In Sweden, they don't have a federation like Canada or Australia. But they have a complex system. They have 20 councils, and their role is to look after hospital care, physician care, academic health science centres, and pharmacare. All those things are under one council that has its own taxing powers. They have about 300 municipal councils. They look after all the things that we would say are determinants of health. They have housing, social services, care for the elderly, home care, and care for the disabled. That council has its own taxing powers. In fact, they have two different councils with distinct taxing powers. One council doesn't need to take from acute care to get the resources—they can tax separately for that.
The mandate of the federal government is really to set national priorities, which they do jointly when negotiating with the councils and agreeing on what the national priorities are. The federal funding going in is quite small, less than 10%. Most of the funding comes through the county councils and municipal councils, but it is a complex structure. They still need to negotiate how to maintain a standard approach to health care throughout those councils, all of which have governance structures over them, to deliver a consistent level of care regardless of where you are in Sweden.
They work very hard on getting consensus and establishing priorities. They manage it very carefully and they do a lot of measurement. They can measure care right down to the physician, the hospital, and the county. They have several years of data available, so they can see how their performance changes over time.