{"id":36035,"date":"2017-09-01T09:02:20","date_gmt":"2017-09-01T07:02:20","guid":{"rendered":"https:\/\/gestions-hospitalieres.fr\/?p=36035"},"modified":"2020-04-09T09:46:44","modified_gmt":"2020-04-09T07:46:44","slug":"systeme-de-sante-suedois","status":"publish","type":"post","link":"https:\/\/www.ricom-web8.com\/gestions\/systeme-de-sante-suedois\/","title":{"rendered":"Le syst\u00e8me de sant\u00e9 su\u00e9dois"},"content":{"rendered":"<span class=\"span-reading-time rt-reading-time\" style=\"display: block;\"><span class=\"rt-label rt-prefix\">Temps de lecture\u00a0: <\/span> <span class=\"rt-time\"> 4<\/span> <span class=\"rt-label rt-postfix\">minutes<\/span><\/span><h1 class=\"p4\"><span class=\"s2\">Des fondements diff\u00e9rents <\/span><span style=\"letter-spacing: -.1pt;\"><span class=\"s2\">du syst\u00e8me de sant\u00e9 fran\u00e7ais<\/span><\/span><\/h1>\n<h2 class=\"p5\">Un syst\u00e8me financ\u00e9 par l\u2019imp\u00f4t<\/h2>\n<p class=\"p6\"><span class=\"s2\">Fruit de l\u2019histoire, la diff\u00e9rence fondamentale entre nos deux syst\u00e8mes de sant\u00e9 r\u00e9side dans le mode de financement. Assis sur l\u2019imp\u00f4t dans le syst\u00e8me su\u00e9dois, il diff\u00e8re du syst\u00e8me fran\u00e7ais inspir\u00e9 de l\u2019histoire bismarckienne et fond\u00e9 sur les cotisations sociales<sup class=\"appel\" data-toggle=\"modal\" data-target=\"#notes\"> (2)<\/sup>.<\/span><\/p>\n<p class=\"p6\"><button data-toggle=\"collapse\" data-target=\"#enc_2017_403_02\">TABLEAU<\/button><div id=\"enc_2017_403_02\" class=\"encadre collapse\"><p><span class=\"surtitre_enc\">tableau\u00a0<\/span><\/p>\n<h2>France\/Su\u00e8de, chiffres cl\u00e9s<\/h2>\n<p><img decoding=\"async\" class=\"size-full wp-image-36139 alignnone\" src=\"https:\/\/gestions-hospitalieres.fr\/wp-content\/uploads\/2017\/10\/Capture-d\u2019\u00e9cran-2017-10-05-\u00e0-12.08.32.png\" alt=\"\" width=\"600\" height=\"152\" srcset=\"https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2017\/10\/Capture-d\u2019\u00e9cran-2017-10-05-\u00e0-12.08.32.png 600w, https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2017\/10\/Capture-d\u2019\u00e9cran-2017-10-05-\u00e0-12.08.32-300x76.png 300w\" sizes=\"(max-width: 600px) 100vw, 600px\" \/><\/p>\n<\/div><\/p>\n<h2 class=\"p7\">Une comp\u00e9tence r\u00e9gionale<\/h2>\n<p class=\"p6\"><span class=\"s2\">Le pr\u00e9l\u00e8vement \u00e0 la source est centralis\u00e9 par l\u2019\u00c9tat et le montant de la contribution locale est fix\u00e9 par les municipalit\u00e9s qui reversent aux comt\u00e9s la part devant financer les d\u00e9penses de sant\u00e9 g\u00e9r\u00e9es par le comt\u00e9, lequel doit fournir \u00e0 ses habitants des soins de sant\u00e9 et des services m\u00e9dicaux de qualit\u00e9.<\/span><span class=\"apple-converted-space\"><span style=\"letter-spacing: -.1pt;\">\u00a0<\/span><\/span><\/p>\n<p class=\"p6\"><span class=\"s2\">La Su\u00e8de compte 1\u2009200\u00a0centres de sant\u00e9, environ 60\u00a0h\u00f4pitaux d\u00e9partementaux \/de district disposant de services d\u2019urgences 24\u00a0h\/24, et 7\u00a0h\u00f4pitaux universitaires. <\/span>Ces derni\u00e8res ann\u00e9es ont \u00e9t\u00e9 marqu\u00e9es par une r\u00e9duction des h\u00f4pitaux d\u2019urgence et des lits d\u2019h\u00f4pital, une augmentation du nombre de centres de sant\u00e9 et un d\u00e9veloppement des soins ambulatoires.\u00a0<span class=\"s3\">L\u2019\u00c9tat arr\u00eate les principes fondamentaux, distribue les responsabilit\u00e9s et assure la p\u00e9r\u00e9quation de l\u2019imp\u00f4t. Il est comp\u00e9tent en mati\u00e8re de recherche \u2013 ainsi, un professeur des universit\u00e9s-praticien hospitalier su\u00e9dois rel\u00e8ve de la r\u00e9gion via son h\u00f4pital d\u2019appartenance pour la partie clinique, et de l\u2019\u00c9tat via son universit\u00e9 de rattachement pour le volet enseignement-recherche.<\/span><\/p>\n<h1 class=\"p4\">Des d\u00e9fis sp\u00e9cifiques, d\u2019autres similaires<\/h1>\n<h2 class=\"p5\">Des difficult\u00e9s pour les services d\u2019urgence<\/h2>\n<p class=\"p6\"><span class=\"s3\">Les services d\u2019urgence sont engorg\u00e9s. Consid\u00e9rant, sans doute \u00e0 juste titre, que les difficult\u00e9s aux urgences sont moins li\u00e9es aux urgences elles-m\u00eames qu\u2019\u00e0 l\u2019organisation des soins primaires, la r\u00e9gion de Stockholm a mis en place un syst\u00e8me de <i>Consistent care chain<\/i> (<i>figure 1<\/i>).<\/span><\/p>\n<p class=\"p6\"><button data-toggle=\"collapse\" data-target=\"#enc_2017_403_01\">FIGURE 1<\/button><div id=\"enc_2017_403_01\" class=\"encadre collapse\"><p><span class=\"surtitre_enc\">figure\u00a01<\/span><\/p>\n<h2>La Consistent care chain en Su\u00e8de<\/h2>\n<p><img decoding=\"async\" class=\"size-full wp-image-36138 alignnone\" src=\"https:\/\/gestions-hospitalieres.fr\/wp-content\/uploads\/2017\/10\/Capture-d\u2019\u00e9cran-2017-10-05-\u00e0-12.08.20.png\" alt=\"\" width=\"600\" height=\"498\" srcset=\"https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2017\/10\/Capture-d\u2019\u00e9cran-2017-10-05-\u00e0-12.08.20.png 600w, https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2017\/10\/Capture-d\u2019\u00e9cran-2017-10-05-\u00e0-12.08.20-300x249.png 300w\" sizes=\"(max-width: 600px) 100vw, 600px\" \/><\/p>\n<\/div><\/p>\n<h2 class=\"p7\">Un d\u00e9ficit en personnel m\u00e9dical et soignant<\/h2>\n<p class=\"p6\"><span class=\"s2\">La Su\u00e8de fait face \u00e0 des difficult\u00e9s de recrutement et de fid\u00e9lisation du personnel, principalement infirmier. Ainsi, le <i>turn-over<\/i> peut atteindre un taux extr\u00eamement \u00e9lev\u00e9 dans un certain nombre de r\u00e9gions. \u00c0 Stockholm, o\u00f9 l\u2019attractivit\u00e9 est plus forte que dans le reste du pays, le taux de rotation du personnel est de 15\u2009% au New Karolinska. Il atteint les 25\u2009% dans un grand nombre d\u2019\u00e9tablissements.<\/span><\/p>\n<h2 class=\"p7\"><span class=\"s3\">Des d\u00e9lais d\u2019attente importants<\/span><\/h2>\n<p class=\"p6\"><span class=\"s3\">Le syst\u00e8me su\u00e9dois repose sur le principe du \u00ab\u20090 8 90 90\u2009\u00bb\u2009:<\/span><\/p>\n<ul>\n<li class=\"p6\"><span class=\"s3\">0\u2009: r\u00e9ponse le premier jour \u2013 pas n\u00e9cessairement par un m\u00e9decin &#8211; lorsque j\u2019entre en contact avec le syst\u00e8me de soins\u2009;<\/span><\/li>\n<li class=\"p6\"><span class=\"s3\">8 jours\u2009: acc\u00e8s \u00e0 un m\u00e9decin aupr\u00e8s duquel je suis inscrit dans le centre de sant\u00e9\u2009;<\/span><\/li>\n<li class=\"p6\"><span class=\"s3\">90 jours\u2009: acc\u00e8s \u00e0 un sp\u00e9cialiste\u2009;<\/span><\/li>\n<li class=\"p6\"><span class=\"s3\">90 jours apr\u00e8s\u2009: acc\u00e8s \u00e0 un service hautement sp\u00e9cialis\u00e9.<\/span><\/li>\n<\/ul>\n<p class=\"p6\"><span class=\"s3\">Une telle organisation s\u2019av\u00e8re probl\u00e9matique, d\u2019o\u00f9 les efforts r\u00e9alis\u00e9s pour r\u00e9duire ces d\u00e9lais, qui sont suivis de pr\u00e8s, par discipline.<\/span><\/p>\n<h1 class=\"p4\"><span class=\"s3\">Des sp\u00e9cificit\u00e9s importables\u00a0?<\/span><\/h1>\n<h2 class=\"p5\"><span class=\"s3\">Un dialogue social abouti <\/span><span style=\"letter-spacing: .1pt;\"><span class=\"s3\">et une culture de la n\u00e9gociation<\/span><\/span><\/h2>\n<p class=\"p6\"><span class=\"s3\">La Su\u00e8de se caract\u00e9rise par un taux de syndicalisation \u00e9lev\u00e9 et une forte place laiss\u00e9e aux conventions collectives issues de n\u00e9gociations.\u00a0<\/span><span class=\"s3\">Fond\u00e9s sur la confiance r\u00e9ciproque entre les acteurs, attach\u00e9s \u00e0 la d\u00e9centralisation et \u00e0 la subsidiarit\u00e9, les \u00e9changes portent sur des questions d\u2019organisation, de temps de travail, de r\u00e9mun\u00e9ration, etc.\u00a0<\/span><span class=\"s3\">Ainsi, le syst\u00e8me repose sur la loi, les accords de branche et les accords d\u2019entreprise, l\u2019accord d\u2019entreprise ne pouvant \u00eatre moins favorable que l\u2019accord de branche.<\/span><\/p>\n<h2 class=\"p7\"><span class=\"s3\">Le num\u00e9rique et l\u2019innovation <\/span><span style=\"letter-spacing: .1pt;\"><span class=\"s3\">parmi les grandes priorit\u00e9s<\/span><\/span><\/h2>\n<p class=\"p6\"><span class=\"s1\">La Su\u00e8de a fait du num\u00e9rique une priorit\u00e9, pas uniquement dans le secteur de la sant\u00e9. Ainsi, chaque Su\u00e9dois dispose d\u2019un <i>personal identity number<\/i>. Introduit en 1947, il est utilis\u00e9 par les acteurs du syst\u00e8me de sant\u00e9, par les universit\u00e9s, les banques, les compagnies d\u2019assurance.<\/span><\/p>\n<p class=\"p6\"><span class=\"s1\">Dans le secteur de la sant\u00e9 plus sp\u00e9cifiquement, le dossier m\u00e9dical et pharmaceutique partag\u00e9 est effectif.<\/span><span class=\"apple-converted-space\"><span style=\"letter-spacing: .25pt;\">\u00a0<\/span><\/span><span class=\"s1\">Un plan d\u2019actions 2017-2019 pour le d\u00e9veloppement de la e-sant\u00e9 a \u00e9t\u00e9 annonc\u00e9 le 23 janvier 2017 et un forum national sur la normalisation de la e-sant\u00e9 a \u00e9t\u00e9 mis en place. Il existe \u00e9galement une plateforme de test des applications propos\u00e9es en mati\u00e8re de e-sant\u00e9.\u00a0<\/span><span class=\"s1\">L\u2019innovation, au sens large \u2013 innovation diagnostique et th\u00e9rapeutique, innovation technologique et num\u00e9rique, innovation organisationnelle et comportementale \u2013 est elle aussi \u00e9rig\u00e9e en priorit\u00e9, avec par exemple la cr\u00e9ation, au New Karolinksa University Hospital, d\u2019une direction de l\u2019innovation compos\u00e9e de vingt professionnels aux profils et comp\u00e9tences vari\u00e9s\u2009: juristes, scientifiques, informaticiens, etc.<\/span><\/p>\n<h2 class=\"p7\"><span class=\"s3\">Une organisation en parcours de soins<\/span><\/h2>\n<p class=\"p6\"><span class=\"s3\">Cette volont\u00e9 d\u2019organisation en parcours de soins se retrouve aux niveaux macro et micro\u2009:<\/span><\/p>\n<ul>\n<li class=\"p6\"><span class=\"s3\">au niveau macro, chaque r\u00e9gion s\u2019oriente vers un mod\u00e8le de <i>Consistent care chain<\/i> (<em>voir pr\u00e9c\u00e9demment\u00a0<\/em><i>figure 1<\/i>) avec, en premier recours, le m\u00e9decin g\u00e9n\u00e9raliste, puis les \u00ab\u2009h\u00f4pitaux d\u2019urgence\u2009\u00bb et les h\u00f4pitaux de recours et d\u2019activit\u00e9 principalement programm\u00e9e\u2009;<\/span><\/li>\n<li class=\"p6\"><span class=\"s3\">au niveau micro, le New Karolinska University Hospital a mis en \u0153uvre un projet immobilier d\u00e9clinant une vision en termes de parcours par type de pathologie plut\u00f4t qu\u2019une approche par service. Une direction des flux et des parcours a \u00e9t\u00e9 cr\u00e9\u00e9e.<\/span><\/li>\n<\/ul>\n<p class=\"p6\"><span class=\"s3\">Cette organisation demeure cependant \u00e0 ce jour unique et n\u2019a pu encore \u00eatre \u00e9valu\u00e9e en raison de son caract\u00e8re tr\u00e8s r\u00e9cent.<\/span><\/p>\n<h2 class=\"p7\"><span class=\"s3\">Des achats au niveau r\u00e9gional<\/span><\/h2>\n<p class=\"p6\"><span class=\"s3\">La r\u00e9gionalisation des achats, notamment concernant les dispositifs m\u00e9dicaux, permet de r\u00e9aliser des \u00e9conomies. La diminution des r\u00e9f\u00e9rences command\u00e9es, via un syst\u00e8me <\/span><span class=\"s4\">centralis\u00e9 au niveau r\u00e9gional favorise des gains achats, tout en garantissant la qualit\u00e9 et la vari\u00e9t\u00e9 n\u00e9cessaire des produits gr\u00e2ce \u00e0 la participation de m\u00e9decins et de pharmaciens dans la commission charg\u00e9e des achats.<\/span><\/p>\n<h2 class=\"p7\"><span class=\"s5\">Une politique active en faveur des personnes handicap\u00e9es<\/span><\/h2>\n<p class=\"p6\"><span class=\"s4\">La Su\u00e8de a mis en \u0153uvre une politique volontariste en faveur des personnes handicap\u00e9es. Deux lois (Lass et LSS) ont fix\u00e9 dix priorit\u00e9s.<\/span><span class=\"apple-converted-space\"><span style=\"letter-spacing: .15pt;\">\u00a0<\/span><\/span><\/p>\n<p class=\"p6\"><span class=\"s4\">Ainsi, un effort a \u00e9t\u00e9 fourni en mati\u00e8re d\u2019aide \u00e0 domicile et de logements adapt\u00e9s. Un <i>ombudsman<\/i> sp\u00e9cialis\u00e9 a \u00e9t\u00e9 mis en place, ainsi qu\u2019un syst\u00e8me volontariste pour l\u2019emploi des personnes handicap\u00e9es gr\u00e2ce notamment \u00e0 l\u2019existence de la Samhall, entreprise accompagnant l\u2019emploi par d\u2019autres entreprises de personnes handicap\u00e9es. Les r\u00e9sultats sont au rendez-vous\u2009: le taux d\u2019emploi est de 70\u2009% pour les personnes handicap\u00e9es.<\/span><\/p>\n<p class=\"p6\"><span class=\"s4\"><i>L\u2019\u00e9dition 2018 du Graph Europe, qui se d\u00e9roulera du 6 au 9 juin 2018 \u00e0 Copenhague, sera l\u2019occasion de prolonger l\u2019analyse des syst\u00e8mes de sant\u00e9 des pays scandinaves et leur mod\u00e8le social\u2009.<\/i><\/span><\/p>\n<p class=\"p6\"><button data-toggle=\"collapse\" data-target=\"#enc_2017_403_03\">LE GRAPH<\/button><div id=\"enc_2017_403_03\" class=\"encadre collapse\"><p><span class=\"surtitre_enc\">Le graph<\/span><\/p>\n<p>Fond\u00e9 en 1974 par six CHU (Clermont-Ferrand, Montpellier, Reims, Rennes, Rouen et Saint-Etienne), le Graph r\u00e9unit \u00e0 ce jour, dans le cadre de la loi de 1901 sur les associations, les \u00e9tablissements publics de sant\u00e9 adh\u00e9rents et les personnalit\u00e9s du monde de la sant\u00e9 associ\u00e9es \u00e0 ses activit\u00e9s \u00e0 titre personnel.<\/p>\n<p>Le Graph est un groupe de directeurs d\u2019h\u00f4pital qui r\u00e9unit m\u00e9decins, philosophes, industriels, \u00e9conomistes\u2026 pour faire avancer la r\u00e9flexion sur les grands sujets de sant\u00e9 et de soci\u00e9t\u00e9. Ses objectifs :<\/p>\n<ul>\n<li>cr\u00e9er un nouvel espace de r\u00e9flexion et de recherche en dehors des sch\u00e9mas traditionnels et du protocole fig\u00e9\u2009;<\/li>\n<li>faire \u00e9voluer le management et apporter des solutions innovantes aux grandes probl\u00e9matiques de sant\u00e9\u2009;<\/li>\n<li>promouvoir la r\u00e9flexion et la recherche en mati\u00e8re de gestion hospitali\u00e8re\u2009;<\/li>\n<li>d\u00e9velopper la recherche et anticiper les \u00e9volutions continues des organisations hospitali\u00e8res ;<\/li>\n<li>faire \u00e9merger de nouveaux talents ;<\/li>\n<li>susciter les contacts et \u00e9changes d\u2019exp\u00e9riences, en France et \u00e0 l\u2019\u00e9tranger, dans une d\u00e9marche de benchmark.<\/li>\n<\/ul>\n<p>Le Graph organise trois s\u00e9minaires par an\u2009: Graph Alpes, Graph M\u00e9diterran\u00e9e et Graph Europe (Berlin en 2014, Londres en 2015, Stockholm en 2017, Copenhague en 2018).<\/p>\n<p><a href=\"http:\/\/www.le-graph.com\" target=\"_blank\" rel=\"noopener noreferrer\">www.le-graph.com<\/a> - twitter\u2009: <a href=\"https:\/\/twitter.com\/le_graph\" target=\"_blank\" rel=\"noopener noreferrer\">@le_graph<\/a><\/p>\n<\/div><\/p>\n<p><em><strong>*<\/strong> Depuis l\u2019assembl\u00e9e g\u00e9n\u00e9rale du 27 septembre 2017, G\u00e9rard Vincent est le nouveau pr\u00e9sident du Graph.<\/em><\/p>\n<script>function PlayerjsAsync(){} if(window[\"Playerjs\"]){PlayerjsAsync();}<\/script>","protected":false},"excerpt":{"rendered":"<p>Des fondements diff\u00e9rents du syst\u00e8me de sant\u00e9 fran\u00e7ais Un syst\u00e8me financ\u00e9 par l\u2019imp\u00f4t Fruit de l\u2019histoire, la diff\u00e9rence fondamentale entre nos deux syst\u00e8mes de sant\u00e9 r\u00e9side dans le mode de financement. Assis sur l\u2019imp\u00f4t dans le syst\u00e8me su\u00e9dois, il diff\u00e8re du syst\u00e8me fran\u00e7ais inspir\u00e9 de l\u2019histoire bismarckienne et fond\u00e9 sur les cotisations sociales (2). Une comp\u00e9tence r\u00e9gionale Le pr\u00e9l\u00e8vement \u00e0 la source est centralis\u00e9 par l\u2019\u00c9tat et le montant de&hellip; <\/p>\n","protected":false},"author":23133,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[2,456],"tags":[2174,6181,6182,6183,216],"class_list":["post-36035","post","type-post","status-publish","format-standard","hentry","category-gestions-hospitalieres","category-graph","tag-benchmark","tag-graph-europe-2017","tag-stockholm","tag-suede","tag-systeme-de-sante"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.8.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Le syst\u00e8me de sant\u00e9 su\u00e9dois - Gestions hospitali\u00e8res<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ricom-web8.com\/gestions\/systeme-de-sante-suedois\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Le syst\u00e8me de sant\u00e9 su\u00e9dois - Gestions hospitali\u00e8res\" \/>\n<meta property=\"og:description\" content=\"Des fondements diff\u00e9rents du syst\u00e8me de sant\u00e9 fran\u00e7ais Un syst\u00e8me financ\u00e9 par l\u2019imp\u00f4t Fruit de l\u2019histoire, la diff\u00e9rence fondamentale entre nos deux syst\u00e8mes de sant\u00e9 r\u00e9side dans le mode de financement. Assis sur l\u2019imp\u00f4t dans le syst\u00e8me su\u00e9dois, il diff\u00e8re du syst\u00e8me fran\u00e7ais inspir\u00e9 de l\u2019histoire bismarckienne et fond\u00e9 sur les cotisations sociales (2). 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