All 112 patients aged 80 and above treated at the intensive care unit at the University Hospital in Lund, Sweden 1994-1995 were followed-up retrospectively in terms of six-month survival (SMS) and for survivors in terms of quality of life. Overall SMS was the same for both men and women--47%. Patients with the poorest SMS were those aged 90 and above with only one patient out of eleven surviving six months. Patients admitted for severe heart failure also showed a very poor outcome with SMS 27%. Patients were grouped in terms of living conditions prior to admission to the ICU, and a significant difference in six-month survival was noted between those living in their own homes (53%) prior to admission compared to those coming from a nursing home (25%). Patients surviving six months were interviewed by telephone regarding their living situation in March 1997. More than 50% of survivors were living in their own homes with external help no more than once a day. The average APACHE II score was 14.9 +/- 8.2. The average score for patients surviving six months was 13.4 +/- 5.9 and for those not surviving six months 16.8 +/- 5.1. No significant statistical difference in APACHE II scores between these two groups was shown.
The health care systems are fairly similar in the Scandinavian countries. The exact details vary, but in all three countries the system is almost exclusively publicly funded through taxation, and most (or all) hospitals are also publicly owned and managed. The countries also have a fairly strong primary care sector (even though it varies between the countries), with family physicians to various degrees acting as gatekeepers to specialist services. In Denmark most of the GP services are free. For the patient in Norway and Sweden there are out-of-pocket co-payments for GP consultations, with upper limits, but consultations for children are free. Hospital treatment is free in Denmark while the other countries use a system with out-of-pocket co-payment. There is a very strong public commitment to access to high quality health care for all. Solidarity and equality form the ideological basis for the Scandinavian welfare state. Means testing, for instance, has been widely rejected in the Scandinavian countries on the grounds that public services should not stigmatise any particular group. Solidarity also means devoting special consideration to the needs of those who have less chance than others of making their voices heard or exercising their rights. Issues of limited access are now, however, challenging the thinking about a health care system based on solidarity.
