International Health Policy Survey 2022

This is a short summary of the Swedish results and analyses of the Commonwealth Fund’s International Health Policy Survey (IHP) 2022. The survey focuses on several key areas of primary care physicians’ experiences, including their workload and stress levels, their access to digital tools, their interactions with other parts of the healthcare system and the quality of the healthcare services provided to their patients. Australia, France, Canada, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom and the United States participated in the survey.

In Sweden, a questionnaire was sent to approximately 6,000 physicians working in primary care. A total of 2,092 physicians responded to the survey, which corresponds to a response rate of 36 percent. In addition to capturing descriptive findings from the survey, we conducted statistical regression analyses on the Swedish data to examine the covariation between the survey results and various physician-related factors related to the physicians such as age, gender, education, geographical location and socio-economic conditions in the areas where they work.

Results and conclusions of the international comparison

According to the survey, Swedish primary care physicians continue to be among the most stressed, although stress levels have increased in the other countries since the last survey in 2019. Only half of the Swedish physicians are satisfied with their work as a doctor.

Two out of three Swedish primary care physicians experience their work as very or extremely stressful. The levels of stress experienced by primary care physicians in other countries have increased compared with what was seen in the IHP 2019. However, Swedish primary care physicians’ levels of stress remain among the highest. In all countries, physicians report that administrative tasks are the most stressful aspects of their work.

Only half of the Swedish primary care physicians are satisfied with working as primary care physicians, and almost a third plan on quitting within the coming three years. The results have not worsened in Sweden since 2019, but have worsened in the other countries. About 35 percent of the Swedish primary care physicians experience symptoms of burnout, which is around the same proportion as in the other countries in the survey. Having experienced mental health problems at any point since the start of the COVID-19 pandemic is more common among the Swedish primary care physicians than among physicians in most of the other countries.

Swedish primary care physicians meet fewer patients and spend more time with them than physicians in other countries.

Although the Swedish primary care physicians experience high levels of stress, according to the survey, they meet fewer patients and have longer consultations on average than the physicians in the other countries.

We cannot say, based on the survey, why patient consultations are longer in Sweden than in other countries. One possible explanation may be the fact that Swedish healthcare faces challenges with providing continuity of care, which may be less of a problem in other countries. For example, only 35 percent of the adult population in Sweden report that they have a designated doctor that they visit while almost everyone in the other countries has a regular doctor. When a physician meets a patient for the first time, they typically have limited information about the patient’s medical history and current health status, which can result in longer appointments compared with if they have met many times before and the physician has more familiarity with the patient’s health.

Swedish primary care physicians regularly follow up on their patients’ results. However, they often lack information from other parts of the healthcare system.

Swedish physicians respond that they regularly (annually or quarterly) review treatment results, prescription of drugs and experiences of care among their patients. In contrast, hospital admissions and visits to emergency departments and patient-reported outcome measures are not reviewed to any significant extent.

Lack of information between primary care and specialist care continues to be a problem in Sweden.

Fewer primary care physicians in Sweden than in other countries respond that they receive information about changes in patient care after their patients visit specialist care. The proportion of respondents who receive information has decreased since 2019. However, almost all primary care physicians respond that they have sent patient history and reasons for referral to specialist care. It is also common for primary care physicians to communicate with the municipality about patients receiving care at home.

Swedish physicians to a lesser extent respond that the primary care centre they work at is prepared to provide care to patients with chronic illnesses.

Swedish physicians to a lesser extent than physicians in other countries respond that the healthcare staff at their primary healthcare centre is prepared to provide care to people with chronic illnesses. In addition, the proportion that respond that they are prepared has declined since 2019. Regarding how well the staff is prepared to provide care to people in the specific disease areas mental illness, addiction and dementia, the Swedish result is generally around the average of the countries, but we see a slight decline since 2019 for all these areas. The only improvement since 2019 is how well the staff is prepared to provide care to people in need of palliative care.

Swedish physicians to a greater extent than physicians in other countries respond that they have care plans that can be used by patients in everyday life and that they give written instructions for self-care to patients with chronic illnesses. Sweden’s results are largely unchanged since 2019, but it has become more common to use digital tools for remote monitoring of patients’ conditions in Sweden and all other countries in the survey.

Sweden remains at the forefront of introducing digital tools for patients and physicians in primary care and we see an increase in introducing digital tools compared to 2019.

Sweden is the country in the survey that offers the highest levels of digital services for patients in their contacts with healthcare, such as providing digital means to contact the healthcare centre with questions, book appointments, renew drug prescriptions or access medical records. In most countries, we see a slight increase in positive responses to most questions compared with in 2019.

Furthermore, Swedish physicians respond that they are usually able to digitally exchange medical records, test results and drug lists with other healthcare providers. Compared with in 2019, the proportion has increased in all countries participating in the survey.

On the other hand, Swedish physicians are less positive about performing care remotely using telehealth compared with physicians in other countries. Swedish physicians to a lesser extent respond that they are satisfied with performing care remotely and they are less likely to agree that digital care has improved their ability to provide care on time.

Compared with in other countries, primary healthcare centres in Sweden are seldom open after 6 pm on weekdays or on weekends.

There does not appear to have been an increase in opening hours during evenings and weekends at Swedish primary healthcare centres since 2019. It is still unusual to have the centre open full-time. However, many clinics offer other opportunities to receive care outside office hours.

Only 12 percent of Swedish physicians answer that they work at a healthcare centre that is open after 6 pm, and 11 percent answer that they work at a healthcare centre that is open on weekends. The figures differ greatly from those for other countries in the survey, where evening and weekend opening hours are more common. However, the survey does not show what the opening hours are in the daytime, which makes it difficult to compare the total availability in terms of opening hours between countries. Sweden is no different from other countries when it comes to the opportunity to see a doctor or nurse in any other ways during evenings and weekends. Six out of ten Swedish doctors answer that it is possible to see a doctor or nurse outside office hours without having to go to an emergency room at a hospital.

Results and conclusions from the analyses of the Swedish result

Below are the results and conclusions of our in-depth analyses of the Swedish results. All results presented here are based on statistical regressions.

Several factors covary with a better working environment for doctors, such as longer patient consultations, educational efforts and having a personal list of patients.

There are both individual factors and factors linked to the primary healthcare centre that correlate with physicians’ job satisfaction and stress levels. Among the individual factors, we find that men are generally more satisfied with working as doctors and less stressed than women. When it comes to factors that are linked to the primary healthcare centre, we find that:

• Physicians who have longer patient consultations are generally less stressed, more satisfied with their work and less likely to plan on quitting.
• Physicians who receive training and support from their employer in the development of their working methods are more satisfied and less stressed.
• Physicians who experience problems with various administrative aspects of their work (for example, recordkeeping and cases at the Swedish Social Insurance Agency) experience more stress, are less satisfied with their work and more often plan on quitting.
• Physicians who work on average more than 40 hours per week experience more stress and are less satisfied with their work than those who work less.
• Physicians who have a personal list of patients for whom they are responsible are more satisfied with their work than those who do not.

These findings indicate that there are several factors that healthcare centres can work with to improve the working environment in primary care. However, the analyses show statistical correlations only, and we cannot say that causal relationships exist between these factors and a better working environment.

Doctors who have a personal list of patients and doctors who receive support and training in their work to a greater extent believe that their healthcare centre is prepared to provide care to people with chronic illnesses.

Doctors who respond that they have a personal list of patients for whom they are responsible to a greater extent respond that the primary healthcare centre they work at is well-prepared to offer care to patients with chronic illnesses, including those with mental health conditions.

Doctors who believe that they receive the training they need to develop their own and their organization’s working methods and to maintain and develop their medical competence to a greater extent report that the healthcare centre they work at is well-prepared to offer care to people with chronic illnesses.

These results also indicate that there are avoidable factors that the healthcare centre can work with to improve primary care.

Older doctors find that the transfer of information from other parts of the healthcare system works better than younger doctors do. They also provide more support for self-care to people with chronic illnesses.

There are some differences between older and younger doctors in the survey. Older doctors more frequently than younger doctors report that the transfer of information from specialist care or emergency departments to primary care works well. Older doctors also more often than younger ones respond that they provide support for self-care to people with chronic illnesses.

It is possible that older doctors have more experience and have built contact routes to other doctors within specialist care – and thus have greater possibilities to exchange information. Similarly, the experience of older doctors can play a role in the ability to provide support for self-care to people with chronic illnesses.

Men are more satisfied with their work situation at primary healthcare centres than women. They also think that the transfer of information from other parts of healthcare works better.

In several areas of the survey, we find that men generally report better results than women. For example, men to a higher extent than women respond that they are satisfied with working as physicians. They also experience less stress in general, including less stress related to administrative tasks. In addition, male physicians more frequently report that the transfer of information from specialist care to primary care works well. We cannot, based on the survey, investigate these gender differences further. Therefore, we cannot explain what causes the differences between men and women. However, these differences are similar to the gender differences found in other sectors.