(cont. from § 9) The organization of health and medical care (cont. SoU16)
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerned the organization of healthcare. V believes that private health insurance creates a sorting where insured individuals come first in the queue 1 and that private actors choose locations where there is money 2. C advocates for the possibility of freedom of choice and believes that private health insurance is an individual matter 3, while at the same time online doctor activities have improved accessibility 4. L wants national frameworks for medicines, the GP reform in law, fewer listed patients, and national competence ladders 5. MP argues that healthcare is underfunded 6, wants a primary care boost with increased resources 6, scrap the efficiency delegation 6, abolish the nationally imposed establishment right 6 and introduce "One way in" for children 6.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Karin Rågsjö (V)
Mr. Speaker! Thanks to Christoffer Bergenblock! The Center Party and the Left are very much in agreement on health and medical care policy, but there are some small things that we do not agree on, for example private health insurance and how we should use such.
We consider that it has spiraled a bit out of control, if I may put it that way, Mr. Speaker. Private health insurance can mean that a culture of demands arises among those who enter in that way and perhaps request a second opinion. In and of itself, everyone should do that, but here it might happen several times, and we have noted this in various ways.
But the big problem, we think, is for example that where I live in Stockholm, and also in other large cities where this is very commonly occurring, you get a question when you call a private actor or specialist department: "Do you have insurance, press 1, if you do not, press 2." These are health centers, specialist clinics and so on. This means that if you have an insurance, you will of course be first in the queue. You have paid for this; it is a business transaction.
But it also results in a sorting that becomes a bit strange, and my question to Centerpartiet is therefore: How should we position ourselves towards private actors who have agreements with the regions and who have these two points of entry? We use the same healthcare personnel and buildings, if one may put it that way. What should we do? Shall we let this continue, or should we review precisely these agreements?
Christofer Bergenblock (C)
Mr. Speaker! Thank you, Member Karin Rågsjö, for the opportunity to have an exchange of remarks between the Left Party and the Centre Party!
The view on private healthcare providers is a clear dividing line where we from the Center Party very clearly advocate for the possibility of freedom of choice, something that we know is very good for the patients and very good for the development and quality within healthcare.
The specific question from the member concerns private health insurance and not the public healthcare. From the Center Party's side, we have no views on the existence of private health insurance. It must be up to each individual if they want to have it, and it must be up to each employer if they want to offer it.
On the other hand, one can possibly see it as a symptom that the Swedish health and medical care is not sufficiently accessible and does not maintain sufficiently good quality. It is something to take with you, and we cannot see that there have been any major improvements during this mandate period in any case.
How it works at the individual health center and whether one presses a one or a two to reach the public or the private care, I actually have no opinions on. However, when regions sign agreements with the private healthcare providers, it must be guaranteed that the public care is not pushed out by the private healthcare providers. That is, however, a matter for the agreement that is written between the region and the private healthcare provider, and that is where that question must be regulated. Then one can press a one or a two as one pleases.
Karin Rågsjö (V)
Mr. Speaker! I still interpret it as that the Center Party is not giving a thumbs up to private healthcare providers that have two entrances and use tax funds from the region to finance it. That is how I interpret it, but perhaps I am overinterpreting – what do I know.
Free choice of care is always an interesting issue – the Center Party and the Left Party could have a seminar on it. It is very good that patients get to choose, but here it is the companies that have chosen where they should place, for example, health centers. Where do the private actors choose to place health centers? Yes, they have chosen, for example, Kungsholmen, Östermalm and Djursholm. They have not chosen to build up their operations in, for example, the countryside, because there is no cash to be had there. They have also not chosen to, so to speak, open up the larger health centers in the outer suburbs. I think that is a problem.
Another problem that I think should be highlighted is the latest incident – I may not call it a scandal – with Kry. It is still a private company that continues to operate by, for example, soliciting customers in the subway, which happens almost daily. Now there is also a system where doctors receive a bonus for having 100 calls per day. That sounds completely insane, and I wonder what Christofer Bergenblock and Centerpartiet have for thoughts regarding that.
In Region Stockholm, where C is part of the government and where we are a coalition partner, some of the private actors have had their permits revoked because they have mismanaged themselves. So that is to be understood, but what are we going to do structurally in this issue – which is only growing?
Christofer Bergenblock (C)
Mr. Speaker! I thank the member for further questions.
First, I must state that the member, just as she herself suspected, misinterpreted me regarding the private health insurance and the healthcare providers. It can, of course, be possible to have healthcare activities both towards private health insurance and towards the public sector. My point is that there must be a very clear distinction between them and that it must be regulated from the region's side.
Regarding the second question, which concerned the online doctors, it is an example of how the quality of care and the accessibility of care have developed in a fantastic way. It probably would not have happened if the care had been solely publicly driven. The online doctor activity has resulted in patients becoming accustomed to being able to contact a doctor digitally. One can see the doctor on the monitor and does not need to take their sick child and travel to the health center or the emergency room. One can directly online turn to a doctor for a digital healthcare visit and then manage the situation thereafter.
This has, however, been a relatively unregulated activity, and in the long run, the system of out-of-county fees that we have today has not functioned. Therefore, it is necessary to review how the network doctor activity can become an integrated part of primary care. We are not going to remove the function, but it shall remain. One should be able to reach one's doctor digitally just as well as physically, but it must be integrated into the normal primary care structure now that this system has developed.
Lina Nordquist (L)
Mr. Speaker! We are now debating the organization of healthcare. The Liberals want to organize Swedish healthcare with clear national frameworks in strategic issues, and I intended to tell you here about some of the main features.
To begin with, Mr. Speaker, the state must set frameworks for medicines and treatments provided – both practically and, in some cases, financially. The care we receive when we become ill should not differ based on postcode. It should also not matter how rare a disease is, what position one has in life, or how poor one's region is.
Above all, the Liberals want to give healthcare back to the patients. A very important part of this is that we intend to implement the family doctor reform all the way in Swedish law, Mr. Speaker, and significantly reduce the number of listed patients per general practitioner. It is about securing good care and a good working environment in healthcare. We have pushed for this since 1976, which is completely insane – it is 50 years! It is good that other parties have now stopped tearing up the reforms we have managed to legislate and instead say they stand wholeheartedly behind this.
Another important matter is to free up time for healthcare's professional groups so that the patients, in turn, receive that time instead of top administrators and requirement machines. The administration that is needed shall, of course, remain, but it shall be performed by others than healthcare's professional personnel. Patient records and digital work tools shall support, not consume time and cause problems, and the records shall also be compatible across the entire country.
The government has taken hold of this, and it will make a big difference both for patient safety and for people who work in Swedish healthcare. We residents shall have our patient information gathered. It is not more difficult than that. It should not be divided among different municipalities and regions, and it must be a national responsibility to implement this.
We also want to include more professional groups and more actors in Swedish healthcare to relieve pressure and free up time. Pharmacists and pharmacies can become part of the care chain in a completely different way, and this too is being pushed through now by the liberal bourgeois government. It is about the patient more easily being able to get the medicines they need and that people in healthcare should be able to devote themselves to patients who need them for something other than simple errands.
Furthermore, we are convinced that the healthcare system will have more time for the patients if it becomes easier to provide small-scale care, Mr. Speaker. Many health centers today have so many patients registered that it corresponds to a medium-sized city. We want to put a stop to this obsession with large-scale operations, which is simply insane. We want to give healthcare professionals a greater mandate and make it possible for them to focus on each patient.
Licensed professionals should simply be able to run small healthcare clinics more easily and create real local care. We assess that this will attract many people back to work within healthcare and also make it fun to work at older ages than today. Patients, in turn, will get closer to care – especially in suburbs, in industrial towns, and in rural areas.
The time for the patients obviously also increases by the healthcare employees getting more colleagues. The state needs to take a holistic approach to secure the supply of competence, including specialist competence, in the entire country's healthcare. Patients and colleagues all need to have more specialized doctors, nurses, physiotherapists, biomedical analysts, and so on. In the future, the regions shall not be able to train specialists solely for their own needs or, in the worst case, hardly at all, but they shall together take responsibility for the entire country's specialized professional groups.
It must also become easier to receive a salary based on competence. A wise specialist nurse I once spoke with compared the wage development in female-dominated healthcare professions to a tired banana. You can imagine. The wage development – or rather, the lack of wage development – is unfair and complicates the supply of competence something absolutely enormous.
A newly hired person should not have to step into a workplace with hectic round-the-clock activity and realize that the most experienced in the same profession perhaps earn 30 percent more – if even that. It causes people to resign, care beds to close, and care queues to grow. Colleagues and patients are left to face the consequences.
The Liberals intend to secure wage development with national competence ladders. Even here, the state needs to take a strategic responsibility. The most competent should earn double compared to a newly graduated.
I move on to the right to knowledge. Even there, the state needs to step in. The right to knowledge allows more people to stay in healthcare and also makes them even wiser than they already are. The Liberals want to legislate that licensed professionals have the right to continuing education and competence development throughout their entire professional lives. Even here, the government has initiated a very important piece of work. We pushed hard for this during the last parliamentary term, but without success. Now, however, things are happening.
The regions must also be given a clear responsibility to contribute to research and to the development of healthcare. This also needs to be written into law. Furthermore, the Liberals want the state to co-finance clinical trial leaders to facilitate the testing of promising medicines. Here, the regions must not be a stumbling block. They must help to drive healthcare forward.
Now some of those listening might have to cover their ears: Another important thing that we need to handle nationally, even if not fully by the state, is to simplify the paths for money and decisions. The regions do finance healthcare. The state chips in a few percent, and those percentages thin out quite radically on their way to the clinic floors.
The member organization Sveriges Kommuner och Regioner, SKR, needs to be de-bureaucratized. SKR is an important employer organization, but for patients and taxpayers, it can at times become very clumsy and non-transparent. The influence over the governance of welfare must be open, understandable, and fully democratically accountable. This must be addressed.
In summary, we simply must stop making healthcare more complicated than it needs to be. Simplification is difficult to implement, and therefore we believe that our goal and all our sub-goals require long-term commitment in the form of a regular, parliamentary healthcare group, equivalent to the Defense Commission or the parliament's pension group.
We intend to put a stop to inequality, over-bureaucracy, understaffing, and organizational slowness. For us residents, it means shorter healthcare queues and wiser use of tax funds. Above all, patients will become healthier and significantly more involved.
Nils Seye Larsen (MP)
Mr. Speaker! Healthcare today faces great challenges. This applies across the entire country. It concerns primary care, hospital care, and psychiatric care. The most important explanation for the problems is that healthcare has for a long time been underfunded and has not received the resources required for it to fulfill its mission.
The underfunding is noticeable in several ways. It is noticeable in a pressured work environment and high workload. It is noticeable in the difficulties of recruiting and retaining staff. It is noticeable in that healthcare has difficulty both managing the daily work and simultaneously developing quality, efficiency, and new ways of working.
This is not just a problem for the staff. It directly affects the patients. When care is understaffed, when employees are exhausted and when there is a lack of time for continuity and follow-up, the availability and quality are also impaired.
Mr. Speaker! If the Riksdag is serious about healthcare being equal, accessible, and of high quality, it must also be given long-term sustainable economic conditions. It is not enough for the government to come with temporary investments, micro-management, and new requirements if the long-term and economic conditions are simultaneously lacking.
Mr. Speaker! This is very clearly visible in the transition to a good and close care. Primary care should be the hub of care. Patients should get better continuity. Care should come closer to people. A stronger primary care would also relieve the rest of the specialized care.
In the report Omtag för omställning, however, the Agency for Health and Social Care Analysis states that none of the transition's goals have been achieved and that an important explanation is that the operations have not received sufficient improved economic or personnel resources.
The National Board of Health and Welfare makes the same assessment in its partial report: Resources and competence supply have not been strengthened to the extent required to carry out the transition.
Mr. Speaker! That is why a clear primary care lift was needed. Increased resources for primary care were needed. Investments in competence supply were needed. Better working conditions were needed. Concrete proposals from the government were also needed on how primary care should be strengthened based on the conclusions that already exist in the authorities' reports.
We know that access to general practitioners, district nurses, psychologists and others has not improved within primary care despite the need being great. We also know that availability differs between different parts of the country. This hits particularly hard in rural areas and in those parts of the country where it is already difficult to recruit staff. Therefore, the government also needs to appoint a special inquiry on how the supply of competence within primary care can be strengthened across the entire country.
But it is not just about more hands. It is also about how the work is organized. Primary care needs to build more on teamwork, where more professional categories are utilized in the daily work. Dietitians, speech therapists, psychologists and specialist nurses need to be a clearer part of the healthcare's basic structure. When more professions are used correctly, the care becomes both more accessible and more efficient.
Mr. Speaker! I also want to highlight the government's efficiency delegation. If the government is serious about developing the quality and efficiency of healthcare, the work must be anchored in the reality of healthcare. It is therefore remarkable that the delegation the government has appointed in practice lacks broad representation from healthcare professions. At present, it consists of a single doctor, who is also the CEO of a large online doctor company, while the emphasis otherwise lies on health economists, an analyst, and someone who is also the welfare representative for Svenskt Näringsliv.
It is not enough. If one is serious about developing healthcare, the healthcare workers must be involved. Representatives for different healthcare professions are needed. Healthcare providers with practical experience are needed. Patient organizations are needed. Research with a broader perspective than solely health economics is needed.
Therefore, our message is clear: Scrap the current efficiency delegation! Do it over and do it right! Instead, appoint a new quality and efficiency delegation where healthcare staff, researchers, healthcare providers, and patient organizations are included! It would provide significantly better conditions for long-term development work that actually takes its starting point in the needs of healthcare.
Mr. Speaker! The regions are responsible for organizing primary care but are simultaneously constrained by a nationally imposed right of establishment according to the law on freedom of choice for private actors. This has created an imbalance. In some metropolitan areas, there are many health centers and fierce competition. In rural areas and in socioeconomically disadvantaged areas, the establishments are significantly fewer. This makes it more difficult for the regions to steer healthcare according to need. It also exacerbates the problems in a situation where the competence shortage is already great.
Miljöpartiet therefore considers that the nationally imposed right of establishment within primary care should be abolished. The regions must be given a greater opportunity to manage establishments so that care is available where it is needed, not just where it is most profitable to establish itself.
Mr. Speaker! Primary care needs to take greater responsibility for early interventions in mental ill-health. All health centers should have psychological or psychosocial competence, and counseling support should be able to be offered without a referral. It is necessary for people to receive help in time and for specialist psychiatry to be able to focus on those with the greatest needs. Around one million people every year seek help in primary care for problems linked to mental ill-health, while at the same time a quarter of the health centers lack a psychologist.
When it comes to comorbidity, the need for better organization is even clearer. Persons with both dependency issues and mental ill-health risk being bounced around between different authorities and receiving deficient interventions. Therefore, the proposals from the Comorbidity Inquiry need to be implemented so that the responsibility for treatment is centralized within health and medical care.
When it comes to children and young people, there must be a clearer path into care. Many do not know where to turn. Therefore, the method of work "En väg in" needs to be introduced in all regions. First-line psychiatry for children and young people needs to be organized better and more equally across the entire country.
Mr. Speaker! I also want to say something about the climate work in healthcare. Healthcare is a large societal sector with significant climate and environmental impact. Therefore, healthcare needs to become better at and receive better support in the work of reducing its emissions and its environmental impact and phasing out substances that are hazardous to health and the environment. A more coordinated national effort is needed here, where the state takes clearer responsibility for knowledge support, data collection, investments, and cooperation with the regions. It is also part of organizing healthcare so that it becomes long-term sustainable and responsible.
Mr. Speaker! In summary, our message is clear: The problems in healthcare cannot be solved with short-term micro-management from the government. What is required are long-term economic conditions for the regions and larger investments in healthcare in general. A clear primary care boost is required. Better working environments and better conditions for the staff are required. It is required that the state supports the development of healthcare in a way that utilizes the profession's knowledge instead of overriding them. That is the direction that Miljöpartiet stands for.
I would like to conclude by moving for approval of reservation 3.
The deliberation was hereby concluded.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.