Why in a European country to pay for ambulance — an interview with the head of the network of private hospitals of Sweden

Delo.UA talked with Daniel Oman during a workshop on the topic “Measurement of results and implementation of modern value-based business models in healthcare”. The workshop was held on 27-28 October. It’s one of three in the training program organized Medical laboratory “Synevo Ukraine”

Tell me, how does the system of healthI’m in Sweden?

All medicine in Sweden is built on the insurance model. For every citizen health insurance mandatory. The insurance policy allows citizens access to medical facilities and to sickness benefits.

How much is medical insurance?

Basic insurance costs from 800 to 1 thousand euros for the year. The package covers the services family doctor (GP and paediatrician). Emergency medical assistance, i.e. call an ambulance in Sweden pay. But it was not always so, there was a time when to call an ambulance was not worth anything, then people started to abuse this and call a doctor or without. Now emergency call costs money. Paid in Sweden and specialized medical care, that is visits to doctors such as an ophthalmologist or surgeon. Surgery also paid.

Yes, we have a high level of medicine, but in public hospitals, long queues, on average, the physician must wait 90 days. In addition, outdated equipment and are dissatisfied with the working conditions of nurses. In such health facilities high staff turnover. Every year about 25% of staff retiring from gasolines.

And who pays the insurance?

All working people pay taxes to the state budget, which, in fact, formed the budget for healthcare. The state pays 10% of the basic insurance for every citizen and 100% of vulnerable people (pensioners, children under 16, etc.).

As for the working population, the remaining 90% of them are paid by the company where they work. If the employment contract is not fixed, then the man will have to issue health insurance. But you can buy more expensive insurance, where there will be a wider range of services and it will spread to secondary and tertiary level of medicine.

What insurance company are you?

At first we had only state insurance company, now on the market there are both public and private insurers.

As private clinics operate in medsystem?

Tell you the example of my network of private clinics GHP Specialty Care AB. First, we participate in public procurement for medical services together with Gorbolnitsa. About 45% of the income of all private clinics in Sweden are filled from the state budget. In turn, the budget of gasolines 90% of the state order. Second, we work with insurers by conventional schemes.

And what about the staff, you mentioned that about 25% working in state hospitals dismissed. They move to the private sector?

Most likely, Yes. But the question is not about the money, because the level of pay in government and private hospitals are the same. For example, a good doctor can receive up to 10 thousand euros per month. Nurse to 4.5 thousand euros, and sanitation to 3.5 million euros. In most cases, people leave because of heavy loads and poor working conditions. In the private sector all the more standardized and predictable. Your doctor may adjust your schedule yourself.

You’re a pretty big private network of hospitals. Tell us how built your job?

On the Scandinavian market the GHP network Specialty Care AB there for 11 years. It includes 24 clinics that are located in Sweden, Denmark, Finland and the UAE. Each clinic has its own specialization. Main activities — problems of musculoskeletal system, neurosurgery, diabetes. Now 25% of all networks are the centres of surgery of the back and orthopedics. Our plans include the development of the network in all areas of medicine. And we intend to grow “organically” based on customer demand. On average our profit is growing at 8% a year.

Why did you decide to enter the market in the Middle East — OAU?

You know there were a couple of reasons. First, by reviewing the statistics of our attendance in Scandinavia in 2006, we saw that many of our patients are residents of the Middle East, namely the OAU. Secondly, having studied the UAE market, we have seen that there is a very low level of medical services and high prices for them.

The first clinic we opened in 2008. And today we have 4 private clinics, with a capacity from 150 to 50 beds. GHP plans to expand its presence in the region.

How much it costs to open one hospital in your network?

The minimum sum of investments in one hospital of 20 million euros. Note that this amount does not include the construction of the building itself. So in each region we are looking for a local partner, which will provide them with a space. So it was in the UAE, our idea responded to a local investor.

What features of the work in the Eastern region?

In the middle East the high demand for the treatment of burns, diabetes, and cardiovascular diseases.

As soon as entered the market, faced with a shortage of qualified nurses and not the relevant price for the service. Even now in the institutions of the network only works 15% of the local population, and all the other experts we have brought from Scandinavia.

What you pay attention to when choosing a country in which open hospital?

Entering new market is a costly process, not only money, but time. First, we analyze the market. The obtained data help to understand what’s going on, who our potential customer is, what features of the legislation. Then, open an office in the country launched preparatory actions, watching local players and pharmaceutical companies. Parallel to looking for our future partner, as the walls of the hospitals we build, we brought in the new country for us by our expert services.

At this point, our long-term strategy to strengthen our presence in those markets in which we operate.

How about entering the Ukrainian market?

At the moment we do not plan to enter new markets, and Ukraine is no exception. Now, we got an offer from China and other countries, but all refuse. Once we planned to enter the market of the Czech Republic, England, Egypt, we even saw Russia, but realized in time that it is very expensive. Because each market has its own culture, law and needs a lot of effort to become really good clinic. Need to know a lot of details.

If you had asked us about this 6-7 years ago, we would say: “Why not?!”. But now you are underdeveloped, and it’s too small. Plus, we are not confident that the investment in Ukraine investment will pay off.

How about medical tourism. You develop this direction in the clinics?

If we talk about medical tourism, for us this is not a priority. In our vision, this is a complex chain of relations between people from different countries, cultures, societies. We did not develop in this segment and do not open offices in other countries. Thanks to patients from the Middle East, we saw that foreign clients are very demanding and it is important the presence of loved ones during treatment. Experience shows that as soon as the planned visit of the client from the Middle East, had to be patient even with 5-10 friends.

Now, we believe that medical tourism is not worth investing. Although we have many customers from Europe, China, Russia.

From Ukraine come to you?

Among our patients there are no Ukrainians. And that is why for us there is no demand on the part of Ukrainians, I don’t even know.