There is currently a heated debate among researchers, civil servants and politicians about why COVID-19 has hit nursing homes in Sweden so hard, and whether it matters whether they are privately or municipally run. Sirona was commissioned by the Confederation of Swedish Enterprise to conduct an analysis.
- "Dealing with sensitive issues and putting facts on them so that rational decisions can be made, based on values and evidence, is one of our main strengths," says Marit Vaagen, CEO of Sirona in a comment.
Mortality from COVID-19 in Swedish nursing homes has been widely discussed in the media in 2020. The discussion has focused, among other things, on whether the type of nursing home, i.e. whether it is run by a municipality or privately, has had any impact on mortality. Based on this, the Confederation of Swedish Enterprise commissioned Sirona to conduct an independent review to analyze whether excess mortality in the spring of 2020 differed between nursing homes under private and municipal management.
- The purpose of the analysis is to contribute to a fact-based and constructive discussion. Sirona is politically independent and has of course acted accordingly in carrying out the assignment," says Shadi Abbas, Senior Manager at Sirona.
To find out what the excess mortality in Swedish nursing homes has looked like linked to the type of region, a thorough analysis was made. Mortality in the homes in 2020 has been compared with the corresponding periods in 2017, 2018 and 2019, but also how it differs between homes in municipal and private management.
- A large part of the work involved quality assurance of the data. The type of management for all nursing homes included in the analysis has been carefully checked. We have used information from the municipalities' websites and compared the data with those in the National Board of Health and Welfare's database. In some cases, we also called individual homes.
In order to study differences in excess mortality at the national level, municipalities with both municipal and private nursing homes were analyzed in depth. Choosing these municipalities that have both private and municipal management is important because the majority of the country's municipalities only have nursing homes under municipal management. In total, 76 municipalities that have both private and municipal management were analyzed. Sirona has also conducted separate analyses of Region Stockholm, Region Västra Götaland and Region Skåne.
What was the result?
- First of all, I would like to say that there was a great variation in excess mortality among both municipal and private homes in the country's municipalities. There were 40 out of 76 municipalities that showed a lower excess mortality rate for the homes under municipal management than those under private management. In the other 36 municipalities, privately run homes had a lower excess mortality rate than homes run by municipalities, although the difference between the types of management was not statistically significant. At the regional level, we could see indications that privately run homes in Region Stockholm and Region Västra Götaland have had a lower excess mortality rate than homes run by municipalities, while in Region Skåne, homes run by municipalities had a lower excess mortality rate than homes run by private operators. Even at the regional level, the difference between the types of management was not statistically significant.
What does it mean?
- This means that the wide variation in excess mortality among the homes means that we cannot statistically establish that the type of setting is a decisive explanatory factor for excess mortality. Further analysis is needed to identify more underlying causes of the results and to gain a better understanding of what drives excess mortality in the country's nursing homes," says Shadi Abbas.
