs and is readily available, and
to receive appropriate and respectful treatment.
For us at the County Council, this means that we
are to provide good health care and other services to
everyone, irrespective of their location in the county.
Medical advances lead to shorter waiting times and
enable the treatment of increasingly elderly patients.
Technological developments mean that many operations
are less problematic than in the past, allowing patients to
leave hospital earlier. More effective medication enables
people to be treated at home rather than in hospital.
Working together for an optimal whole
Boosting health, curing diseases or improving quality
of life often involves a chain of events and other players
besides the County Council. To ensure that county
residents do not “slip through the gaps”, we at the County
Council liaise with municipalities, social insurance offices
and others to optimise the efficiency of the whole process.
Greater accessibility
The Council is working hard to increase access to health
services in order to meet patient demands for shorter
waiting times. This is being achieved through specific
measures in various health care operations as well as
through cooperation with other providers.
Who does what in Sweden?
care, support and help to the disabled, some education and
culture. The Council also helps finance various companies
and foundations such as Länstrafiken i Örebro AB (public
transport), the County Theatre, and Länsmusiken (which is
responsible for Örebro Concert Hall, the Swedish Chamber
Orchestra in Örebro and other music associations). Örebro
County Council and the county’s 12 municipalities work
together in a regional association.
The County Council should not be confused with the
County Administrative Board, which is national government
activity at regional level. The executive of the County
Administrative Board is made up of the governmentappointed County Governor and representatives appointed
by the County Council.
Sweden is a democracy, which means that everyone has equal
value and rights. In a democracy, everyone is able to influence
decisions; as the Swedish Constitution puts it, all public power
stems from the people.
National level: Parliament and Government
The Swedish Riksdag (parliament) is the principal popular
representative body. It has 349 members, elected by Swedes in
parliamentary elections every four years. The parties that form
a majority in the Riksdag appoint a government. The Riksdag
makes decisions that affect the whole of society, and interacts
with other tiers of the public sector such as county councils and
municipalities.
The Riksdag also determines the fundamental framework
of health care. The overall objective of the Swedish Health and
Medical Services Act is to ensure good health and health care
on equal terms for the entire population.
Swedish health care is decentralised, with the County
Councils playing a key role. Health care is largely financed
through taxes.
The County Councils are responsible for planning all health
care in their county, for providing health care, financing
privately-run health care and for levying taxes on county
residents. The County Councils cooperate at national level in
the Swedish Association of Local Authorities and Regions. They
work together in six health care regions to provide highly
specialised care. They also have cost responsibility for drugs.
Apoteket AB is the state-owned chain of pharmacies that has a
monopoly on the sale of drugs throughout Sweden.
At local level: municipalities
Sweden is divided into 290 municipalities led by directly
elected politicians elected by the municipality’s residents
every four years. Each municipality is responsible for
providing its inhabitants with nurseries, schools, care and
services for the elderly and the disabled, housing, water and
sewage, road maintenance, waste disposal and other
amenities. Örebro County contains 12 municipalities.
’’The market’’
Democratically elected bodies at national, municipal and
county level are not alone in being able to exercise power
and influence. Other entities such as “the market”, the mass
media and the courts also wield considerable power.
The market impacts on the country’s economy; private
sector growth has a major impact on employment, which in
turn affects tax revenue at national, county and municipal
levels. The media play a part in steering the development of
society by influencing public opinion and as purveyors of
news and information. Judicial power is exerted by
independent courts of law.
Regional level: County Councils
Sweden has 21 County Councils, led by politicians who are
directly elected in general elections every four years. County
Councils are the only popularly elected regional parliamentary
bodies.
Örebro County Council is responsible for health care, dental
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Health care guarantee
Freedom of choice
Patients with urgent conditions are always treated directly.
Planned operations or treatments are subject to a
guarantee for maximum waiting times that applies
throughout Sweden. The guarantee states the number
of days within which the patient is to be offered planned
medical care. The number of days varies, depending on
the treatment that the patient needs, but nobody should
need to wait more than three months for a planned
operation or treatment. If the County Council cannot
manage this, the patient is offered the treatment by
another care provider.
Residents of Örebro County can choose any care provider
in the county or elsewhere in Sweden. This freedom of
choice does not apply to highly specialised care such as
heart surgery and transplants.
Cost ceiling and free care for under-20s
In Örebro County, health care is free to all under-20s;
others pay a patient fee. There are three types of cost
ceiling to ensure that nobody incurs prohibitive costs for
health care. These are for health care appointments, for
patient transport and for medication.
Örebro County Council’s main task is to provide
the county’s 275,000 residents with health care.
About 1,900 people visit a doctor in Örebro County each day.
Some 1,000 patients a day are cared for
at one or other of the county’s hospitals.
The County Council employs roughly 8,700 people whose task
is to ensure the health and security of county residents.
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First tier:
Local primary care centres
Local primary care centres are the bedrock of Swedish
health care. These centres treat 90 per cent of all illnesses
and injuries. If necessary, the doctor will refer a patient to
a specialist at the county’s hospitals.
About 1,900 people in Örebro County visit a doctor
on any given day. The vast majority of patients see doctors
at their primary care centres. These doctors are specialists
in general medicine and are experienced in dealing with
most conditions. Doctors, district nurses, child health
care, midwives and physiotherapy are available at primary
care centres. Patients can also see a social worker or
psychologist. In addition there are special youth family
planning clinics where teenagers can get advice and help.
Örebro County has 29 primary care centres, four of
which are run by sub-contractors. Each municipality has
at least one primary care centre.
People who fall ill during an evening or weekend can
turn to the primary care centre’s on-call and telephone
advisory services.
Round-the-clock health care advice
The health care advisory service Sjukvårdsrådgivningen
is a supplement to the primary care centre, and serves the
entire county. People can call the service 24 hours a day,
7 days a week. Experienced district nurses take the calls
and provide medical information and advice about selfcare. They also assess whether the patient needs to contact
a doctor.
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Second tier:
County health care at our hospitals
Specialist care, such as surgery or treatment, is provided at
hospitals. County health care services are also responsible
for providing support and help to the mentally ill.
Örebro County has three hospitals. The largest is
Örebro University Hospital (USÖ), with 37 clinics, 590
beds and 3,500 employees. Karlskoga Hospital in the west
of the county has 6 clinics, 150 beds and 900 employees.
Lindesberg Hospital, in the north of the county, has
5 clinics, 100 beds and 700 employees. All three hospitals
have accident and emergency departments that are open
24 hours a day.
The hospitals in Karlskoga and Lindesberg primarily
provide specialist care to residents in their catchment
areas, but they work together with USÖ in various ways.
Karlskoga Hospital cooperates with health care services
in Värmland County and also treats patients from
Värmland.
Ambulance care is an important part of the health
care chain. Skilled ambulance staff often start treatment
at the scene, thus saving lives. Örebro County Council
has long focused on having highly qualified ambulance
staff, and each ambulance must be staffed by at least one
nurse. The roof of USÖ has a helipad for patients who
need to be transported to the hospital especially quickly,
due to urgent illnesses or injuries.
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Third tier: Highly specialised care at USÖ
Patients with complicated or rare diseases or injuries
receive highly specialised care. Hospitals that provide such
care are also centres of research and medical training.
Örebro University Hospital – USÖ – is one of eight
University hospitals in Sweden and a centre for highly
specialised care. USÖ has an impressive track record of
success in cardiology, cancer therapy and eye treatments.
Most of USÖ’s clinics work with highly specialised
care, but the hospital also provides second-tier specialist
care to county residents. Highly specialised care is provided to patients from large areas of central Sweden and
the rest of the country, as well as patients from Örebro
County.
USÖ trains doctors from the Department of Medicine
at Linköping University. Each year, 60–70 medical students do part of their training at USÖ. The County
Council works with Örebro University in the field of
medical sciences, and are currently jointly working on the
establishment of a comprehensive medical degree course
in Örebro.
USÖ’s medical device projects attract widespread
attention throughout Sweden. One such project is the
development of digital imaging technology, which is
also linked to a system between the different hospitals.
Research in Örebro County Council
Örebro County Council is working hard alongside
Örebro University to build up the field of medical sciences. We are concentrating on establishing scientific
expertise with the main focus on clinical point-of-care
research. A number of research groups are studying
different types of ill-health, spanning the field from stress
and burn-out to modern genetics, and common diseases
such as diabetes and cancer. The clinical research centre at
USÖ is a hub of education, research and health care
evaluation.
Örebro County Council earmarks about SEK
100 million a year for research; part of this is financed
through various funds.
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What else do the health services do?
Lifestyle and health promotion work
Care of the elderly – cooperation between the
County Council and municipalities is crucial
Lifestyle – our habits regarding diet, exercise, stress, sleep,
tobacco and alcohol – has a significant impact on our
wellbeing. With the right support we can make wiser
choices and stay healthy for most of our lives. This is why
the County Council is focusing on maternity care,
paediatric care, stop-smoking groups, and weight loss and
exercise groups. The County Council also provides
financial assistance to sports and exercise activities that
contribute to better health in the county.
This health promotion work aims to give people the
basis they need to make sound choices. The County
Council is working to eradicate differences in health based
on gender, class and ethnic origin. Most emphasis is
placed on children and young people, the elderly and
people with psychiatric conditions.
The County Council wants to enable detection of
disease at an early stage through regular health checks.
Mammography and smear tests help in the early detection
and cure of many cases of cancer.
An increasingly elderly population requires more health
care and nursing. Responsibility for provision of good
health care to the elderly is shared by the county’s
municipalities and the County Council. Municipal nurses
and occupational therapists and County Council doctors
and physiotherapists at primary care centres are
responsible for different treatment measures.
The County Council provides health care at primary
care centres and hospitals, and each of the county’s three
hospitals has a geriatric clinic for treatment and rehabilitation.
Home care enables people with prolonged illnesses
to receive care in their own home. This care is given
by nurses, occupational therapists and other care staff
employed by the municipality, as well as doctors and
physiotherapists employed by the County Council.
Palliative care is a joint effort involving doctors at
primary care centres and municipal nurses and care staff.
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Psychiatry
Services for the disabled
Psychiatry is part of the County Council’s specialist
health care, with the task of examining and treating the
mentally ill. Primary care services are responsible for
initial care of patients with mental health problems. If
the problems become very severe, the patient is referred
to the County Council’s specialist psychiatric services.
Most psychiatry is provided as outpatient and primary
care, but County Council psychiatric services also include
150 inpatient beds.
Besides general psychiatry, Örebro County Council’s
services have psychiatric units for children and young
people, addiction problems, forensic psychiatry and
psychosis care. There are also teams working on special
areas such as crisis and trauma clinics and teams for the
deaf and hearing impaired.
People with brain damage, learning difficulties or who
for other reasons have difficulty in coping with everyday
life are to be able to live as normally as possible. Services
to the disabled are provided by municipalities and the
County Council. Municipalities give support in day-today living and the County Council provides health care
and treatment. The most important task of Council-run
habilitation activities is to make life easier for people with
disabilities.
Assistive technology for people with disabilities
The Council supplies assistive technology for people
with physical disabilities, learning difficulties and various
communication difficulties such as blindness or impaired
vision, deafness or hearing impairments. The Council also
runs an interpretation centre for the deaf, adult deaf and
deaf-blind.
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largest dental training clinics. Folktandvården has a
dental laboratory in the same building.
Dental care is free for children and young people
under 20. The County Council pays for all dental care
for children, including specialist treatment, irrespective
of whether the child, parent or guardian chooses a private
dentist or Folktandvården.
From the year when patients turn 20, they must
pay for a large proportion of their dental care themselves.
Patients are covered by national dental insurance, which
means that the Social Insurance Agency pays some of the
cost of dental care.
The County Council is responsible for outreach
activities to certain care-intensive groups such as the
elderly and the disabled. The visits take place in the
patients’ own homes. Most of these patients receive
necessary dental care according to the same fee system
that applies to the County Council’s health care services.
The Council finances dental care in the same way for
a number of other patient groups with special needs.
Dental care for everyone in the county
The County Council is responsible for the dental health
of the population and for the provision of good needsbased dental care. Patients can choose Council-run dental
care or private dentists. About 95 per cent of children and
young people up to 19 years old, and some 40 per cent of
the county’s adult population, choose Council-run dental
care, Folktandvården.
Folktandvården is the collective name of the County
Council’s dental clinics. Most of their work is general
dental care, i.e. ordinary dental care for children, young
people and adults. There are 23 clinics in Örebro County.
Folktandvården also provides specialist dental care
at hospitals. These services offer more complicated
treatments. Folktandvården’s centre for specialist dental
care includes all types of specialist dentistry. Patients
referred to the centre might have serious periodontal
diseases, require tooth implants or orthodontic treatment,
or be children in need of some form of specialist dental
treatment. The centre is also home to one of Sweden’s
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The County Council: a democratically-governed body
The County Council Assembly is the County Council’s
highest decision-making body, and is the only popularlyelected county-level parliamentary body. Every four years,
the county’s inhabitants elect 71 members of different
political parties to the County Council Assembly. The
politicians come from all over the county. Their task is
to represent the county’s inhabitants.
comprises 15 members elected by the County Council
Assembly. The members come from the political majority
as well as from the opposition.
Preparatory committees identify needs
The basis of the political organisation is made up of
preparatory committees that survey the population’s
needs and requests, and propose changes from a citizen’s
perspective. The committees work in various parts of the
county to make it easy for inhabitants to interact with
politicians.
The needs of the population are paramount
Örebro County Council exists to serve the county’s
inhabitants, and their needs are to guide Council
planning. The politicians must also ensure that Council
activities are run so efficiently that taxpayers’ money is
used appropriately.
Specialist boards weigh proposals
The preparatory committees’ proposals are then brought
to two specialist boards for decision. Health care issues are
processed by the Health Care Board, while the Research
Board deals with research issues.
County Council Assembly
Each year, the County Council Assembly decides how
much county tax county residents will pay. The Assembly
sets economic frameworks and guidelines for the County
Council’s activities and adopts the budget. The Assembly
holds six meetings a year, which are open to the public.
The vast majority of those elected to the Assembly are
politicians in their spare time; only a few are salaried
full-time or part-time politicians.
Preparatory work and contact with citizens
Between County Council Assembly meetings, many
politicians meet in various working groups. This is where
all issues are prepared for later decisions.
As a democratic organisation, the County Council
complies with the Swedish principle of public access. This
means that citizens are entitled to see public documentation and keep themselves informed of the County
Council’s activities. All county inhabitants can also submit
citizens’ proposals to the County Council Assembly.
Citizens’ proposals are prepared and processed in the same
way as proposals from elected members.
The County Council Executive Board leads
The County Council Executive Board leads and
coordinates Council activities. All issues raised by the
County Council Assembly have first been processed
by the County Council Executive Board. The Board
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Örebro County Council´s
political organisation as from 2007
The Örebro County Council
Assembly has 71 seats.
Distribution of seats for 2007–2010:
Social Democratic Party (s) 31 seats
Moderate Party (m) 13 seats
Christian Democrats (kd) 6 seats
Centre Party (c) 5 seats
Liberal Party (fp) 5 seats
Left Party (v) 5 seats
Green Party (mp) 3 seats
Sweden Democrats (sd) 3 seats
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County Council
administrative organisation
Örebro County Council´s
administrative organisation 2007–2010
Politicians decide which goals the County Council
will work towards and how the money is to be
distributed between different areas. A great deal
of the work however is governed by legislation such
as the Swedish Health and Medical Services Act.
The practical work of leading the County
Council’s activities and complying with
legislation and decisions is a task for the
civil service (administrative) organisation
and senior County Council staff. The
County Council Director leads the
administrative organisation with its 8,700
employees. This is the highest civil service
position in the County Council.
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SEK 6 billion
to run the County Council
Eighty-six per cent
is spent on health care
Örebro County Council’s activities cost about SEK
6 billion a year to run. This is mainly funded through
taxes paid by the county’s inhabitants. An average wage
earner pays about SEK 2,000 a month in tax to the
County Council. Thanks to that money, the Council can
provide good health care to all, free health and dental care
to children and young people, habilitation for people with
disabilities, education, support for culture, and generally
safeguard of the interests of county inhabitants.
Health care is the County Council’s largest area of
operation. It accounts for more than 86 per cent of the
Council’s costs. More than half of the County Council’s
costs are salaries. With 8,700 employees, the County
Council is one of the county’s biggest employers.
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A typical day in Örebro County
Seven babies are born, and nine people die.
Ambulances make 64 call-outs.
1,000 patients are cared for at the
county’s three hospitals.
About 1,900 people go to a doctor somewhere
in the county.
Health care costs SEK 12.8 million.
About 4,700 people are at work in Council-run
health care services.
Box 1613, SE-701 16 Örebro, Sweden
Tel. (switchboard): +46 19-602 70 00
E-mail: [email protected]
www.orebroll.se
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Production: Tammerman/Koubek. Photos: Magnus Wahman, Magnus Westerborn and Weine Ahlstrand. Printing: Tetab Tryckeri AB. 2008
70 patients undergo surgery in the county’s hospitals.