Medicines and dental care

Jesper Skalberg Karlsson (M)

Mr. Speaker! In the next election, 2026, the young generation that votes will have lived more than half their lives in a Sweden with a Moderate Prime Minister. I swear it is the first time it happens in our country. The country that has been shaped during this time is different from the one that previous generations have known. We have our problems; that must be said. But much has also become better, not least in the area that we are debating today.

In Sweden, you can now choose a health center. You can visit pharmacies that are located in more places and have longer opening hours. You have real alternatives to the public dental care. And the stressed parent of small children who needs to buy painkillers can now do so at the gas station and does not need to wait for the pharmacy to open its doors the next day. It is a richer, more pleasant and more accessible Sweden where adults have greater influence over their own health.

Mr. Speaker! The development of new medicines and treatment therapies is moving very fast, perhaps faster than ever before. That is good. Medicines improve and prolong life. Therefore, accessibility when it comes to medicines is crucial.

In this context, I want to say that accessibility is a very broad issue. It is about new treatments being approved in Sweden, about the implementation taking place in an equal manner in the regions, about deliveries functioning, and about the follow-up of treatments being able to take place.

Let me make some observations on what is happening in this policy area. In the European Union, work is underway to develop new pharmaceutical legislation that will secure access to medicines at reasonable prices. During the spring, the Belgian presidency will hopefully take major steps in this area. I want to clearly declare that Moderaterna want to see European legislation that enables the Union and Sweden to compete with the USA and Asia in terms of competitiveness. We shall not just be the best runner-up. It will require a lot, but it will be worth it.

Last spring, a memorandum, department report number 8, was presented regarding proposals that can create better conditions for clinical trials. It is an area where Sweden has continuously lost ground for a long time. Even though the room for reform is very limited today, I want to say from my party's side that this is a critical issue for a competitive life science sector in Sweden. The proposals are being prepared in the Government Offices, and our hopes are very great.

The tripartite government, with the support of the Sweden Democrats, also continues to take initiatives in the area of digitalization. There is already work regarding a national medicine list, and much is being done regarding the national digital infrastructure for health data. Work is also ongoing on a national website regarding quality and efficiency in healthcare.

At the same time as we embrace the possibilities of digitalization, we need to be honest that there are errors and fraud in these systems. By breaking down confidentiality barriers and using digital tools, over-prescriptions and crime linked to pharmaceuticals can be better curbed. Strangling the criminal economy is a priority for the entire government, so here as well.

A question that we debated extensively when this report was taken up last year was that there is a lack of a strategy for rare health conditions. It is pleasing that work on such a strategy has now started, on the initiative of the government. We Moderates are following it with great interest.

The work to strengthen the healthcare system's supply preparedness continues with full force under the leadership of Ministers Ankarberg Johansson and Bohlin. For us, it is also crucial that the measures to be taken strengthen the supply preparedness in a long-term way and that they do not risk leading to diminished availability today. There are reasons to be clear: an armed attack against Sweden cannot be ruled out. For that, we need to prepare today, not when the crisis is at the door. Those who do not prepare are unprepared.

Mr. Speaker! Let me also say something about vaccines. There are those in the Swedish debate who say that the only thing that can reduce the overload within healthcare is to pump out new billions without requirements for performance and without taking into account the inflationary blaze that is still burning. At the same time, there is a significant movement that miscredits vaccines. We saw this, not least during the pandemic, which, by the way, is exactly four years old today. It is today four years since the first case was identified in Sweden.

It is in a sense true that new medicines that magically cure every discomfort completely without side effects is a fever dream. But the proven vaccines and even new vaccines that are on the European market could, with broad vaccination campaigns, make an entirely decisive difference. During the year, the government has pointed out, for example, the HPV vaccine for boys and men as a priority issue. I am very proud of that.

We Moderates also know that large health gains that provide healthier lives and reduced pressure on healthcare are achievable with the help of vaccines against, for example, RS virus, shingles, and pneumococci. It is clear that the investigation on the vaccination programs presented earlier in January provides some but not all answers. It may not be entirely in line with the expectations that existed from the committee when the announcement regarding specifically elderly vaccination programs was made in 2022. It cannot be ruled out that a new approach to the issue needs to be taken.

Mr. Speaker! The new government has, in a relatively short time, changed the course for Sweden. But we want to do more. In the agreement that our four coalition parties have concluded, we establish that the role of pharmacies in the care chain needs to be developed. We want more services, for example health examinations and not just blood pressure checks and the like, to be able to be offered at pharmacies. We will also move forward with proposals for a new pharmaceutical range that shall be an intermediate position between over-the-counter and prescription-only.

With our proposals, which a majority in the chamber stands behind, more adults can take responsibility for their own and their family's health while an overburdened healthcare system can get a breather and accessibility can increase. It is good for Sweden, for healthcare, and for the broad public health.

I wish to move for approval of the committee's proposal for a decision.

(Applause)

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Mikael Dahlqvist (S)

Mr. Speaker! I note that we agree on some issues but are far apart on others. However, I lack a portion of humility in the member's speech. One may certainly think that the government is the best, but at the same time, one must see the challenges.

The members of the committee addressed, among other things, the state of preparedness. This is good because it is an extremely important issue. We must be prepared and prepare ourselves. But the government is doing the opposite. We have a healthcare crisis due to a cost crisis because the government has not chosen to prioritize that sector. What happens then to the healthcare system's preparedness?

Mr. Speaker! I also intend to ask other questions to the member. In the government's budget bill, a fairly substantial reduction in dental health is signaled. It is proposed that the limit for free dental care be lowered in 2025 from today's level of 23 years to 19 years. The double dental care subsidy for those between 24 and 29 years will also be removed, which is estimated to provide a saving of hundreds of millions. My questions to the member are how the government's representatives here in the Riksdag think about this historical reduction and why those funds are not used to initiate a high-cost protection.

(Applause)

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Jesper Skalberg Karlsson (M)

Mr. Speaker! Thanks to Member Dahlqvist for the question on this subject! First and foremost, the government needs to strengthen confidence in the Swedish economy. It is clear that inflation is afflicting many households and thereby the entire society. It is clear that the weak krona, for example, affects what medicines cost and how they end up on the Swedish market.

It is important that we do not worsen the situation with inflation in this situation. It is important so that pharmaceutical companies will want to sell therapies in Sweden and so that the nurse's salary will be enough for food, fuel, and other things. Regardless of that, one should remember that 40 percent of the reform space that exists in the economy goes to the welfare sector.

Regarding dental care, it is a complex issue that also concerns many other policy areas. It is about more people needing to be trained so that the competence shortage will decrease and about prioritizing resources to those with the worst dental health. My view is that in order to be able to prioritize resources correctly and ensure that competence is used where it is needed most, we need to make certain reprioritizations. That is the background to why certain changes are being made regarding age limits.

The government will move forward with reforms aimed at ensuring that the elderly who have the worst dental health receive the care they need and deserve. There must be a clear answer as to what one receives for their tax money after having worked a whole life, and it must be a dental care system that works.

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Mikael Dahlqvist (S)

Mr. Speaker! I thank the member for the answer. There are different views among experts in the field of economics on how inflation affects society. Most claim that a strong public sector does not affect inflation. Furthermore, it is on its way down. Now, some experts warn that we are heading towards deflation. That question, therefore, I think we can leave there.

Mr. Speaker! I did not quite get an answer to my question. It was about in what way dental care will become better by the government cutting almost half a billion, especially in these times of cost shock for Swedish households and when we know that a large part of dental treatments are paid from one's own pocket. What happens to the groups that have a weak economy? I ask for a clearer answer from the member.

It seems that the government has picked parts out of the previous dental care investigation, so I would also like to hear the member's answer as to why one does not fulfill what was said in that investigation regarding that the money released through certain reforms should be put towards a type of high-cost protection. The government chooses instead to announce that one is proceeding with only a saving.

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Jesper Skalberg Karlsson (M)

Mr. Speaker! I thank Member Dahlqvist for the follow-up questions.

One can look at the economy in different ways. That is why there are different parties. But it is important to note that regardless of how much one invests in healthcare - we are putting 40 percent of the reform space on welfare specifically - for example, Sweden's Riksbank has said that all reforms outside the reform space, that is, unfunded reforms, will be met with the interest rate weapon. I think that would be the wrong way forward.

When it comes to picking parts out of investigations and not proceeding with all proposals, I would say that it is every government's right to take the proposals they think are good and proceed with them. The proposals they think are bad, they leave there. It is also a strategy or a way of working that the Social Democrats have used during their time in government. After, for example, the pharmaceutical investigation, it was only the cost-saving proposal that was implemented and none of the others. That the government proceeds with the proposals they find appealing is therefore nothing new for this government, but something that has happened for a very long time.

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Karin Rågsjö (V)

Mr. Speaker! The member says that we will be very prepared if there is a crisis in Sweden. But the fact is that the population might be prepared while the health and medical care definitely is not anymore. We are currently living with a crisis within health and medical care. I will not elaborate further on that now.

This debate is about pharmacies and dental care and also about medicines. Among the medicines that are out of stock at suppliers, for example, painkillers for children stand out, which is quite serious, and the diabetes medicine Ozempic, which is also used for overweight people. The shortage also applies to antibiotics. I have experienced this myself when I got borrelia and had to hunt around even though I do not live at Kebnekaise but in Stockholm.

I think this is a mega-problem and that we must do more. My first question is what the government intends to do. The problem has grown over a number of years. Should the pharmacy industry, for example, as a collective not be obliged to have stock management? There are a multitude of questions.

The member spoke very little about dental care, which is a huge issue right now. Among people with very low incomes, only 52 percent visit the dentist within a two-year period. This was measured in 2018 and 2019. This can be compared with a proportion of 82 percent among people with higher incomes. It leads to very acute dental visits, specifically at the public dental clinics. Does the member consider this to be a problem? What needs to be done?

Another question concerns the lack of requirements for private dentists. Today, it is primarily Folktandvården that receives children, young people, and the elderly. It creates an incredible inequality. I will return to that.

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Jesper Skalberg Karlsson (M)

Mr. Speaker! Thanks to Karin Rågsjö for a wealth of different questions regarding what we are debating today! First and foremost, I want to clarify that in my speech I did not say that we are incredibly well prepared for crises. On the contrary, we need to clearly and powerfully start preparing ourselves for crises already now.

It is not the case that Swedish crisis preparedness is good in all areas. There are reasons for clear priorities in this area and for a major effort, but that being said, my view is that, just as Karin Rågsjö says, there is a certain preparedness among the population. It has increased in recent weeks, but more needs to be done.

When it comes to the shortage of medicines, it is a multi-layered crisis. It involves, among other things, disruptions in the supply chain and value networks globally after the pandemic. It is not the case that we in Sweden have the entire production here and can influence it; rather, it is very much about other countries catching up. We also need to ensure that free trade functions. Furthermore, the weak krona is a problem, and in the area of approval of new medicines, we see that there is more to be done.

In the short perspective, it is still worth noting that TLV, Tandvårds- och läkemedelsförmånsverket, is actively working on the issue and carries out certain price adjustments precisely so that medicines do not only exist as back-ordered. They must be on the shelf. It is on the shelf and in the hands of patients that they do good, and here work is ongoing at the agency level.

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Karin Rågsjö (V)

Mr. Speaker! I think this is a catastrophic situation. The number of backordered medicines that were not available at the pharmacies increased by 100 percent during 2023 compared to the year before. We are therefore talking about massive problems, and then perhaps one must start looking at this even in Sweden. This is global, but we must also look at what we can do in Sweden. Can we do something ourselves? If we were hit by an enormous crisis now – such as, God forbid, a new pandemic – we would be very poorly equipped. There is no doubt about that.

Then we have this with dental care, which I think is a huge issue. It is precisely about what should be done. The member did not say many words about just dental care, and one can wonder why. Private dental care accounts for only 14 percent of dental care for children, young people, and adults with poor dental health, while as much as 58 percent of the state dental care support went to the private dental care sector. One can wonder about that, I think.

I believe we must review the distribution so that private dentists also receive young people, children, the elderly, and people with poorer dental health, because they do not do that today. Instead, it falls on the public dental care. This is noticeable even in a large city like Stockholm, where there are enormous queues to just the public dental care while the private sector takes in people who have slightly easier problems. It then, of course, becomes a larger piece of the cake for them.

I think we must look at this. Does the member consider it an issue we should look at, or shall we continue in the way we do now – which increases inequality within dental care?

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Jesper Skalberg Karlsson (M)

Mr. Speaker! I thank Member Rågsjö for her follow-up questions.

I agree with Member Rågsjö that it is not satisfactory that so many medicines are reported as remaining. At the same time, it is important to note that during the past year we have received a better picture of what the situation actually looks like.

The government has put forward proposals and also legislation regarding that those who risk facing a shortage situation should report this. The obligation to provide information, that is, the obligation to report when shortage situations arise, has thus been established. This means that more people can report and tell when there is a risk of shortage. Even though the problem is large, a part of this is that the obligation to provide information has been strengthened.

When it comes to the elderly who have the worst oral health, I share Rågsjö's ambition that they should be prioritized. There are certainly different ways to do this, and we will discuss it further ahead. When it comes specifically to those elderly people who have the worst oral health, they shall however be prioritized; this is mentioned on page 8 in the so-called Tidö Agreement and is also well described in the budget bills that we have debated in this chamber.

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Anders W Jonsson (C)

Mr. Speaker! I will begin with a small observation: It is always exciting when the debates that the Social Affairs Committee has on various specific issues sooner or later go off the rails and become a debate between Social Democrats and Moderates on how we should best combat inflation. I believe it would be good if one could go into a bit more of the specific issues that this actually concerns.

I was pleased when I heard the Moderate member raise exactly accessibility as a major challenge regarding pharmaceuticals. I was then, however, disappointed because the truly major problems regarding accessibility are not mentioned.

I will raise one point, and it concerns the requisitioned medicines. New medicines are approved by the NT Council, and then it is up to the regions to use them. It often concerns very severe diseases. Here we see a significant difference between the regions regarding whether they can even afford to requisition the medicines. It is a very large problem regarding accessibility.

The Chairman also highlighted the joy that we will receive many additional vaccines, but even there we see this problematic issue. The Stockholm region has strong finances, and is prepared to lead the way when it comes to using new vaccines - but regions that have major economic problems due to geographical distances and other factors, for example Norrbotten and Västerbotten, do not have the economic resources.

We have this situation, and when the government also puts the regions and Swedish healthcare on a starvation diet, this will become even more serious. I think it would be interesting to hear how Jesper Skalberg Karlsson views the issues regarding availability, where we get larger and larger differences between different regions precisely because of how the government views pharmaceuticals - and additionally because of how it chooses to finance the regions.

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Jesper Skalberg Karlsson (M)

Mr. Speaker! I thank Member W Jonsson for a very specific, direct and concrete question. I agree that the situation in this area is not satisfactory. I also do not think it has been satisfactory for a relatively long time.

When it comes to an equal introduction of new medicines and therapies in the regions, the Moderaterna in opposition have, for example, pushed for proposals to legally regulate the NT Council's activities in a way that is not the case today. I can agree that it is important to strengthen equality.

I also know, however, that work is ongoing within the so-called Care Responsibility Committee, which is to look not only at the entirety of the Swedish healthcare system but also at parts of the Swedish healthcare system where more national governance and greater national responsibility were needed. I both expect that this will be discussed extensively and know that it will be discussed extensively. I look forward to the conclusions, and I hope that they will come as a partial report instead of in the final report.

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Anders W Jonsson (C)

Mr. Speaker! I did not quite perceive any answer to my question. This is a real problem. The member says that the situation is not satisfactory, which I would rather consider an understatement given how it looks around the country. The regions cannot afford to requisition new medicines and cannot afford to offer new vaccines.

The proposal to regulate the NT Council by law does not help the poor region. The problem is not that the NT Council has not made decisions, but the problem is that the regions do not have the money to requisition medicines – and even less to offer new vaccines. That this is a problem that has existed for a long time is a very poor defense, even if one should certainly read into it that it is the social democratic government's fault. But this is a problem that is now accentuated, and therefore I think it would be appropriate to hear some proposals from the Moderate member.

One could, for example, imagine that the state stepped in and took financial responsibility for new vaccinations. One could also imagine that the financing of pharmaceuticals was reviewed. Furthermore, the starvation that the current government has subjected the healthcare system in Sweden to could be reviewed. Even Stockholm is facing very large cuts.

I think it would be interesting if the member used these two minutes to clarify. What are the thoughts regarding how this situation should be resolved? This is, in fact, a serious problem regarding availability: Some regions cannot afford to requisition new medicines. It is a national problem, and therefore a representative for the government should have thoughts on how it could be resolved.

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Jesper Skalberg Karlsson (M)

Mr. Speaker! The Centre Party is a small party, but it is truly a party with big words and big promises.

When we now speak about the financing of healthcare and that the regions cannot afford it, it is worth reminding that in the expenditure area where health and medical care is located, Centerpartiet invests 1 billion less than the government. I find it difficult to see how there will be radically many more requested medicines with its budget proposal.

When it comes to changing the distribution of responsibility, not only for the introduction of but also for the financing of medicines, my answer is that it is a matter to be discussed in the Vårdansvarskommittén. It is not my place to stand here and come up with various imaginative proposals about how it could look. It is about a systematic, well-thought-out, and long-term effort to establish a situation that works better than it does today.

We Moderates have, during our time in opposition, had several proposals in this area to achieve more equal access to medicines. We will now raise such proposals in the Healthcare Responsibility Committee. We hope that it can come out with parts that the Riksdag can discuss and decide on and not just come with a final report in several years.

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Mikael Dahlqvist (S)

Mr. Speaker! Initially, I just want to mark that we Social Democrats have a specific reservation, reservation 10 under point 7, which I move for approval for the sake of time. But we naturally stand behind all reservations.

Today we are debating a large area that concerns both pharmaceuticals and pharmacies, but also our dental health. I want to start with pharmaceuticals.

Being able to pick up a prescription medication at a pharmacy is something most of us take for granted. But that is not always the case. More and more medicines are missing in Sweden. According to statistics from the Medical Products Agency, the number of medicines with shortages doubled during 2023 compared to 2022. For the individual, it has serious consequences if one cannot find a substitutable medication. But healthcare also suffers major consequences.

Mr. Speaker! This problem has existed for a few years. But what worries me is that the development is going in the wrong direction. I agree that the solution is complex. It depends on many different factors. But about a year ago, the Medical Products Agency submitted a report on the situation and also a number of proposals. What is the government doing with that basis? Here, we Social Democrats have specifically demanded under the point regarding back-ordered medicines that more must be done and that it must happen faster.

Mr. Speaker! Another major problem is doctors who liberally prescribe various medicines, perhaps on insufficient indications. We have, for example, a diabetes medication called Ozempic which today is used as a weight-loss drug instead of for diabetes, which it is intended for.

It has had very serious consequences because the medicine has run out in many places. This means that diabetics are left without treatment. Furthermore, there is not sufficient research in the area on what the consequences are when it is used for a completely different indication.

But that is not enough. The doctor also fills in the box that it should be included in the pharmaceutical benefits, i.e., be subsidized, for an incorrect indication. It only cost the state 20 million kronor over just two months. Unfortunately, this also occurs for other medicines.

I want to emphasize that the right of free prescription is important for doctors, patients, and Swedish healthcare. But it must never be abused. The Medical Products Agency can impose restrictions on the right of prescription, but those tools are blunt. Here, one needs to consider quite a bit whether the right of prescription can be adjusted.

Mr. Speaker! In 2009, Social Minister Göran Hägglund announced on DN Debatt that the government had adopted a bill to break the pharmacy monopoly. The reform could then enter into force during the summer. The motive for the reform was then that it would lead to improved service, increased accessibility, and lower prices.

Did it happen? Both yes and no, if one is to be humble. Accessibility generally has increased in the large cities. But in rural areas, I want to assert that in many cases it has become worse. Pharmacies have been closed down, and no new ones have arrived.

The boom of new pharmacies that we saw earlier, which followed the deregulation, is gone. TLV assesses that every tenth pharmacy has poor profitability. There are reports that if nothing is done, 800,000 Swedes could be left without their pharmacy.

Already in 2012, TLV saw that the goal the government had then regarding diversity and accessibility was not being met. But that was unfortunately nothing surprising. The market only serves the profit interest.

Previously, Apoteket AB had a clear responsibility for Sweden's medicine supply in a crisis. In 2009, Sweden's medicine preparedness and also the national preparedness stocks were phased out. Here one has to wonder what the Alliance government intended. Who should be responsible for the medicine stocks, and where should they be located? Some work is being done on that question now, Mr. Speaker. But there is reason to hurry, especially considering what we saw during the pandemic. We Social Democrats believe that after 15 years, it is time to conduct a comprehensive review of the pharmacy market.

There are also, as a result of the deregulation, interests from private actors both within healthcare and in the pharmacy market to take over health centers within the same group. Here, we are concerned. The risk is obvious that the staff could end up in different loyalty conflicts and conflicts of interest where the profit interest can govern the choice of, for example, medical products.

That is why we have in the report proposed that healthcare providers shall not be allowed to own pharmacies and that pharmacies shall not be allowed to own healthcare providers. I think that is obvious. We also want to raise the issue that remote pharmacists shall be introduced. Certain pilots are being conducted in this area. We believe that it is a way to increase the pharmacy presence in rural areas.

Mr. Speaker! I turn to the question of dental care. At the same time as we see that oral health at the population level is positive, we see clear socioeconomic differences. Income differences reinforce differences in oral health. Persons with lower education levels have poorer oral health. Socioeconomic differences also have significance for children's oral health.

By dental patients paying the largest share of the cost, the possibility of good dental health is unfortunately an economic issue for many. This applies especially in times when Swedish households are undergoing a cost shock and more and more people are finding it difficult to manage everyday expenses. Unfortunately, I believe we will see even poorer dental health ahead, especially in those groups that are economically strapped.

The SD-led government has announced a historic saving within the dental care area. It has picked parts out of the dental care investigation. It wants to remove the free dental care up to 23 years of age as it is today and lower the age to 19 years and also remove the double compensation.

Mr. Speaker! One might ask where the proposal to redistribute the money to, among other things, a high-cost protection went. Here, it is obvious to us Social Democrats that the government is once again prioritizing tax cuts for the rich.

That is why we Social Democrats in the committee have opposed the cuts that the government has announced. We want to introduce a model for high-cost protection to achieve an equitable system where needs are prioritized more clearly. It aims to counteract inequality. I have noted that the government has commissioned a review of the risk assessment, which is good. But we want to see more in this area.

Mr. Speaker! Another important area is, finally, the control of primarily private actors who provide dental care. Let me give some examples. Profitability is, to begin with, twice as high within dental care compared to other private sectors within healthcare. Even the Swedish National Audit Office has previously pointed out in a report that there is a tendency towards over-treatment, primarily among private healthcare providers. Therefore, it is time to review the system and perhaps introduce a licensing requirement.

We also want a protected professional title for dental nurses, as has been granted for assistant nurses, because we know that this is also a way to counteract the ongoing skills shortage.

(Applause)

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Jesper Skalberg Karlsson (M)

Mr. Speaker! Thank you, Member Mikael Dahlqvist, for the speech! The Social Democrats are on tour with their new social analysis. They state that they went too far in climate policy and that it was the Green Party's fault. They were wrong about migration, and it was the social climate's fault. They have changed their minds about Nato, and they have changed their minds about nuclear power. They say that they did too little for the integration of new Swedes, too little in the crime prevention area, and too little in the crime-fighting area.

My question, however, concerns the report we are discussing today: Is it not time that the Social Democrats' social analysis also includes that too little was done in this area?

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Mikael Dahlqvist (S)

Mr. Speaker! Thank you very much, Jesper Skalberg Karlsson, for your question! The member refers to an internal ongoing work where a number of groups have been given the opportunity to conduct analyses of the party's past and future policies. I just want to emphasize that the most interesting part of this work will come in the future: What sharp proposals will we put forward?

I do not share the member's analysis in all its parts either. Nuclear power, for example, is such an issue that the Social Democrats have always stood behind – naturally in combination with renewables.

I can humbly state that it is clear that we can do more. This also applies to when I was a representative for the government side here in the Riksdag during the last parliamentary term; we could have done more and done things differently even then. Personally, I am very disappointed that we did not reach a conclusion on the pharmaceutical investigation, because we need a review of the financing issue, the decision-making levels, and so on.

I am also surprised by the government's representatives and way of working. We often received announcements in various areas that it was going too slowly and that they were ending up in the wrong place. But it has almost been two years with the new government, Mr. Speaker, and I can only state that all our requests have been rejected in the report and that the government refers to ongoing investigations. Many of these investigations have been finished for several years now, Mr. Speaker, but it states that they are being prepared in the Government Offices. One can wonder a bit about the government's pace.

In response to Jesper Skalberg Karlsson's question about what we have requested in the report, I can say that more needs to be done, and we have mentioned fully concrete proposals in the area.

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Jesper Skalberg Karlsson (M)

Mr. Speaker and Member Dahlqvist! A theme in the debates is often that a lot is happening in the field. New medicines and new treatment therapies are arriving. There is a new dynamic in healthcare in Sweden.

The government has a very ambitious reform agenda in this area. It is about strengthening the pharmacies' role in the care chain, about a national digital infrastructure, about pharmaceutical assortments, and about a strategy for rare diseases. It is a very ambitious reform agenda.

Just as Member Dahlqvist says, it is important to be humble. Then the question arises regarding the future. The proposal that the Social Democrats gather the broadest support for in the report is a small part of the Treklöver Investigation's proposals from 2021. Otherwise, the main aim is that the government implements the Tidö Agreement faster. In light of the fact that it is precisely a small part of a three-year-old investigation that is your major proposal, my question is: When will the Social Democrats' new proposal arrive?

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Mikael Dahlqvist (S)

Mr. Speaker! I thank Jesper Skalberg Karlsson for the question. I can humbly state that during the eight years we governed, largely together with Centerpartiet, Vänsterpartiet, and Liberalerna, we could have done some things differently and faster. Some proposals were perhaps also not such as we in the party liked most.

Mr. Speaker! I note that we must do more. What I feel confident about today is that our demands are quite clear in several important areas. This concerns, for example, the financing of dental health, where a large saving is proposed. We want to use those funds to introduce a high-cost protection, which would provide more equal care and treatment in the country. We also have concrete proposals regarding rural pharmacies, pharmacists at a distance, and so on.

I agree with the member that you have many ideas and many inquiries. It will be extremely exciting to follow what becomes concrete proposals. When I read the report, however, I see that some inquiries that have been finished for several years – which perhaps were finished already at the end of the Sledda government's time – are just lying around. Some proposals go, as I perceive it, in line with the government's ambitions. Why are these proposals not presented concretely here on the floor of the chamber?

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Anders W Jonsson (C)

Mr. Speaker! The deregulation of the pharmacy market is one of the most successful reforms that has been implemented. We have gone from 900 to 1,400 pharmacies. Furthermore, the opening hours are completely different.

I remember the time when we had a monopoly, when parents who were prescribed penicillin could possibly get a tablet from the stock at the emergency room. Now you can say: Go to Ica Maxi - the pharmacy there is open at the same times as the store, which means they open at 7 in the morning and close at 21!

In the reform, there were some things left to do. But the historical record must be correct. The alliance government was clear that the stockpiling of medicines had to be investigated further. Then we had a change of government in 2014, and the Löfven government chose not to investigate the issue further. The historical record must be correct.

I am fascinated that from the Social Democrats' side it is often said that pharmacies have been closed in rural areas. We have 100 municipalities that have only a single pharmacy, and that is a challenge. I will return to that later in the debate. But when it comes to the myth that pharmacies are being closed in rural areas, as far as I know, it concerns two pharmacies: the pharmacy in Lima and the pharmacy in Ljusne. There, the pharmacies have been located right next to the health center. The region has decided to close the health center, and then of course it is not possible to keep a pharmacy.

My question to Mikael Dahlqvist is: What does the business model look like in Ljusne outside Söderhamn and in Lima in Dalarna if one is to be able to run a pharmacy in a location where the region has closed the health center? What is the picture that Mikael Dahlqvist has for it to be possible at all? I think it is a pity that the pharmacies have been closed, but it follows, of course, from the decision the region has made. It would be interesting to hear how it could work with a pharmacy without a health center.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Mikael Dahlqvist (S)

Mr. Speaker! I thank Anders W Jonsson for the question. I am surprised by the member's view that the deregulation of the pharmacy market was so fantastically good. The Centre Party is a rural party - or at least it was previously. Anders W Jonsson himself notes that 100 municipalities have only one pharmacy.

I live in a part of Värmland where we absolutely have not received better accessibility when it comes to the pharmacy market. We do still have a pharmacy, but if we drive a bit north in Värmland, we come to Likenäs, a fairly large town with a large catchment area, especially during the winter. That pharmacy is now under scrutiny. Among other things, they close it for three months every summer.

I was merely reporting, Mr. Speaker, figures from the Medical Products Agency and TLV, where it is now seen that more and more pharmacies are being closed. This is happening fastest in the cities due to lack of profitability, but also in rural areas they are being closed, despite the rural support we introduced so that pharmacies could be operated there as well.

In that report it says - I assume the figure is correct because it comes from the authorities - that 800,000 Swedes risk being left without a pharmacy nearby. To then think that the pharmacy reform is good and positive is not an opinion I share.

I share the view that in cities in general, opening hours and so on have improved. But for large parts of Sweden's interior, it has absolutely not improved.

If we are to return to state responsibility again, I do not know. Our proposal is that we shall review this. A review was needed. We need to sort out a number of issues. I hope that C is on board with that.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Anders W Jonsson (C)

Mr. Speaker! My question to Mikael Dahlqvist was whether he believes it is even possible to operate a pharmacy in a situation where the region is closing the health center.

Then I share Mikael Dahlqvist's image, and it is serious. The TLV report that came out last year shows that 11 percent of all pharmacies in the country - rural pharmacies are not specifically singled out, but there are also a number of such - are threatened. This is due to the fact that the trade margins have become significantly smaller and a number of other things. It is a serious problem that I assume the government will handle.

However, a picture is being spread that previously, when we had the monopoly, there were pharmacies all around throughout Sweden, but when we got the deregulation and opened up for other actors, it suddenly became worse and people started closing down. That is not true. We have a large number of places where there has been a pharmacy and where there still is a pharmacy. Then there are smaller towns that have received new establishments of pharmacies, and then there are, as mentioned, a few where they have closed. But there, it has most often been linked to the health centers being closed down.

There are a number of measures that can be taken to achieve improvement. But do not come with the image that it is because we abolished the monopoly that pharmacies were closed down in the Swedish countryside! During the 90s and 00s, it was a number of pharmacies in Swedish small towns that were closed down despite the fact that we had a monopoly. Since then, the situation for the vast majority has become very much better, not least the opening hours. There is a quite dramatic difference today for the people who live in small towns in relation to how it was during the monopoly period.

I feel completely certain about this: If we go out on the streets, whether it is at home in Hedesunda or in Stockholm, and ask people if they want the monopoly back and that the state should own all pharmacies, the answer will be: No, we do not want to go back to that time. It is much better now.

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Mikael Dahlqvist (S)

Mr. Speaker! I did not perceive that I received any direct question from the member. It was more an argumentation for why the current reform is so good.

I share the member's view that the accessibility and opening hours in parts of the country are better, for example in Stockholm, Gothenburg, Malmö and Karlstad. But if I visit the emergency room at Torsby hospital after 6 p.m. - and it looks the same in large parts of Värmland - it is the same opening hours. One does not have Ica Maxi hours there.

It makes me a bit concerned, Anders W Jonsson, that you have such an uncritical view of how the deregulation has occurred. We Social Democrats demand a review of the pharmacy market to counter a potential upcoming large-scale closure of pharmacies, which TLV warns about. I also assume that the government is acting in this matter.

At the same time, I believe we must consider the pharmacies' role, what product range they should have, how the ownership structure should look, and whether one should be allowed to operate a pharmacy and a health center simultaneously. It is those types of questions that we Social Democrats, at least the committee members, want to see a review of. It has been 15 years since the last one, and I think it is good to have a checkpoint sometimes.

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Dan Hovskär (KD)

Mr. Speaker! I would like to begin by expressing my approval of the committee's proposal for a decision.

Medicines and medical devices are an integrated part of healthcare and care. When one becomes ill and needs care, it is important to quickly receive a medical assessment – can I manage it myself with self-care, or do I need to receive part of the primary care or inpatient care's interventions? If self-care is best, pharmacies constitute an indispensable part for providing approved medicines and medical devices.

Pharmacies can also contribute with counseling to a greater extent than today given the pharmacists' high competence. If I need to receive parts of primary or secondary care interventions, pharmaceuticals and medical technology products will probably be an important part of the treatment. Within care, pharmacies, pharmaceuticals, and medical technology products are equally important parts to maintain good quality and to provide the care recipient with good living conditions.

The Christian Democrats' view is that pharmaceuticals and medical technology products, the role of pharmacies and pharmacists in the healthcare chain, and a secure pharmaceutical supply are important for the whole to function. All parts are needed if we are to achieve need-based care and nursing on equal terms for the entire population.

The medicine shortage is, however, a major problem. It has also increased, as we have heard earlier in the debate.

How does it look internationally? It is very difficult to make a comparison of the number of rest situations in different countries. The main reason is that there are not the same requirements to report rest situations in all countries. In some countries, there are not even requirements to report these.

The countries' authorities also have different views on to what extent they want to present information regarding shortage situations concerning medicines. In Greece, they are only published as news when there is a risk that patient safety will be affected, which makes it look as if Greece has had very few shortage situations.

In Sweden, we are unique in that we publish a list of all adverse situations. Comparisons between countries should therefore be made between the number of adverse situations in relation to the number of marketed products in the country.

If one makes such a comparison, one can put the Nordic countries in relation to each other. One can then see that Denmark has the smallest number of adverse situations in relation to the number of marketed products, with Sweden as a good second, while Norway has the largest number of adverse situations.

The government has now given concrete assignments to resolve the situation.

The Medical Products Agency has received an extensive assignment to map out, analyze, and propose measures aimed at preventing and managing situations of surplus and shortage regarding medicines for the Swedish market for humans and animals in all parts of the country.

The National Board of Health and Welfare shall provide information on self-preparedness regarding pharmaceuticals and medical devices and also has other assignments aimed at strengthening the supply preparedness for pharmaceuticals and other healthcare products.

The Dental and Pharmaceutical Benefits Agency, TLV, shall investigate issues regarding the stockpiling of medicines.

The Medical Products Agency and the eHealth Agency have conducted a preliminary study on a system for a national situation report on access to medicines, all so that we can resolve the shortage situations of medicines. These are some of the measures that are now underway.

Madam Speaker! Now I will move on to dental care.

No one should have to refrain from going to the dentist because they have major problems. The resources of dental care should go to those who need it most, we in the Christian Democrats believe. Far too many in Sweden, not least the elderly, cannot afford the dental care they need today. Therefore, we are now taking the first step towards a new dental care reform.

The government and its coalition partners have commissioned an inquiry into making the high-cost protection for dental care more closely resemble the high-cost protection that exists in health and medical care, which we Christian Democrats are very pleased with. It is important for us that elderly people with the worst oral health are prioritized. An enhanced high-cost protection would mean lower dental care costs for patients, which can contribute to a visit frequency adapted to the patient's needs and thereby better oral health and public health.

Madam Speaker! That prioritizing elderly people with the worst oral health means that we want the state dental care subsidy to primarily go to persons in need of dental care. That group consists primarily of elderly people with great needs.

Among older people, there are several factors that can contribute to impaired oral health. For example, older people often experience impaired saliva secretion partly due to advanced age and partly because many have medications that affect saliva production. Older people can also experience impaired motor skills and thus have more difficulty maintaining their oral hygiene.

That the group should be prioritized means that we want the investigator to specifically look at this and link proposals to the elderly group. We look forward to that. We Christian Democrats think it is good that the new high-cost protection should be strengthened so that it more closely resembles what exists within the rest of the healthcare.

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Anders W Jonsson (C)

Madam Speaker! During the autumn, the recurring report from TLV regarding the development of the pharmacy market was released. It was a very frightening read. Unlike previously, TLV now showed that up to 11 percent of the Swedish pharmacies had a threatened economy and could even be threatened with closure.

Pharmacies constitute key functions. In 100 of Sweden's municipalities, there is only a single pharmacy, and when such a report arrives, it becomes incredibly important to have a proactive government that is prepared to step in with measures to prevent closures.

TLV has submitted a proposal that is out for consultation, or perhaps the consultation period has expired now. But what scares me in this is that when TLV describes how the development may look in the coming years, not least in the 100 municipalities where there is only one pharmacy, absolutely nothing happens from the government's side.

I would like to ask the question to Dan Hovskär as representative for KD: What are the proposals that are in the drawer? What measures does one intend to take to avoid this catastrophe in many places? The pharmacies have a key function. It is not just about the distribution of medicines, but they have so many other tasks.

I would therefore like to hear which proposals KD sees as potentially relevant in a situation where one says they want to protect the rural areas in Sweden, where there is now, according to TLV, a great threat. What measures does KD propose to avoid that happening?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Dan Hovskär (KD)

Madam Speaker! It is a grave question that Anders W Jonsson raises here. As we have touched upon before, the pharmacy reform was a good initiative that we agreed upon and implemented together. There we have seen a good development.

The pharmacy industry is not just any industry. Those who operate in this sector take on a responsibility to provide life-saving medicines and medical technology products that are important for our population.

I know that the government is working on certain measures. I do not sit in the government myself, so I have not seen the final proposal yet. But I know that there are a number of different parts up there to specifically preserve where it is most crowded, especially in these 100 municipalities that only have one pharmacy.

At this point, I have not heard what measures will be put forward from the government's side, but I know that they are processing this serious issue.

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Anders W Jonsson (C)

Madam Speaker! My question was not what the government is doing, for nothing is coming from the government now. My question was what measures the Christian Democrats as a party propose. There must be a number of thoughts within the Christian Democrats on how to solve this.

TLV has come forward with a proposal, and it is that one should enter and increase the trade margin quite quickly. Unlike in other industries, it is actually an authority that makes the decision on how large the trade margin should be. This is a simple measure that can be implemented here and now.

The second thing is, as I see it, the rural area support which was introduced already by the Alliance government. There is a possibility to steer it significantly more and, above all, increase the amount of money in the system. That could also be a proposal.

The third thing, which KD unfortunately seems to be completely uninterested in, is to open up the possibility for remote pharmacists. What is described as the problem for many pharmacies located in the more peripheral parts of the country is precisely getting pharmacists there. It is clear that if I as a patient can meet my doctor digitally, it should also be possible to meet my pharmacist at the pharmacy digitally. Then someone else, for example a pharmacy technician, can handle the actual dispensing of the medicines.

The fourth proposal is to ensure that one opens up for modern pharmacies where it is allowed for the pharmacies to be integrated much more with healthcare and puts a stop to some of the proposals that come from, not least the Treklöverutredningen, regarding the ownership issue. One should rather embrace that the pharmacies should be able to offer more of healthcare.

So there are a number of measures that could be taken. But what does KD propose? This is an acute problem and not something long-term over a decade. This appeared in a report during the autumn, and now it is required that one steps forward with proposals on how one can avoid the major problems.

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Dan Hovskär (KD)

Madam Speaker! Thank you for the question, Anders W Jonsson!

This is an important part that the Christian Democrats have talked about. It is also about how we can continue to expand different parts, for example how one can distribute medicines with the help of e-commerce and so on. We are looking at this with internal pharmacies and how one can support so that the margins become better.

There are, therefore, several things in the pipeline that we from Kristdemokraterna want to support. It is about daring to turn and twist different parts, and rural support is one such issue that is being tossed around to see how one can support this important activity.

A lot is happening in the area. That is what I can say today.

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Karin Rågsjö (V)

Madam Speaker! I have a number of questions for the member. I am concerned about the current medicine shortage, and it is constantly increasing. Now I am speaking about Sweden.

I see no provisions regarding stocks in the regions, which we have talked about so much. We talked a lot during the pandemic about how it would be clever if it were legislated that regions should hold stocks. It is not wrong. It is not possible to have a system roughly like the one in the food industry, namely that when the coffee is almost finished, more is ordered. Here, there must be a robust system. What does the member think happens with the stocks?

I move on to the major question regarding dental care. During the election campaign, one could hear from the Tidö parties that a high-cost protection would be established. Now it will not be quite like that, but what I understand is that a limited high-cost protection for the elderly is in the works.

One aspect that I wonder about is the need for a solidarity principle, that is, that those who have the worst dental health come first - even at the private dental clinics. That is not the case today, but here, for example, the private dental care "picks" patients while the public dental care is "forced" to take many children and young people. Therefore, there are also long queues to the public dental care all over Sweden because they are busy with children, young people, and people who have more difficult problems with their teeth.

Have the Tidö parties looked at what is to govern this?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Dan Hovskär (KD)

Madam Speaker! I thank Karin Rågsjö for the questions. I have noted down quite a lot here, and we will see how much I manage to answer.

Let us begin with the medicine shortage. We agree that there are great challenges there. Here, we are far ahead with registration so that it is truly possible to follow where the shortages are. That is the simpler part for following the inventory where not everything is available to be used directly. Here we have come far comparatively – I tried to do an overview of how it looks in the neighboring countries. Denmark has come even further, but we are close.

All of this must improve, and we must continue to work. We are now reviewing how the deadlines can be extended so that a longer period in advance is visible for when a medicine must be restocked. We must constantly look at how we can reduce the current situation. The number of restockings for medicines in Sweden has increased from 2.4 percent in 2021 to 3.8 percent in 2022. The problem has existed previously, and we are now trying to rectify this.

Let me say something about dental care. In the investigation that has been started, the question of whether those who have the greatest need should get access to dental care first should be looked at. I think it is important to move the time limits for young people who have good dental health to older ones. It is a good proposal.

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Karin Rågsjö (V)

Madam Speaker! The reform you are working on is about focusing on the elderly, not the class-based. One can have poor dental health and be 42 years old.

Among people with low incomes, only 42 percent visited the dental clinic during a two-year period. That period was measured as 2018-2019. This can be compared with 82 percent of those with higher incomes, for example, those of us in this chamber. It is a significant difference.

This leads to many acute dental visits, and it primarily affects the rural regions. They have major problems in, for example, Västerbotten. This also affects people in a weaker economic position.

How did you think regarding turning only to the elderly? It still creates a stratification. Then there was also something about nationality being baked into this. I haven't looked, and I don't remember what it was. Perhaps the member can enlighten me.

I have another question. A private dental clinic does not have to accept everyone who calls. One can, for example, largely say no to children and young people, and one can say no to those who have troublesome dental problems. It is those who then end up in the public dental care, which becomes a problem. The rest of us, who do not have huge problems with our teeth, do not get in through the public dental care in, for example, Stockholm. There are queues everywhere. The government should look into ensuring that even the private dental providers take a responsibility for the whole. Otherwise, we are left with the problems we have.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Dan Hovskär (KD)

Madam Speaker! Let us begin with the investigation on reinforced high-cost protection. What would it entail? It is about lower dental care costs for the patients, and those who need to make many visits shall receive higher subsidies. It also applies to those with great needs. This will result in better public health and oral health. It is a good reform, and it will benefit many. Many elderly people can have it tough in terms of oral health. It is, therefore, a good reform, which implies a better distribution than today.

Let us discuss the private actors within dental care. They take a large part of the cake. We in the government parties think that a diversity of providers is good, and we consider it important that it is possible to choose in or choose out. We believe that it raises the quality.

It is difficult to distribute the patient flows. Children are automatically referred to the public dental care today, and I have not seen that anyone wants to change that system right now. The reform being investigated now, a high-cost protection, is good for everyone.

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Mikael Dahlqvist (S)

Madam Speaker! I thank you for Dan Hovskär's speech.

I do not doubt for a second that the member protects Swedish healthcare or dental care. What I am surprised by, however, is that the Christian Democrats have held the banner high regarding Swedish health and medical care. It is a prioritized issue. Furthermore, you hold most of the ministerial posts in the Ministry of Health and Social Affairs, which shows a clear prioritization.

But I am surprised, Madam Speaker, by the enormous cost crisis within healthcare right now. We receive alarm reports every day that virtually all 21 regions will be phasing out activities due to enormously large deficits. It is connected to pharmaceuticals because pharmaceuticals are largely purchased by the regions.

Member of the Board Anders W Jonsson previously raised an important issue regarding the requisition of medicines. It is an adequate question. What will happen now when staff are being laid off?

My question to Member Dan Hovskär is to him as a party representative but also to the government. Does the Member take this seriously, and what do the Member and subsequently the government intend to come forward with for measures to counteract the pharmaceutical crisis and the healthcare crisis?

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Dan Hovskär (KD)

Madam Speaker! Thank you, Mikael Dahlqvist, for the question!

I must begin by saying that we have a very tough economic situation. It is tough for regions and municipalities. We have a tough situation for the country. Inflation is rising. Now we have seen that it might slow down somewhat, but that is why we have had to hold onto our money from the state side. Our krona has been weak, and that affects our economic development and the costs when it comes to pharmaceuticals. One must have respect for that.

Then it looks different in different regions. Some have it extremely tough and have to almost borrow for operations, while other regions function quite well and have stability. But I agree that it is a tough economic situation. We must look at how we can be involved and support the regions, above all, moving forward.

What can be stated is that, even in a tough economic situation, we have nevertheless used 40 percent of the reform space in the budget for welfare initiatives. We will continue to monitor this area, as it is one of the core missions we have.

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Mikael Dahlqvist (S)

Madam Speaker! Thank you very much, Dan Hovskär, for the answer!

Politics is about will. Politics is about prioritizing. That is why the Social Democrats, in their budget proposal for this year, for example have a doubling of the general support to the welfare sector, primarily to the regions. Reform room and economic room exists, we believe.

It is about what priorities one makes, Madam Speaker. If one chooses as a government to prioritize tax cuts for the wealthy and other reforms that benefit a few, there may be a limited scope for health and medical care and dental health. It surprises me that KD, which is part of the government and has a high profile in health and medical care issues, chooses to turn a blind eye to that problem.

My question remains, Dan Hovskär. Specifically, here and now, are you prepared to provide more money to health and medical care and thereby, in an extended sense, also provide better opportunities for the area we are debating now regarding pharmaceuticals?

My second, short question concerns dental care. I note that the Tidö government has announced a historic saving in 2025. Parts of an old investigation are being carried out and a high-cost protection is being looked at. That is good, but my question is why the proposals that exist in a previous investigation are not being used. Then one can probably reach a decision faster when it comes to a general protection.

While waiting for the so-called high-cost protection, which we support, the money should be used to counteract acute inequalities. We see them particularly among socioeconomically weak groups when it comes to dental health.

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Dan Hovskär (KD)

Madam Speaker! Thank you very much, Mikael Dahlqvist, for the questions!

To begin with the last question, it is what I understand that one needed to take the previous investigation in its entirety to make it work. Those are the pieces of information I have received. The Government has chosen not to proceed with it but to extract certain parts that we believe will have a greater effect for the individual patient. That is what is important. The system in itself may not be the important thing, but it is about what we can do for the elderly, for example, who are struggling with dental health and perhaps cannot afford it. With a new proposal that is now being investigated, we could address this. That is a positive thing, I think.

Then it is once again a matter of prioritizing. In the recession that we entered a couple of years ago, we have had a tough economy. Then we must also take responsibility for the development. Inflation is perhaps the single hardest part, because increasing inflation reduces the value of money. There we must regulate, and that is what we have been involved in doing now. It was an important measure.

Now we have, to some extent, dealt with this. We have obtained a somewhat more stable economy, and moving forward we must look at how we can participate in supporting the regions in the best way.

The Christian Democrats are a guarantee that we will invest in healthcare in various ways. It is our core issue. And we now have a government that also has this as one of the highest prioritized goals, so things will happen here moving forward. We have already initiated an enormous number of assignments, and we will continue to work with this.

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Leonid Yurkovskiy (SD)

Madam Speaker! It may not be entirely intuitive that pharmaceutical issues and dental care end up under the same report, but we thank you for the opportunity to discuss so much interesting at one and the same time.

A lot is happening in the areas. Let us begin with dental care.

I am obviously not completely impartial, but I still want to assert that the Sweden Democrats are the government cooperation's dental care party. Both in the election campaign and in negotiations, we have pushed hard for important dental care reforms.

Perhaps the most important thing is what has already been mentioned several times in this debate, namely that dental care should be covered by a high-cost protection to make it more accessible regardless of economic situation. Oral health is obviously a part of health as a whole and should be treated accordingly.

According to the Public Health Agency's annual report from 2023, it unfortunately turned out that approximately 9 percent of the population forgo dental care for economic reasons. In other surveys, the proportion is significantly higher.

We are therefore very optimistic that an investigation has been commissioned to strengthen the high-cost protection for dental care to more closely resemble what exists in other areas of healthcare. This means, in short, cheaper dental care for the vast majority with severe problems.

It is actually thanks to the Sweden Democrats that this is being investigated now. We were completely alone in pushing for it during the election, I can say with pride. There are other parties who complain that it is not moving fast enough. I think one can take greater responsibility even before the election.

Then we have the question of a protected title for dental nurses, something that we are pursuing in our committee motion.

A protected title would mean higher status, better conditions, and greater opportunities for salary increases within the profession. At the same time, it would contribute to increasing patient safety and making the profession more attractive. Retaining, recruiting, and attracting new staff is of utmost importance to create a long-term and sustainable work environment.

We are pleased that the government has also here met us halfway and commissioned an inquiry into precisely professional regulation within health care and dental care.

Finally, regarding dental care in this statement, we have the so-called "fifty-kronor note" (femtiolappen).

On May 22, 2013, the Riksdag debated and decided to grant illegal foreigners, i.e., persons who are not even permitted to stay in Sweden, the right to free healthcare and dental care. SD was the only party that fought against the proposal, while the other parties in the former – with emphasis on former – healthcare board defended it and voted it through.

We naturally considered the policy to be deeply unjust then, and it is so now as well. While Swedish pensioners who perhaps have worked their entire lives waived dental care due to a lack of money, they gave it to the other parties free of charge to persons who do not have the right to reside in the country.

Furthermore, the policy created completely wrong incentives regarding illegal immigration to Sweden. It has most likely contributed to the situation we have today with problems with illegal immigration.

When Björn Söder exemplarily summarized the debate, he spoke of the "day of shame." I want to assert that the time of shame is over. Now we can finally look forward to a policy to be proud of. The discrimination of Swedes within the Swedish dental care system will finally come to an end.

This is a supplementary directive in the investigation on strengthened support for dental care for victims of violence and increased control over the dental care sector, with an end date of 31 October this year.

For everyone who wants to see how it can work in practice with dental care for illegal [individuals], I really recommend searching for "hidden camera, dental care for 50 kronor" in any search engine. It is a frightening demonstration of how easily the system has been able to be abused over the years.

Then something about medicines. As we have touched upon during the day, medicine shortages and rare health conditions are perhaps the most current issues in the medicine field now. We have EU legislation that directly or indirectly affects all these matters.

The Sweden Democrats have, in their committee motions, pointed out the absurdity that Sweden still lacks a national strategy for rare diseases. It should be remembered that even though the diseases themselves are rare, they are many; the collective patient group is therefore large.

Therefore, it is very pleasing for us that this too can soon be ticked off the to-do list, as the government has officially begun work on producing such a strategy. This is, of course, something that the Sverigedemokraterna see with pleasure and will follow up on.

The Medical Products Agency's statistics show that the medicine shortage is increasing. This is obviously not always linked to politics - perhaps that should be added to the previous posts. It could be about problems on the manufacturing side or a shortage of active substances and other components, as you surely know. Unexpectedly high demand is also something that is sometimes difficult to account for.

In May 2023, the government tasked the Medical Products Agency to map, analyze, and propose measures to prevent and manage residual and shortage situations regarding medicines for the Swedish market. We also look forward to following up on this later.

There are perhaps quite few things that we Sweden Democrats consider are handled better at the EU level, but medicine availability is probably one such issue. The new proposals from the EU will entail simplified patent processes and increased cooperation, which we hope will contribute to better availability of medicines not only in Sweden but in all of Europe.

In summary, it is therefore very much good work that is being done and which will continue to need to be done, likely also by future governments.

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Anders W Jonsson (C)

Madam Speaker! It is interesting to hear Yurkovskiy say that the Sweden Democrats are the Tidö agreement's dental care party. In that case, it would be interesting to ask how this dental care party intended to act when negotiating the budget and making a very large cut to precisely dental care. It was upwards of half a billion that you cut there in order to, I assume, be able to finance the reduction of the snus tax or something of the sort. It would be interesting to hear what Yurkovskiy has to say about this, if the Sweden Democrats are now the dental care party.

The Pharmaceutical Party, they definitely are not. During the last parliamentary term, the Center Party, together with the other opposition parties – the Sweden Democrats were included – pushed quite hard to ensure that orphan drugs, that is, medicines used for a very small group of people but which are very expensive, could also become available in Sweden. Together, we saw to it that we pushed forward with motions and really pressured the Social Democratic government in front of us.

The worst example of this concerned Kaftrio, a medicine that truly changes the lives of people with the severe lung disease cystic fibrosis. That problem was solved by TLV, so that medicine is, thank goodness, now available.

But what I find surprising regarding the parties that the Center Party joined forces with to push the Social Democratic government and which obtain government power after the election is that absolutely nothing happens regarding orphan drugs. Then the interest suddenly disappears. Now Yurkovskiy says: But we are going to develop a strategy for rare diagnoses. A strategy, yes - but this is about the medicines that these patients should have access to here and now.

My question to Yurkovskiy regarding this is: Why is nothing happening? Why were there such harsh and tough words before the election but silence after the election? So, those were two questions.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Leonid Yurkovskiy (SD)

Madam Speaker! Thank you, Member, for the questions! When it first concerns dental care and the economy, it is, as previous members have pointed out, not at all reprioritizations regarding snus or anything else that this is about, but it is a tough economic situation that makes reprioritizations required. And the keyword is precisely reprioritizations; it is not about any total cut in dental care for the patients. What is happening instead is a prioritization within dental care of those with the worst oral health.

This is something that even the profession backs. What we have seen so far, before we started focusing on the elderly, is that very many who seek dental care are not really in need of it - in combination with enormous deficiencies regarding personnel resources. This thus becomes a kind of win-win situation, even though it is naturally not desirable that resources decrease over time. This will change.

For the Sweden Democrats, the most important thing in the negotiations has been precisely the high-cost protection, and we have had that through. In a government cooperation, as the Centre Party itself knows, especially after previous government cooperations recently, one really cannot get everything; it is absolutely worth reminding of. But we in the Sweden Democrats are very satisfied that we have had through precisely this with the high-cost protection, which I hope we can agree is good.

A brief comment regarding rare diseases: The Member of Parliament obviously possesses detailed knowledge that is difficult for me to delve into here and now. We can state that this is something that perhaps is better suited for an interpellation debate, where a responsible minister can comment on the concrete situation and what work is underway. Within the government cooperation, it is the ministers who have worked towards our party.

But one can note that TLV in September 2023 submitted a final report where they provide proposals on what can be done to improve the situation regarding rare health conditions. They propose, among other things, a higher tolerance for costs. I assume that the government will follow these recommendations and, if not, take a position in another appropriate way.

In this speech, Jonas Andersson (SD) agreed.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Anders W Jonsson (C)

Madam Speaker! Yes, it was indeed a reprioritization. One says that one wants to invest in dental care for people and starts by reprioritizing and removing on the order of half a billion from the support for people who need dental care and putting those money towards lowering the tax on snus. For me, this is a very clear reprioritization, but it is definitely not an investment in dental care.

The Sweden Democrats have, in that case, been completely blown in the negotiations, because when it comes to the high-cost protection, an investigation has been commissioned. It is not the case that the direct reduction of half a billion in any way was offset by receiving a high-cost protection at the same time. Instead, the money disappeared, and the snus tax was lowered. And then one has received an investigation that is to produce a proposal. This lies several years into the future.

One beats their chest and says: We are the great dental care party! Perhaps there should be a bit more reflection there.

This contrast becomes so great for me. I have, in fact, heard a party leader admit that one says one thing before the election and something else after. It is this logic that the Sverigedemokraterna stand for.

Here in the Riksdag, we pushed hard together to ensure that our demands regarding orphan drugs - specific medicines for a very small group, which can be life-saving and life-changing - would be realized. The Social Democratic government tasked TLV with preparing a proposal. It has now been quite a long time since that proposal, which was thus a response from the Social Democratic government, arrived.

Since the Sweden Democrats have gained power over the government, they have not said a word about the very vulnerable group of people who need specialized medicines. Even there, one is to receive an investigation into a strategy, but no concrete announcements are coming from the Sweden Democrats. They say one thing before the election and something completely different after.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Leonid Yurkovskiy (SD)

Madam Speaker! I unfortunately must correct the member regarding some details. Firstly, the snus was not financed through dental care. It was primarily financed through an increase in the tax on cigarettes. What is happening within dental care must be seen as a holistic measure for the budget, not as a measure to lower the price of snus.

We have commissioned an investigation into the high-cost protection, and as the member very well knows, that is how the process works.

Furthermore, the investigation is quite clear that the intention is for this to become a reality, as is appropriate in an investigation. The Sweden Democrats can absolutely be satisfied.

Then I have a general comment regarding what one says before an election and after an election. No one can deny that the Sverigedemokraterna is the party that has achieved the most impact, in reasonable proportion to its size, when it comes to the policy being implemented. No other party in modern history that has not had its own majority can be as satisfied as the Sverigedemokraterna. That is a correction.

Finally, I want to bring up this issue regarding rare diseases. Yes, one wishes that this would go faster. What I can refer to is the Sweden Democrats' policy, which is in the committee motion. There, we want a national strategy which we are still awaiting. Work has been officially started. Then we shall take a position on what TLV submits in its reports.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Rågsjö (V)

Madam Speaker! The member mentioned the day of shame. If I were to stand here and speak about shameful moments since the Tidö government took office, I would have to stand here until tomorrow. But enough about that.

Just as Anders W Jonsson, I think this issue with orphan drugs is serious. People talk about it for four years, push the issue and write articles - we all did - but then nothing happens. That is when I become concerned. That is what I can say.

This fact that half a billion kronor disappeared from dental care can also be considered. It means that dental care will become even worse right now. Is this not something the member is concerned about? Class differences are increasing even further.

Then we have this with the high-cost protection. It sounds very good. We have also advocated for it in Vänsterpartiet. But then we mean that it should apply to the entire adult population, because we see that the differences are so great. But when the Sverigedemokraterna talk about high-cost protection - you did that before the election - I wonder what is included. The member says that it covers the vast majority. I would like to have this explained.

I understand this issue regarding immigration. It is always a card in one way or another. You call yourselves the driving party. Everyone in this chamber and everyone listening knows that if you were to withdraw, this government would also disappear. It is good to remember that the government is completely dependent on you, for better or for worse.

I would like to have clarity on what is included in the proposal that is to be developed. What are the directives to the inquiry? Who should be included, and how should it be allocated? How is it intended budget-wise – do you know that? And what are you going to do about the fact that only 52 percent of those with a small economy visit the dental care during a two-year period, while the figure is 82 percent when it concerns those who have a better economy?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Leonid Yurkovskiy (SD)

Madam Speaker! Thank you, Karin Rågsjö, for further interesting questions! I can also recommend that the Left Party's voters vote for the Sweden Democrats in the next election to have a greater probability of a perfect budget, so to speak. Now it is about the economic situation and about the compromises that one needs to make in a cooperation, with the reservation that I myself do not sit with all the details that have caused the economic reality in the budget that we witness now.

What is stated in the investigation regarding the high-cost protection is that we shall emulate what applies in other healthcare. In that way, it will help the vast majority who suffer from severe oral health issues.

When it comes to rare diseases, I refer to the previous exchange of remarks and the ongoing work.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Rågsjö (V)

Madam Speaker! "The vast majority" the member says all the time. I hear "elderly", and that is not the vast majority. It is probably good that one emphasizes what the high-cost protection is actually about.

A question that you raised before the election was that there is a shortage of many dentists and dental hygienists, for example in Västernorrland but not only there but somewhat everywhere in the upper part of Sweden. In 2022, 17 and 19 regions respectively reported a shortage of dentists and dental hygienists. This has particularly affected sparsely populated areas but also somewhat larger cities.

I wonder: How have you thought about this now that you have also withdrawn money? This could become a problem. Do you have any mandate for the National Healthcare Competence Council to perform and dimension the dental care's competence needs? This is really something that is ticking. We all have to take responsibility for that, but now you sit close to power and steer from the backseat, so you might have thoughts on how to fix this. This is a huge problem, specifically for regions that call themselves rural regions. In all of northern Sweden, from Dalarna and upwards, there is a shortage of dentists and dental hygienists. People have huge problems. SD, which considers itself the new dental care party, must have some kind of answer to this.

For me, it is a very big problem that over a two-year period, only 52 percent have utilized dental care among those with lower incomes, while it is 82 percent among those with slightly higher incomes who have visited a dentist during the same period. This seems to be something SD does not have any solution for.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Leonid Yurkovskiy (SD)

Madam Speaker! Thank you, Karin Rågsjö, for the follow-up questions! The member speaks about the prioritization of the elderly, and what I believe she is referring to is the limit for free dental care. There, a prioritization has been made of those with the worst oral health, that is to say the elderly, and so one tries to relieve the dental care staff when it concerns those with perhaps the best oral health, that is to say the slightly younger.

Regarding the investigation on the high-cost protection, I must return to my previous formulation about the vast majority. Those who are in need of a high-cost protection will receive cheaper dental care.

Then it is correct what the member says regarding the shortage of dentists, nurses, and other dental care staff. This is in particular a major problem in rural areas. Sveriges Radio reported earlier that in some places one could wait for two years to get an appointment at the public dental clinic, and unfortunately, it could become even longer.

Much of this concerns an ongoing work that is not contained within a committee debate in this chamber with individual proposals. From the Sverigedemokraterna's side, I can mention our proposal that dental nurse should become a protected title. As I touched upon earlier, a kind of process is currently underway regarding this as well.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Mikael Dahlqvist (S)

Madam Speaker! Thank you, Member Yurkovskiy, for the speech!

In previous parliamentary terms, the Sweden Democrats have rightly pointed out that they have not been part of the government, but have always been an opposition party. Therefore, representatives of the member's party have been able to lean back and say that it is not they who have caused the problems.

Now, however, the Sweden Democrats are part of the government. The member himself emphasizes what great influence the Sweden Democrats have over the current government. It is important to clarify this, because now my question to the member comes, and it is about demanding accountability. Then one can rightly demand accountability from the Sweden Democrats just as well as from the government.

Medicines are largely a cost issue. A large part of the medicines are paid for by the regions. We have a cost crisis, in my opinion. It is 18 of 21 regions that are making extensive savings, which will have serious consequences. This is something that is being noticed increasingly among the profession and in the media these days.

Madam Speaker! My question to Member Yurkovskiy is the following: What does the Member, as part of the government base, intend to do here and now – are the Sweden Democrats prepared to provide the resources that Swedish healthcare needs and thereby also secure the purchase of medicines?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Leonid Yurkovskiy (SD)

Madam Speaker! Thank you, member, for the questions! First, I must state that it does not matter how often the Social Democrats repeat this. It is not an SD government regardless of how much one repeats it. SD is part of the government cooperation. We have a good influence in proportion to our size. That is for better and for worse. This is something that even the party leading the government can, so to speak, feel pride in. SD is not part of the basis. By that, I mean that the government can also take credit for what turns out well.

It is unreasonable that the Social Democrats, after eight years without any major dental care reform whatsoever, come in here and complain that the Sweden Democrats, who de facto stand outside the government itself, have not delivered when it comes to, for example, the high-cost protection after barely two years of the mandate period. It is, of course, unreasonable.

We Sweden Democrats are very pleased that we have had two very important points included. One concerns, of course, the high-cost protection. The other concerns the unreasonable discrimination that the Social Democrats introduced: that free dental care should be given to illegal immigrants and asylum seekers.

It is, once again, stomach-turning to speak of a lack of resources when, completely uncompromising and completely without any shame in one's body - if we refer to the day of shame - year after year, this prioritization is made.

I will soon be granted a turn to speak again, but otherwise I refer to what I have already said. Many of these questions have been repeated since previous exchanges of remarks.

In this speech, Jonas Andersson (SD) agreed.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Mikael Dahlqvist (S)

Madam Speaker! Thank you for your speech, Yurkovskiy! I did not get an answer to the question at all. I asked a concrete question to the member - and it is I who am asking the questions now: What does the member intend to do here and now to secure the economy in the regions?

You mislead the listeners by saying: We are not part of the government. I think that is false marketing. The government would never have been able to be formed without the support of you, Sverigedemokraterna. The government would never have been able to move forward with the budget in the Riksdag. You and your party comrades are therefore equally responsible for what is being done in the government, both good and bad, when it comes to the economy. I hope we can agree on that, member!

I can take a specific question. We are at least in agreement on one thing. That is that we want a protected professional title for dental nurse. It was the previous Social Democratic-led government that pushed this through for assistant nurse. Now we want to move forward, and even the Sweden Democrats are pushing that issue.

Madam Speaker! My simple question to the member then is: Why do you not stand behind our motion in our committee motion to introduce a protected professional title? In the report, it is rejected. But in reality, you are the ones driving this. It would be somewhat interesting to get an answer to that question.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Leonid Yurkovskiy (SD)

Madam Speaker! First, I must say that I do not agree. We are probably not in agreement regarding the definitions of government and government cooperation. Yes, the Sweden Democrats are part of the government cooperation. Yes, the Sweden Democrats are a prerequisite. But there is perhaps a reason why we are not part of the government. And this entails certain consequences.

With that said, I still want to say that we absolutely have confidence in the government and the budget process, as it stands.

I will give a concrete answer to the original question. It is not appropriate for me to anticipate any kind of budget process. That is not the role I have as a member of the Social Affairs Committee. Of course, we will provide input on sensible policies that we want to implement, but I cannot give any statement here on what the budget will look like. The members cannot do that from their side either.

When it comes to protected professional titles, it is correct that it is something our parties have in common. As I mentioned in my original statement, the government has actually met with us and started investigating the matter. That is the concrete reason why we do not want to proceed with a motion.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Lina Nordquist (L)

Madam Speaker! It is a broad debate we have today. It concerns everything from the shortage of existing medicines to difficulties in getting new medicines, the structure of the pharmacy market, and the financing of dental care. It is very much and very diverse. How does this actually hang together?

I think that what these questions have in common is that they are often forgotten despite the fact that they are actually extremely important. They play a very large role for people in their everyday lives, especially for sick people.

But the opposition parties' motion proposals in these areas simply do not hold up for a full debate for each area. The Liberals' policy, on the other hand, holds up perfectly well. Therefore, Madam Speaker, I will speak for approximately six hours, until tonight's Rapport.

I will start by telling you about what I think is fantastic, what is currently happening in the government. Now things are happening that I believe we have been waiting for for a long time. Some things are continuing from the Socialdemokraternas previously initiated work but now at a higher tempo. Other things are such things that have not been underway at all previously but where it is now starting to roll forward.

The government base is, to begin with, in agreement on strengthening the high-cost protection for dental care. It is simply time to fix the gaps in dental care. It should not be a question of wallet. Everyone should be able to afford a healthy mouth and healthy teeth. Here we agree that the elderly with the worst oral health shall be prioritized.

Then we have this with pharmaceuticals and pharmaceutical development. There, previous work continues but at a slightly higher pace. In the autumn, for example, the Medical Products Agency was commissioned by the government to increase the competence for clinical trials in Sweden, even when it concerns medical technology, not just pharmaceuticals.

Before that, in May I believe it was, the government gave the Medical Products Agency the assignment to analyze and propose measures to prevent and manage backorders of medicines and shortages of medicines. When a medicine actually exists and it is possible to prescribe it, the patient must also be able to get it in their hand. It should not be so damn difficult, Madam Speaker.

The role of the pharmacy shall be strengthened. We have an agreement to develop the pharmacy's role in the care chain both through new services, such as health examinations and others, and by introducing a pharmacist assortment. This is something completely new for Sweden, but it is not new in the world. It is an intermediate position between over-the-counter and prescription-only. This work has now begun, and parts are actually being investigated already. This makes me happy.

I could, as I said, speak until the Report, but I will refrain. I intend instead to conclude with that which I am most happy and hopeful about: Finally, a strategy for rare health conditions is on its way.

We know that there may be only one or very few in the country who are affected by a certain disease or disability. Often, the entire daily life and entire life are affected. The individuals end up caught in a bind in healthcare and in everyday life. Their relatives end up caught in a bind.

When life creaks or perhaps even breaks, it should not matter whether what has happened to us is common, uncommon, or rare. But that is how it has been.

We fought for a long time - Centerpartiet, Kristdemokraterna, Moderaterna and Liberalerna. Sverigedemokraterna joined. We got an announcement. And now, several years after this, it is actually happening. In close cooperation with patient associations, this strategy is now actually being developed.

We in the Liberals are also pushing on the issue of the work that continues in the Government Offices regarding a greater responsibility for the financing of medicines for rare diseases and diagnoses.

When it comes to this entire area, regardless of whether we are talking about pharmacies, medical technology, development of new medicines or rare diagnoses, is it really any stranger than that patients, wherever they live and whatever they are affected by, should have access to the best possible care, reception, knowledge and treatment.

It should not matter whether one is affected by a common or an uncommon disease, and it should not matter which zip code one has. Regardless of this, one should meet knowledgeable people and know that one is well cared for.

I want to thank you in the chamber, who I know have pushed for this, and naturally the government which is now taking the proposals forward for new steps towards a life in freedom, even for those who are affected by something unusual and also for those who happen to live in a place where care has previously been more difficult to provide.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Rågsjö (V)

Madam Speaker! This debate is about medicines, pharmacies and the increasingly unequal dental care.

The number of backordered medicines, i.e., medicines that are not available at pharmacies, increased by more than 100 percent during 2023 compared to the previous year according to new figures from the Medical Products Agency. And it has been that way for quite a long time.

The medicines that ran out at the suppliers are painkillers for children – many have contacted us about this – and Ozempic, a medication for diabetics but which is also used by those who want to lose weight and are overweight. But it is also about antibiotics, which is extremely serious. I have had to study this myself, so to speak, when I tried to get Kåvepenin in Kungsholmen.

The system we have now with pharmaceutical manufacturing in Sweden and in other countries with insufficient requirements for stockholding creates enormous risk situations for thousands of people. We believe that the pharmacy industry as a collective should be given an obligation for stockholding.

Those who dispense and ship medicines must have full control over what is available. Läkemedelsverket should be given responsibility for a national list where one can quickly see where medicines are located. Also hospitals, pharmacies and pharmaceutical companies - everything - shall be included there.

In 2009, the now-defunct Alliance, if you remember them – it was Center, Moderates, People's Party, as it was called then, and Christian Democrats, and they wore orange shirts – sold a large part of the state-owned Apoteket AB to private actors. How did it turn out? One can wonder about that. It became both good and bad. This was an ideological decision.

As usual when the right does business, the winner is the industry, one must say. The companies that bought pharmacies in connection with the deregulation made very good deals. The state sold off parts of Apoteket AB for 5.9 billion kronor to four companies. And some years later, only one of the companies was worth almost the same amount. They cashed in, so to speak.

It was said that one of the main reasons was that they wanted to increase accessibility to pharmacies and that they wanted more flexible pharmacies when it comes to opening hours. And so it is. I live in the city center and have four pharmacies within 200 meters. It is superb. You can go there at any time. But it is not like that everywhere.

We have talked a little bit about the rural areas. I am also thinking of Jordbro in Haninge. It is not a rural area. But there, the pharmacy disappeared. It is a suburb and a socially disadvantaged area. And there was no viability in having a pharmacy there.

The deregulation also aimed to give small owners a chance to open pharmacies. It was talked about, and it was almost a bit cute. But it didn't quite turn out that way. I am thinking of Apotek Hjärtats market share, which amounts to 25 percent. It is, therefore, an oligopoly that we have received instead. It is not small family-run pharmacies, we must remember that, but these pharmacies also have international branches.

Accessibility is so much more than the number of pharmacies per inhabitant. It is about the possibility of obtaining medicines. And which region one lives in should not govern this. Simply put, a review of the pharmacy market is needed.

Just the market is not super interested in public health, but profit is the primary thing and has always been.

Now I move on to dental care. The high costs for examination and treatment mean that many who earn less visit the dentist much less often or refrain from dental visits. And those who have very low incomes have no benefit from today's high-cost protection, because it only applies to costs over 3,000 kronor and because it is only half of the cost that is reimbursed.

Vänsterpartiet has a reform package for dental care that is about increased equality, improved accessibility, and better general dental health. We submitted a proposal already before the election regarding a real high-cost protection. It would mean that the patient pays a maximum of 1,200 kronor over twelve months, similar to the system we have within healthcare. Costs above that shall be subsidized. The proposal has been investigated and is a finished proposal that can be rolled out.

We also want the most common treatments to have a national tariff that implies a ceiling for what each respective treatment may cost. Then one has a better grasp of the situation when visiting a dentist, and then one knows what one is to pay.

Socioeconomic conditions have a major impact on oral health. And as usual, it is a matter of class. This is particularly noticeable among children, as children in families with low income run a 60 percent greater risk of caries compared to children in families with high income.

Like welfare in general, we believe that dental care should be governed by the principle of need and solidarity, where the greatest need comes first. We do not want to remove private dentists, but we just want a little more regulation. It is never wrong. For private providers, it is the healthiest patients who require the least intervention who receive high compensation and are the most profitable.

Therefore, the public dental care must also take greater responsibility. We have talked about this a little earlier. We believe that the principle of care based on need should govern prioritization and resource distribution in dental care more clearly than it does today.

The Government should return with proposals on how the principle of need and solidarity can be incorporated into the Dental Care Act based on the proposals in SOU 2021:8. We will raise this in reservation 20.

Among people with very low incomes, only 52 percent visited dental care during a two-year period - 2018-2019. This can be compared to 82 percent among people with higher incomes. This means that all acute dental visits are piling up specifically for Folktandvården.

The large regional differences, where the ultimate consequence is unequal dental and oral health, must be removed. We want to see an investigation with a mandate to produce proposals on how dental care can work more across regional boundaries. More must be able to be done between the regions.

Madam Speaker! Freedom of establishment means that there is practically no waiting list for adult patients with special needs in Stockholm's city center, and that is good. At the same time, the waiting time can be several years in other places in the country and for patients with special needs.

The development within the private dental care sector is, one could say, absolutely brilliant. For several years, dental care has been the most profitable sector, seen from the perspective of private actors. In 2019, the operating margin was 12.7 percent, which can be compared with private health centers within primary care where it was 5.6 percent.

The same requirements are not placed on private dental care companies as on public dental care. It is a matter of some kind of lack of requirements. This means that private dental care companies can refuse to accept patients for emergency dental care, can refuse to provide dental care to children, and can refuse dental care to the elderly and the multi-morbid. Is that to be the case? We do not think so.

For example, in 2019, private dental care accounted for only 14 percent of dental care for children and young people, while as much as 58 percent of the state dental care subsidy went to private dental care specifically. I think those are interesting figures. It means that an ever larger part of Folktandvårdens resources is being utilized for dental care for children and young adults, for population responsibility, and for patient groups with special needs.

We want to see proposals from the government where the same requirements are placed on private dental care as on public dental care when it concerns acute dental care, children's dental care, and dental care for the elderly and the multi-morbid, so that the graces are shared a little bit.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Anders W Jonsson (C)

Madam Speaker! I intend to focus on pharmaceuticals, for that is where I see the greatest concerns, not least when it comes to the availability of pharmaceuticals in Sweden. I have previously in replies highlighted various problem areas. It is primarily three areas that are truly concerning.

The first thing we have discussed. It concerns orphan drugs - specific medicines used for very small patient groups. Because they are used for small patient groups, the development costs become very large in relation to the number of patients. The cost therefore becomes high. The Swedish way of calculating and pricing medicines means that these medicines have a very difficult time entering the Swedish market. This is something that we noted together during the previous parliamentary term. Several parties pushed forward announcements and motions from the Riksdag. But it is sad, I think, to see that nothing happens after the election. It is about accessibility for a very small patient group, and these medicines are actually completely life-saving.

What has happened in this area is that we finally got the Social Democratic government to task TLV with developing a new model. TLV has done that. But from the Tidö government, nothing has happened. Several people have been up at the rostrum and said that a mandate has now been given to develop a strategy for rare diagnoses. That is very good. It is about time we get a strategy for this entire area and these diagnoses. But that mandate does not include orphan drugs. That is also why Riksförbundet Sällsynta diagnoser is very critical of this government, which does nothing regarding medicines and, above all, does not include them in this work. Then it is also the case that the strategy will not be ready until sometime during 2025 and thus will not become a reality until much later. This is therefore a very poor consolation for the patients who day after day wait to receive these very important medicines. There, one can speak of lack of accessibility. There, one can speak of saying one thing before the election but then, after the election in a government position, saying something completely different.

The second challenge we have regarding accessibility is described in a report that also came from TLV during last year. They reviewed the pharmacy market in Sweden and were able to state that 11 percent of all pharmacies - there are approximately 1,400 in the country - are economically threatened because the margins are far too small. TLV has the mandate to produce these types of reports at regular intervals, given that it is political decisions that lie behind how large the margins should be.

From an action-oriented government that protects rural areas, one could have expected a long series of different measures to ensure that what TLV paints as 11 percent of pharmacies being threatened does not become a reality. But even there, it is completely silent from the government. What is on the table is a proposal directly from the authority TLV which says that we must directly step in and change the trade margin. The proposal is out for consultation, and I hope that it becomes a reality.

The government could also have issued a decision to increase the special rural area support that exists - it is not many millions - and direct it specifically towards the 100 municipalities in Sweden where there is only a single pharmacy, so that those pharmacies are not closed under any circumstances. No such decision has, however, come from the government.

What one could also do is to introduce this with remote pharmacist. One of the things that threatens pharmacies in Sweden, besides small margins, is the very large shortage of pharmacists. Open up for the possibility of a remote pharmacist! Then, in exactly the same way as one can meet one's doctor remotely, one can also meet one's pharmacist to then have a medicinal product dispatched by someone from another staff category, preferably a pharmacy technician. It is accessibility for real, but here nothing is coming from the government. That, Madam Speaker, makes me really worried.

The third area concerns the medicines that the hospitals requisition. It is the so-called NT Council that decides whether the medicines should be used in the country or not. But several regions today have such a pressured economy that they lack the financial means to do so, even if the NT Council gives the green light for a new medicine for, for example, cancer treatment. It is the same thing regarding new vaccines. The Stockholm region wants to take the lead and offer vaccinations for its citizens, but poorer regions do not have those possibilities.

These are real problems regarding the availability of medicines. We have several reservations from the Center Party's side, but the most important is reservation 2, which concerns the fact that the government must take a holistic approach regarding the availability of medicines, whether it is a question of orphan drugs, new vaccines, medicines that are requisitioned, or those that one orders at a pharmacy. Something must be done from the government's side. Time is running out. I stand behind all our reservations, Madam Speaker, but I choose to move for approval only for reservation 2.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Ulrika Westerlund (MP)

Madam Speaker! Remaining colleagues in the chamber! This debate concerns issues that concern many people. We have noticed that here today. It is not surprising, as many people have experiences of, for example, trying to pick up an important medicine and receiving the information that it is backordered or that the nearest pharmacy does not have the medicine in stock and must order it. Many also have experience of having to pay a high dental bill, sometimes so high that it is not possible to balance personal finances for a long period as a result of the high cost for completely necessary care. It can be particularly difficult for young people with poorer finances and for elderly people who often have both poorer finances than they had earlier in life and poorer dental health.

Miljöpartiet often raises questions about the importance of preventive work for health, and that is what I want to do today as well. There are medical conditions that can be improved just as easily, or rather preferably, in other ways than through medication. We have a challenge as a society in how we can work for lifestyle changes that reduce the risks of disease. What is needed here, as usual, is more research, but Miljöpartiet also wants to see a public health law that could contribute to a better foundation for health in the entire society and thereby a reduced risk of ill health.

Which instances in society should be responsible for ensuring that information on what the individual themselves can do to reduce the risk of disease reaches everyone? Most probably know that alcohol and tobacco are harmful to health, but perhaps not quite as many have been reached by information on, for example, the importance of reducing salt intake. Just such a measure could lower high blood pressure for many affected and in that way reduce the need for medication.

But at the same time, there are many medicines that are necessary and that we need. There are many reforms that Miljöpartiet would like to see to ensure availability for everyone, regardless of where in Sweden we live. Much has happened since the pharmacies were deregulated in 2009, and it is time for a comprehensive review of the Swedish pharmacy market that does not exclude a re-nationalization.

In recent times, for obvious reasons, there has been a strong focus on the fact that the healthcare system's preparedness to secure access to, for example, necessary medicines must be strengthened. Also for this reason, there is therefore reason to conduct a review of the pharmacy market. The Government must ensure that Sweden has sufficient emergency stocks of medicines to cope with both normal conditions as well as crisis and, in the worst case, war. A strategy must exist for how the supply of medicines can be strengthened.

There are more measures that would need to be taken. More patients in Sweden should be given access to innovative medicines, orphan drugs, and the government should review what changes are necessary for this to be possible. Additionally, the role of pharmacists should be strengthened. Pharmacists should be able to prescribe prescription renewals for, for example, birth control pills, asthma medicines, insulin, blood pressure medicines, and similar medicines.

Pharmacies should also be given greater opportunities to remedy the problems with medicines running out. Among the measures that the pharmacies themselves have proposed are to allow substitutions that are currently prohibited, for example regarding package size, strength, dosage, other dosage forms, and in some cases another medicinal substance. This is also an issue that the government should review. Among the urgent measures in the pharmaceutical area that Miljöpartiet would like to take are also free contraceptives for young people. We also want measures to be taken to address incorrect use of medicines. This occurs in all age groups, but the elderly are often particularly vulnerable. The government should investigate whether, for example, a reporting obligation for suspected medication misuse should be introduced.

Madam Speaker! Miljöpartiet has long advocated for the issue of equating dental care with healthcare in general for everyone in Sweden. Our goal is therefore that dental care should be included in the same high-cost protection as healthcare in general. But we consider that the proposal which came from the dental care inquiry regarding a separate high-cost protection of 1,200 kronor per year is an important step along the way. It would mean a lot for individual persons. Since that path can be more accessible, we believe that at this moment it is that proposal that should form the basis for necessary reforms.

Another important proposal from the dental care investigation that we want to emphasize is that those people who have the greatest need should be prioritized. The already submitted proposals should be a starting point for continued work on a high-cost protection for dental care.

We oppose the savings that the government proposes within the dental care area as long as these are not complemented by the other proposed reforms from the dental care investigation. Lowering the age limit for free dental care from 23 years to 19 years and abolishing the system of double dental care subsidies for young people between 24 and 29 without introducing a high-cost protection risks affecting those who have the worst dental health.

I support all of the Miljöpartiet's reservations, but I move for approval only of reservation 16.

In this speech, Katarina Luhr (MP) agreed.

The deliberation was hereby concluded.

(Decisions were made under § 11.)

The speech at riksdagen.se, in Swedish (opens in a new tab)