Growth Analysis has analysed trends concerning accessibility to a selected number of services during the last two years. Trends in the last few years have followed the same pattern as during preceding years: the number of permanent service facilities has decreased for most types of services. However, the deregulation of pharmacies and the choice of healthcare reforms have meant that the number of primary care pharmacies and health clinics has increased during the last five years which, from a national perspective, has led to improved accessibility to pharmaceuticals and health clinics.
The trend shows that the number of shops has continued to fall during the last two years. During the 2012–2014 period, the total number of grocery shops decreased by 2.8 %. The decrease between 2013 and 2014 was slightly smaller than the year before. Since 1996, the number of grocery shops in Sweden has gone down by almost 28 %. The number of communities with only one shop has also decreased year by year. In 2014, there were just over 800 communities of that type, of which 100 were in areas with low accessibility to towns and 35 were in areas with very low accessibility to towns.
All types of areas have been affected by these changes but the greatest relative changes during the last decade have occurred in areas with medium and low accessibility to towns. During this period, the number of shops has decreased in all counties, the largest relative changes being in the counties of Jämtland and Gotland.
The trend varies with regard to both type of area and type of shop. The number of small shops (other grocery shops) has dropped dramatically throughout the whole period that has been studied. Since 2004, the decrease has been about 37 % while since 1996, the number of other grocery shops has dropped by 70 %. During 2014, the decrease was about 1 %. The number of service and traffic shops has also decreased during the period but the number of shops of the very largest type has increased for a number of consecutive years.
Because the network of shops has changed, many people now have further to travel to their nearest shop and accessibility varies greatly in different parts of the country. Almost 157 000 people have to travel more than 10 minutes to their nearest grocery shop, which is an increase of some 6,000 people since 2012 and about 37,000 people since 2004.
The deterioration during the last two years has primarily occurred in areas with high, very high or medium accessibility to towns, while the number of people with more than a 10-minute car journey to their closest shop has decreased in areas with low or very low accessibility to towns. However, the changes in areas with low or very low accessibility to towns are caused by decreasing population rather than by an improved network of services in these areas.
During the last decade, the network of fuel sales outlets has changed markedly. The largest oil companies have altered their network of fuel stations; less profitable sales outlets have either been turned into unmanned stations or closed. More than half of the fuel stations are now unmanned stations. At the same time, in many places, new local solutions have come about in order to meet people's service needs.
The number of sales outlets for petrol and/or diesel has decreased by almost 500 since 2009 and about 40 since 2012. During this period, the market has gradually stabilised which is why there have only been small changes during the most recent years. In the last year, the number of sales outlets has increased slightly in all types of areas.
The greatest relative changes since 2009 have occurred in areas with high or very high accessibility to towns. In these areas, the number of fuel stations dropped in total by 400 during the period, which is a 16 % decrease. In areas with low accessibility to towns, the number of stations decreased by 8 percent during the period while the number of stations in areas with very low accessibility to towns increased somewhat during the same period. In areas with low or very low accessibility, the number of sales outlets is relatively small which means that small changes in absolute figures have a big impact on relative figures. During the period, the number of fuel stations decreased in all counties with the exception of Västerbotten where there was actually a slight increase. The greatest relative changes occurred in Halland and Skåne.
Accessibility varies enormously in different parts of the country. In 2014, 221,000 people had to travel for more than 10 minutes to their closest petrol/diesel filling station. That is an increase of over 7,000 people since 2009. Almost 16,000 people had more than 20 minutes to their closest filling station, which is a decrease of 3,700 since 2009. At least 4,400 people had to travel for more than 30 minutes to their closest fuel station. That is about 300 people more than in 2009.
Between 2013 and 2014, the number of compulsory schools in Sweden went down by 26, which is a decrease of about 0.5 %. The changes in absolute figures are quite evenly distributed among different areas of the country but the change in relative figures is greatest in areas with low accessibility to towns where the number of schools has dropped by about 4.5 %. In areas with very low accessibility to towns, the number of schools has not changed since 2013.
It is primarily small schools with fewer than 50 pupils that have decreased in number since 2013. Here, the decrease is larger than the change in the total number of schools because some of the larger schools have grown, either by schools being merged or because the number of pupils has increased.
In 2014, more than 600 pupils in years 1 - 6 had to travel for more than 20 minutes from their home to school, which is an increase of about 70 pupils since 2004. It is mostly pupils in the most northerly parts of Sweden who have to travel furthest from home to school, more than 20 minutes, but there are also pupils in the archipelago areas of Stockholm and the county of Västra Götaland who have to travel a long way to school.
Growth Analysis’ follow-up shows that in September 2014, there were 1,319 primary care pharmacies in Sweden. That is an increase of 395 pharmacies, or about 43 %, since the pharmacy market was opened up for competition in 2009. 68 % of the new pharmacies have been established in areas with very high accessibility to towns while 26 % have been established in areas with high accessibility to towns. In areas with low accessibility, the number of pharmacies has marginally decreased since 2009 while the number of pharmacies in areas with very low accessibility to towns has not changed.
The majority of the new pharmacies have been established in areas or communities where there have previously been pharmacies and where accessibility in most cases was already good. Only a small number of pharmacies have been established in places where there had previously not been any but some pharmacies have been opened in the suburbs of larger towns and in town districts where there was previously no pharmacy.
The number of pharmacy representatives has decreased by 173 since 2009 and by 48 since September 2013.¹ The change since 2009 is the equivalent of a drop of just over 20 % in relative figures. Since 1999, the number of representatives has fallen from 963 to the current level, a decrease of almost 300 representatives or just over 31 % in relative terms. The main reason for the decrease is that the shops that had served as pharmacy representatives have been closed and there has been no one else interested in taking over.
In 2014, just over 127,000 people had to travel for more than 20 minutes to their closest pharmacy and 38,000 people had to travel for at least 30 minutes. However, 78 % of the population have less than 5 minutes to their nearest pharmacy and 92 % of the population can get to their closest pharmacy by car in less than 10 minutes.
Accessibility, measured as proximity to the nearest pharmacy, has improved from a national perspective since the introduction of the pharmacy reform. It is mainly people living in areas with very high or high accessibility to towns who now enjoy improved accessibility but, in addition, the number of people who have to travel for at least 30 minutes to their closest pharmacy has decreased during the last five years.
There have been relatively small changes in the postal service network since 2012. During the two-year period, the number of postal service facilities went down by 40, which is a 2 % decrease. The changes are evenly distributed over the two years and also relatively evenly among the different accessibility categories.
339,000 people have more than a 10-minute car journey to their nearest permanent postal service facility. That is an increase of about 21,000 people since 2009. Approximately 34,000 people have longer than 20 minutes to their closest permanent service facility, an increase of some 1,700 people since 2009. 96 % of Sweden’s population still have less than 10 minutes to their closest permanent postal service facility. In sparsely populated and rural areas, much of the postal services are done through rural delivery.
In areas with low or very low accessibility to towns, there are a total of 114 service facilities where cash can be withdrawn. These service facilities are found in 13 of 21 counties and they comprise about 2.8 % of the total number of service facilities. 84 % of the total number of service facilities are located in areas with high or very high accessibility to towns. The number of service facilities has dropped by 2.7 % between 2013 and 2014.
Approximately 133,000 people have to travel more than 20 km to their closest service facility for cash withdrawal. Of these, about 57,000 have more than 30 km to their closest service facility.
Growth Analysis' report ”Accessibility to basic payment services” gives more information about trends and accessibility to payment services, i.e. being able to withdraw cash, transfer payments and handle daily takings.²
On 1 January 2010, it became obligatory for county councils to apply the Act on System of Choice in the Public Sector (2008:962) within primary care which gave all patients the possibility to choose which health clinic they want to go to. Growth Analysis’ follow-up shows that the number of health clinics has increased considerably since 2007. The increase has mainly occurred in areas with high or very high accessibility to towns. 80 % of all health clinics are located in these areas. The greater number of health clinics is almost exclusively a result of an increase in private health clinics.
In 2014, more than 95,000 people had at least a 20-minute car journey to their closest health clinic while 29,000 people had more than a 30-minute journey. The majority of people, just over 97 % of the population, have less than 20 minutes to their closest health clinic.
Figur 1 in the Swedish summary shows the population's accessibility to a selected number of services. The services included in this analysis are grocery shops, fuel stations, compulsory schools, pharmacies, and health clinics. The figure shows how many of these services are accessible within a 10-minute car journey for people living in different parts of the country. The orange areas show which people have access to four out of five of these services within 10 minutes; the light blue areas show those who have more than 10 minutes to all of the listed services.
Figur 2 in the Swedish summary shows the gender and age distribution of the people who live in the areas with more than a 10-minute car journey to the nearest grocery shop, fuel station, compulsory school, pharmacy and health clinic. (The light blue areas in Figur 1 above). 46 % of the people living in these areas are female while 54 % are male. 31 % of the population in these areas is aged 65 years or older.
¹ During the calendar year of 2014, the number of representatives fell by 23.
² Tillväxtanalys (2014). Accessibility to basic payment services - Interim report 5. Memo 2014:26
Accessibility to commercial and public service 2014 Analysis of trends in the different regions of Sweden