The History of Swedish Military Healthcare System and Its Path Toward Civilian-Military Collaboration From a Total Defense Perspective

Abstract

Introduction The interaction between military and civilian healthcare systems has contributed to the development of medical care. Swedish innovations such as the Seldinger technique for angiography, Leksell Gamma Knife for cranial surgery, and the introduction of pacemakers and ultrasound have contributed to the global development of medicine. Several authors have described the Swedish civilian healthcare system and its development. However, the development and history of its military healthcare system and its influence on the civilian healthcare system remain untold. This review aims to describe the historical development of the Swedish military healthcare system and its path toward civilian-military collaboration and a total defense healthcare system. Material and Methods A search for all published scientific papers in Swedish and English, along with available legal documents and directives, was made. We used CINAHL, PubMed, Scopus, and Gothenburg University’s databases and search engines. The following keywords, Swedish, military, civilian, healthcare, collaboration, and development, were searched for, alone or in combination, using a PRISMA flow chart. Duplicates, abstracts, and nonscientific publications were excluded. Results Each of the four distinct periods of historical development in the Swedish military healthcare system can be characterized by the changes necessary for transforming Sweden from an aggressive to a defensive and collaborative nation, with national and international engagement. Collaboration not only encompasses readiness and willingness to share resources and information, and to adjust routines and guidelines, but also needs a culture of consensus and respect for each other’s limitations and capabilities. The definition of military medicine and the military physician’s role in Sweden is imperative for further civilian-military collaboration. Conclusions Recent global sociopolitical changes necessitate civilian-military healthcare collaboration. Although civilian-military healthcare partnerships in various medical fields have been reported earlier, the Swedish concept of total defense’s healthcare system integration and collaboration may be a more fruitful approach. The collaboration within the total defense healthcare system will result in technical achievements, innovations, and medical advancements for the benefit of the whole nation.

The Development of Swedish Military Healthcare System: Part II—Re-evaluating the Military and Civilian Healthcare Systems in Crises Through a Dialogue and Study Among Practitioners

“…The results of this study emphasize the need for a separate MHS and CHS, and a long-term collaboration and investment building on the historical development in the Swedish MHS first described in Part I. 17 According to all 14 different nations included in this study, there are advantages and disadvantages of a dedicated MHS. Although the respondents identified the necessity of implementing disaster and military medicine in medical education programs, the cost-effectiveness of a dedicated MHS over an integrated civilian–military solution is dependent on multiple unknown covariates and requires further study.…”

“… 16 Although the critics in the USA aim to close medical facilities and outsource the care to the private sector because of the high costs, uneven quality in care delivery, and scarcity in the number of complex cases to keep provider skills sharp between deployments, the Swedish approach aims to retain and strengthen the MHS as a powerful instrument for potential conflicts, and to treat nonbattle injuries among military staff. 14 , 17 The concept of a TDH System is characterized by the need to use both the MHS and CHS to facilitate the care of military staff and particularly the civilian population during times of armed conflicts and humanitarian disasters.…”

“…From a Swedish defense perspective, the military operational activity cannot be maintained without an integration between the military and the civilian healthcare philosophy. 17 Therefore, the current approach to achieve integration and collaborative work facilitates resource allocation, knowledge sharing, and determination of responsibilities and limitations. Additionally, it has a profound impact on the guidelines and procedures as well as the choice of equipment to support the most critically injured in the military context.…”

“…Additionally, it has a profound impact on the guidelines and procedures as well as the choice of equipment to support the most critically injured in the military context. 17 Altogether, there would be numerous long-term socioeconomic benefits as a result of such collaboration.…”

Regional Flexible Surge Capacity—A Flexible Response System

“…A recent publication from Sweden indicated a high willingness among civilians to participate in the management of MIDs [32]. Civilian defense conscription can be activated by the government without declaring heightened alert and can potentially contribute (at least in part) to staffing ACFs [33][34][35][36].…”