Increased control in healthcare

Linda Lindberg (SD)

Mr. Speaker! Today we are debating the bill on increased control in health and medical care, which was put forward by the previous Social Democratic government. I move for approval of the committee's proposal for a decision, which entails partial approval and partial rejection of the bill.

The committee therefore supports the proposal to a law on amendment of the Patient Safety Act as well as other proposals in the Health and Medical Services Act. These proposals mean, among other things, that the Health and Social Care Inspectorate shall require the person who has not fulfilled their obligation to report to the healthcare provider register to fulfill this obligation. A decision on a requirement shall be accompanied by a fine. At the same time, the provision on criminal liability for failure to report shall cease to apply.

It is further proposed that the primary care's basic mandate shall also include rehabilitative interventions.

We Sweden Democrats are positive towards increased control within the Swedish health and medical care but want to prevent the government's proposal that increased control should only apply to regions that enter into cooperation with private healthcare providers that have multiple clients. We are therefore saying no to the government's - the previous government's - proposal on changed conditions when regions sign agreements with private healthcare providers that also have insurance companies as clients.

It is precisely this that the Social Democratic government has fixated on. There is nothing to indicate that this would be a problem or that there is such a need, but this is in principle a highly ideological issue.

It is also not seen in the investigation that there is a need for such a legislative change as proposed in the bill. Rather, the investigation's examination shows that there is generally a good relationship between the regions and the private healthcare providers and, furthermore, that the regions have great confidence in the private healthcare providers. There are thus no clear reasons to suspect that the private healthcare providers make unfair or incorrect assessments regarding the ethical platform's ranking, which is based on the principle that those in greatest need of care should also be prioritized in care.

One can however observe that issues concerning private health insurance are essentially unregulated, but we do not see that the current proposal would develop and improve the way private health insurances function.

Mr. Speaker! At the same time, the number of private health insurance policies has increased during the 2000s, and around 700,000 people today have a private health insurance. It is clear that it is primarily smaller companies and small business owners who take out insurance for their employees in order to be able to get their staff back to work quickly. And that in itself, Mr. Speaker, speaks volumes. We – or rather the previous government – have failed with Swedish healthcare when the number of those who take out health insurance increases. One simply cannot trust the Swedish healthcare system and that one receives the care one needs when one needs it.

It is also worth mentioning at the same time that payments for health and medical care via private health insurance are estimated to amount to approximately 0.7 percent of the total health and medical care expenditure - i.e., a vanishingly small part.

Furthermore, as several referral bodies point out, it is already possible today to regulate via agreements that patients whose care is financed by private health insurance may not receive more favorable waiting times than others. This is currently regulated in the Health and Medical Services Act, and there are also provisions in the Local Government Act that municipalities and regions that have, through agreements, handed over the management of a municipal matter shall monitor and follow up the operations.

It could be the case, Mr. Speaker, that the Social Democrats are shifting their failure with the Swedish health and medical care onto the country's private healthcare providers instead of talking about what is actually the problem: the governance of and the challenge with the Swedish healthcare. It could be here we have the problem. I believe it would be good for Sweden if the previous government had had a little more interest in this than in finding faults with others, as in so many other contexts. It is always someone else's fault, Mr. Speaker.

What I mean is that Swedish health and medical care faces many, many challenges. We all know that in this chamber and far too many around the country, both patients and professionals. Not least, the unreasonably long care queues are worth mentioning in this context. They are actually so long that people manage to pass away before they receive their care.

To present proposals in the same breath that restrict healthcare providers who want to step forward and do their part is strange. No, Mr. Speaker, instead we need to ensure that we increase efficiency and reduce the healthcare queues. Then we cannot restrict and tighten things for those who want to help deliver healthcare in our country.

It is of great importance for Swedish healthcare that work is done to strengthen and possibly simplify the cooperation between public and private healthcare in order to achieve equitable care and reach the maximum capacity that Swedish healthcare is in need of.

Regardless of the healthcare provider, ethical prioritization must be fundamental, along with ensuring that patient-safe and qualitative care is performed within the healthcare guarantee's timeframe. Likewise, it is important that those who have the greatest need for health and medical care shall be given priority to care. These principles shall be guiding within all health and medical care and should be pursued in all care conducted in Sweden.

(Applause)

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

Karin Rågsjö (V)

Mr. Speaker! The member is rather carefree when it comes to the private health insurance, which I can find a bit strange.

It is no small market we are talking about, and it is a market that is completely unregulated. It is a market that brings in 3.9 billion kronor to the insurance companies. There is, therefore, money in this. It is not a charitable cause; it is not Save the Children stepping in.

The boring and strange thing about this is that private healthcare companies have the possibility, through agreements with the regions, to both take in us who do not have healthcare insurance, and the others who do. You always get such a question when you call a healthcare company that has an agreement.

It is the same doctors, the same nurses and so on who take care of the whole. Many of the private healthcare companies also have agreements with several insurance companies at the same time, so the money keeps coming in. At the same time, it becomes a bit strange, I might think, because they use the same doctors and the same nurses as we others do. Isn't that a bit strange? Isn't this something that one should look at?

Today the market is growing. That is to say, 14 percent of the number of employed people have a private health insurance. And it is not just the carpenter with a bad back, but when one has investigated this, one sees that it is most often men who have high positions, for example within the financial world, who have this insurance and who push others out.

Is this reasonable? Is this equal? Is it something that the Sweden Democrats think we should revere? Should we provide even better conditions for the private healthcare providers, who obviously cash in so much? I can say that there were huge cheers from the healthcare companies and the insurance companies when they saw your motions.

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

Linda Lindberg (SD)

Mr. Speaker! It is very clear that we do not agree. We differ completely on these issues and also on this issue.

The proposal contained in the bill would de facto not solve what Karin Rågsjö is looking for, rather the opposite. When Member Rågsjö speaks, it usually concerns class society and class differences, and in that case, we would instead get units that exclusively dealt with private health insurance and then have care that did not do so. That could be the effect of the proposal that is on the table today. I do not see that it would be to the benefit of Sweden and the Swedish health and medical care.

Instead, we should ensure that we take advantage of the capacity of the healthcare providers who are in and want to operate in Sweden so that we can deliver as much care as is possible. It is here that we need to deploy efforts and resources.

As I mentioned in my speech, the market is largely unregulated. But there is nothing to suggest that this proposal would be a solution to that.

My questions to Member Rågsjö are: How does the Member imagine we are to get productivity started in the Swedish health and medical care? How does the Member imagine we are to get down the care queues? Is this the solution to that problem? Will we really get more equal care if this proposal were to go through?

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

Karin Rågsjö (V)

Mr. Speaker! I thought it was I who was to ask the questions to the member. But in order to get momentum in the entire healthcare system, one must nevertheless look at the aspect of equality. One can hardly say that we have received more equal care over the last ten years. Then one must look at the market elements that exist and regulate them.

We have a completely unregulated market. I think it is very strange that I, as a taxpayer in, for example, Stockholm, where both the member and I live, should pay for those who have private insurance. It benefits the insurance companies, who think this is a fantastic market and who are friends with the healthcare companies. They carry out an enormous amount of lobbying.

I think it is rather strange that the member and the Sverigedemokraterna have adopted this to such an extent as you have now done for eight years. You think it is completely reasonable that private healthcare companies that have an agreement with the region and that have a number of doctors and nurses should have two doors in - one door from the insurance companies and one door for the rest of us. Then it reasonably follows that we subsidize the insurance companies. I think it is strange. It might be better if these companies that have so much capital started their own healthcare companies for those who have insurance.

How do you get the healthcare system moving? Well, one can start with a budget that is reasonable for the needs that exist. That is a piece of advice to the member.

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

Linda Lindberg (SD)

Mr. Speaker! Once again, it is very clear that we do not agree on this issue, as well as on many other issues. On the other hand, we are in complete agreement that we need to see increased control over the Swedish health and medical care.

I also agree that over the last eight years, we have actually not succeeded anywhere in achieving more equal care. Now we have tried a system for a very long time, which Vänsterpartiet has partly been involved in and struggled through. I think it is an enormous failure for the Swedish health and medical care that the previous government has not succeeded in either shortening the queues, ensuring that we have a supply of competence, ensuring that we strengthen mental health in Sweden, or ensuring that we have a good preparedness. Many parts have been and are extremely neglected.

Now we have another government moving forward with a powerful engine. The health and medical care area is being prioritized. We have four ministers in the area. I am very positive that we will succeed in increasing equality within the Swedish health and medical care. There is a very high ambition level in the Ministry of Health, and I am completely convinced that many good and great proposals will be delivered moving forward - something that has failed for a very long time.

When it comes to equal care and health, we agree, Member Rågsjö. When it comes to this bill, however, we differ strongly. I am pleased that my party, together with several others, a majority in the Riksdag, has landed on the conclusion that this is the right way to go.

Then one must remember that the market is largely unregulated, and we need to look at how it should be regulated. But in the bill submitted by the previous government, there were no incentives for it to become better, neither for the individual nor for Swedish health and medical care.

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

Fredrik Lundh Sammeli (S)

Mr. Speaker! Care on equal terms and care based on need is a very fundamental principle in Swedish healthcare. For a Swede, it may sound obvious, but we also need to see that there is a reality that does not function in relation to that principle. It is very clear that today we have a healthcare system where patients and persons with a private health insurance can get priority in our jointly funded healthcare. If one is to have care based on need and care based on equal conditions, it rhymes very poorly.

This is a reality that we have seen for a long time and which is developing and becoming more extensive. From our side, we have repeatedly pointed out and tried to present various proposals to meet this, which I believe is completely insane.

That one can have private health insurance and thus be able to jump the queue despite not having greater medical needs than those who are waiting is a worrying development. They are fast lanes that are neither fair for the individual nor a good way to prioritize healthcare.

My question to Member Lindberg is: Why do you want to retain the possibility for predominantly men with good health and good finances to buy themselves priority in the jointly funded healthcare that we have?

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

Linda Lindberg (SD)

Madam Speaker! This is typical rhetoric from the Social Democrats. Here, one has sat in power for eight years. One has failed in practically everything within the Swedish healthcare system. We have hysterically long healthcare queues. We have people who die in the healthcare queues. I mentioned exactly this in my speech, member Sammeli.

In the election campaign, people step forward and create a fog of smoke about how this would be fast lanes for directors and so on. To begin with, there is no basis showing that there would be any displacement effect. There is also nothing showing that this would be about directors and wealthy people. In broad terms, it is the Social Democrats' former electorate, the one that has now been lost – the ordinary worker, quite simply. It is the carpenter or the construction worker whose employer has signed an agreement so that one can quickly get out into production. That it would be fast lanes is just rather poor rhetoric.

It is, however, interesting, again, that there is nothing in this proposal that would make a greater difference for the individual and address the "fast lanes" that Member Sammeli points out. Instead, it would lead to us having healthcare providers who only dealt with private health insurance. I do not know if that is so much better. Then it would truly become class differences.

I think the proposal is bad, and I stand by that. A majority in the Riksdag thinks it is bad. In principle, it is the Social Democrats and the Left who think it is good.

But to get to that point: What have social democratically led governments done for good over the last eight years to increase equality in Swedish health and medical care?

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

Fredrik Lundh Sammeli (S)

Madam Speaker! I gladly take the opportunity to tell what we have done, even though it is I who am asking the questions in the exchange of remarks.

We have contributed immensely more welfare billions to be able to strengthen welfare, not least at the municipal and regional level. We have navigated a pandemic where we took collective responsibility to shorten queues, strengthen the parts that have been challenged, and increase the number of employees in health and medical care. It is largely about financing and competence supply. That is what we, in a government position, have focused on and delivered on.

I still intend to return to the reality linked to the principles of care based on need and care on equal terms. Does Member Lindberg not see that it is a problem that we jointly finance a welfare system with these principles, which we say should be guiding, and at the same time passively stand and watch when there is an insurance solution that erodes those principles? People with private health insurance come first in the queue without having a greater need, without them being prioritized according to the healthcare system's priorities.

One can stand here and say that the Social Democrats have done nothing. I think it is easy to look at the recent years and see that we have delivered. But what do the Sweden Democrats intend to deliver? Fast lanes in healthcare is an actual problem. If you say no to this bill, what is then the concrete proposal you intend to put forward to rectify these problems?

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

Linda Lindberg (SD)

Madam Speaker! I do not know if Member Sammeli is not quite listening to what I am actually saying. I say that it is important that we ensure that we have an equal healthcare in Sweden. It is paramount. The one who has the greatest need for care shall also receive it. That is what we completely agree on.

But this proposal does not solve those problems. Instead, we get individual healthcare facilities that only deal with that type of care. That is exactly what I am standing and saying and have said several times now; this is not the solution to what we all actually want to achieve, but rather it means that one wants to limit the healthcare capacity in Sweden. It is a very bad thought and idea in the context and the time we live in, when the Swedish health and medical care is so neglected.

We have hysterically, illegally long healthcare queues. We cannot continue with such things. There are other, significantly much better and more effective things and measures to create equal healthcare in Sweden.

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

Fredrik Lundh Sammeli (S)

Madam Speaker! The statutory goal for Swedish health and medical care is good health and care on equal terms for the entire population. As it stands in the law, care shall be provided with respect for all people's equal value and for the individual person's dignity. The one who has the greatest need shall be given priority in care.

The principles are completely fundamental for Swedish healthcare. Concretely, it means that everyone should receive healthcare services on equal terms. Your access to healthcare should not be affected by your age, gender, ability to take initiative, education, or ability to pay. You should have the same access to care and receive the same waiting times. That is how our legislation looks. That is how it is intended to function, and that is how we in broad agreement here in the chamber say we think it should function.

At the same time, we know that is not the case in reality. Through a private health insurance, the person with a high income and a sufficiently attractive medical history can buy themselves a faster assessment and treatment. In cases where the healthcare visit leads to a referral, the insured patient can then use it at other healthcare providers.

Madam Speaker! Insurance patients receive faster care today in our publicly funded health and medical care system. We Social Democrats want to change that. We tried to do so already in 2005 through a stop law that was implemented but which was overturned by Fredrik Reinfeldt and the Alliance government.

We regained government power in 2017 and tried to change it through a government bill, which unfortunately was voted down by the bourgeois parties and the Sweden Democrats. The arguments then were that the bill lacked a basis and that the problem was not sufficiently described. A bit earlier here, we also heard that in the presentation and the exchange of remarks. The right-wing parties thus claimed that it had not been proven that patients with insurance received faster care.

During the last parliamentary term, we Social Democrats therefore saw to it that the Social Democrat-led government investigated the issue thoroughly. This was first done in 2020 through an investigation by the Agency for Health and Care Analysis. In 2021, a government investigation, a so-called SOU, was conducted. In 2022, a supplementary legislative memorandum was finally produced within the Government Offices. Thus, there is a solid basis that describes the problem and which also contains elaborated legislative proposals to remedy today's deficiencies.

The bill that we are debating today is the first of two intended bills that were to be developed based on this collective basis. But it is now clear that these proposals will not be implemented. The new government and its support party Sverigedemokraterna apparently think that the current order works well.

They think it is good that predominantly men with good health and high incomes can keep the current fast tracks in publicly funded care. They apparently do not think it is a problem that people with chronic illnesses or elderly people have to wait longer. Those groups are also often unable to take out an insurance, and even if they could, they cannot afford to do so.

The government does not think that the principle of care based on need is worth defending. If they had thought that care on equal terms and with equal conditions is an important principle, not just on paper and as something we say here in the chamber, but a principle that would have aligned with reality, they would have, in fact, supported this proposal.

For us Social Democrats, the matter is clear. Care shall be provided based on need, not based on the size of the wallet. In this case, there is only one reasonable course of action. It is to approve reservation 1.

(Applause)

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

Anders W Jonsson (C)

Madam Speaker! We have a number of major problems in Swedish healthcare. One of them is the queues. These are queues that are getting longer and longer with every passing day and week. That is how it has been since more than ten years ago. Unfortunately, we see no change in that.

It has all possible difficult consequences. A number of employers choose to take out private health insurance for their employees. That is what we see when the number of those who have private health insurance increases from year to year. It is a problem. And then the Social Democrats attack the symptom, that certain employers try to find ways around.

The problem with this proposal is that it misses the mark on the real problem: that we have too low capacity in the Swedish healthcare system. If this bill were to become reality, it would mean that a number of private healthcare providers who work with both private healthcare insurance patients as well as patients in public care, and perhaps foreign patients and those who pay out of pocket, would not be able to use their available capacity to support public healthcare.

The result would therefore have been significantly longer queues than today, and if there is one thing Sweden does not need is for the Riksdag to decide on measures that make the queues in healthcare even longer. Therefore, my question to Fredrik Lundh Sammeli is why the Social Democrats time and again return with this proposal. It came in 2006, 2010, 2014, 2018, and now ahead of the 2022 election. The consequence of the proposal is that an already concerning situation becomes even worse by making the queues in Swedish healthcare longer and longer.

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

Fredrik Lundh Sammeli (S)

Madam Speaker! Healthcare faces major challenges with queues. It is an issue we need to focus on together. A great deal is about resources for healthcare. It is also about competence supply linked to education and educational places, and about management and governance. This is something previous governments have struggled with, and it is something future governments must also struggle with. It is a challenge in itself that the issue affects all three levels. We know all of that, and we need to work on it together.

That the healthcare system has queues does not mean that one can lie down and give up on all other problems. Therefore, I think it is strange that the issue of queues is used as an argument to say no to this change. Fundamentally, this is not about any available capacity. It may sound very innocent and nice, but it becomes clear when one examines reality that it is not just available capacity that makes insured patients receive care. On the other hand, they often receive care faster, and thus go ahead in the queue without it being based on the principle of care according to need and care on equal terms.

I really hope that the parties in the government basis see that this is an injustice in Swedish healthcare. It is a reality that risks eroding the entire collective will to pay for healthcare when some, through their insurance, get their own door in. At the same time, one must manage to work with all the issues regarding the queues.

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

Anders W Jonsson (C)

Madam Speaker! The Social Democrats are therefore prepared to submit a proposal that increases queues and reduces the capacity for operations and specialist doctor visits. That is, in fact, what will be the effect. The clinic that today has capacity for 100 patients, but only receives 50 from the public sector, has the possibility to fill up with additional patients with the current system.

A concrete example for Fredrik Lundh Sammeli, so that he understands what this is about: Say that I am at position 50 at home in Gävle to have my shoulder operated on. Then it turns out that some of those who are ahead of me in the queue, five people to be precise, have employers who have signed private health insurance policies. They work in the construction industry and in other places where one cannot be without staff for that long.

Now say that the five patients get the opportunity to go to Sigtuna, Stockholm or Eskilstuna and have their shoulder treated via their private health insurance. In practice, this means that I, who previously stood at position 50, suddenly end up at position 45. Can I then claim that these five construction workers have gone ahead of me in the queue? No! I can claim that thanks to them having private health insurance, I had the luck of being moved forward in the queue and thus having my shoulder operated on significantly faster. But that cannot be accepted in the social democratic world, because there everyone is supposed to stand in exactly the same queue and wait for their turn, even though the result is that the queues become longer and the capacity lower in Swedish healthcare while more patients have to wait longer.

I will not say that I am upset about this, but I am nevertheless surprised that the Social Democrats time and again return with this type of proposal which will definitely make the queues longer in Swedish healthcare.

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

Fredrik Lundh Sammeli (S)

Madam Speaker! It is not the case that the queues in health and medical care exist because there is, in parallel, a huge amount of available capacity. One can easily get that impression when hearing the arguments for continuing with a model that undermines the basic principles of care based on need and on equal terms.

It is not true that there is a huge amount of capacity that those insurance solutions just help us manage. In reality, it doesn't work that way, and it is very clear. We need to shorten the queues and work much more on skills supply, financing, and ensuring that we get even better health and medical care.

The problem remains: You are safeguarding an insurance model that erodes the jointly funded healthcare. One can always discuss where a society is headed where one can purchase insurance that covers operations by conducting its own activities. Does it create strong cohesion and good health and medical care?

In this case, people pretend as if private health insurance is something positive that fills available capacity and shortens queues in some fair way and that there is no problem. For me as a Social Democrat, it is very clear when one takes into account all the work that has been done in the area that the reality is not good from the principles. That is why we have submitted these proposals. I think it is unfortunate that the government base, together with the Sweden Democrats, says no.

(Applause)

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

Jesper Skalberg Karlsson (M)

Madam Speaker! Today we are debating the Committee on Health and Welfare's report number 5 on increased control in health and medical care. It contains a number of different proposals. It is important that we have this debate because there are several clear and major problems that need to be solved within Swedish health and medical care. It is about shortening the queues, creating conditions for more care beds, and securing the supply of competence. It is important, to say the least, when fewer than half of all women with breast cancer and fewer than four out of ten men with prostate cancer receive care in time. Several of these issues have been addressed by the new government even before the government has been in power for 100 days.

Socialstyrelsen has been tasked with developing proposals to improve the healthcare sector's competence supply. The investment to increase the number of healthcare places has been doubled, and agreements have been entered into with Sveriges Kommuner och Regioner regarding, among other things, cancer care and mental health, as well as a collaborative project has been started to strengthen health and medical care. The goal of the project is to cut queues, improve accessibility, and ensure equality throughout the country.

Therefore, I want to mention that parts of the committee's report are matters we completely agree on and which should be taken forward by the new government. Changes in, for example, the Patient Safety Act are welcome, as they would increase the pressure on healthcare providers to register in the healthcare provider register. We cannot be satisfied with only 70 percent of healthcare providers being in the register. Sweden can do better! We Moderates have previously, together with our coalition partners, proposed that such decisions be followed up after they have been made, to ensure compliance. More can also be done regarding other registers within healthcare, which we will return to during the parliamentary term.

Another noteworthy position that the committee stands behind is that rehabilitation shall be included in primary care's basic mandate. The committee has already previously announced this to the previous government, and there is a broad consensus behind such an orientation.

Madam Speaker! There are also things the committee disagrees on in the case of private health insurance. The previous government claimed that private health insurance is more dangerous than gang shootings and therefore put great effort into finding ways to make it difficult for regions that have agreements with private healthcare providers, where the insured receive care. This goes directly against how we Moderates and the new government want to proceed moving forward.

If we are to address the healthcare queues, all good forces that contribute to more accessible care are needed, and we believe that the regions need more partners and tools to cut the queues. We are also prepared to give the regions the responsibility and opportunity to enter into the agreements they see as necessary.

Let me therefore mention that the proposal put forward by the previous government to make it more difficult for those with private health insurance is no small matter. Approximately 700,000 Swedes today have a private health insurance, and a large part of the unions offer and procure insurance as an offer to their members. A total of 15 of 21 unions within Saco and 5 of 13 within TCO utilize that possibility. I share their frustration that they need to pay twice for care in order to receive it in time.

The proposal submitted by the previous government aimed to complicate and worsen the options for patients instead of developing and strengthening accessibility. It is partly an interference in local self-determination, and according to the Council on Legislation, it is difficult to assess what purposes the proposal actually has, which leads to it being difficult to evaluate whether the objectives will be achieved.

Madam Speaker! In summary, we Moderates are committed to increasing accessibility, safeguarding diversity, and cutting queues. We welcome increased control in health and medical care if it benefits patients and healthcare providers. But we decline the ideological proposals from the previous government that lack any such benefit. If we are to get Sweden in order, more is required.

I vote in favor of the committee's proposal for a decision.

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

Karin Rågsjö (V)

Madam Speaker! I do not think the member is answering some of the rather complicated questions. Let me give an example.

This is very much about money and the market. It is an activity that generates a lot of money from those who are involved in it, that is, the healthcare companies and the insurance companies. Around this, there is also a strong lobbying activity. I will return to that in my main speech.

The interesting thing is that the private healthcare companies that have agreements with the regions so that the regions pay them usually have two entrances, which has been confirmed in very many investigations. They have one entrance for those who are insured and another entrance for the rest of us, but it is the same number of doctors and nurses who take care of all patients. I think that is something one can reflect on.

They are also subsidized through tax funds because the region has an agreement with the healthcare company in question. The clever part for the healthcare company is that they can have several agreements with different insurance companies. This can therefore mean that very many people can join the second queue. I wonder how this facilitates healthcare. Those of us who do not have the private health insurance remain in the queue.

Would it not be better with specific departments that the insurance companies with their enormous capital had to build up together with the enormously wealthy healthcare companies? These would in that case only be directed to those who are insured. Is this not a good idea? Or should we mix? Should we taxpayers subsidize the insured? I am doubtful.

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

Jesper Skalberg Karlsson (M)

Madam Speaker! Freedom of choice has never ranked particularly high on the Left Party's agenda, at least not when I look back at previous parliamentary terms. Even though the member now says that if we just get rid of the insurance companies, the private healthcare companies can have their own clinics. Sure, but the Left Party is also against that, so it is not actually a solution they themselves are promoting.

Furthermore, this is about regions having the opportunity to enter into the agreements they see themselves needing in order to be able to provide accessible care. If one looks at the investigation, SOU 2021:80, one sees that there is rather a good business relationship between the regions and the private healthcare providers. The regions have a great confidence in their work and consider them to be a complementary activity to that which the region carries out.

We believe that all good forces are needed if healthcare is to become more accessible for more people. In this context, it can be mentioned that approximately 700,000 people in Sweden have chosen to have a private health insurance. That is significantly more than the number of people who, for example, voted for Vänsterpartiet in the autumn election.

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

Karin Rågsjö (V)

Madam Speaker! The Right has always surrounded itself with powerful lobbying for all sorts of things, hasn't it? It has concerned everything from eels to schools and healthcare facilities. One must still say that.

The interesting thing is that the proposal you submitted in your motions generated cheers. The insurance companies' lobby organization Svensk Försäkring said they were completely satisfied, and the private healthcare providers' organization stated that the motion was a success for the healthcare companies' lobbying efforts. I just wanted to say that.

This is exactly what it is about; it is about money. There are incredible interests when it comes to private health insurance. They are enormous interests! It generates as much money as anyone can imagine. Furthermore, it is an opening for an Americanized healthcare. It is completely obvious. The member comes from the party that has promoted a completely different type of welfare model than what we stand for.

We are not against freedom of choice. The patient's freedom of choice should of course be protected, but hardly the companies'. That is not what I think.

This is very much on the companies' terms. I am concerned that the Swedish health and medical care is becoming increasingly influenced by the market in various ways. I think one should have collaborations and would have liked to see more collaboration during, for example, the pandemic. I would have liked to see the private healthcare companies standing on the steps of Södersjukhuset, but they didn't really do that.

So it is very much about money and not so much about freedom of choice. It is about the resources: As a taxpayer in my region, I should not have to subsidize the private healthcare company's intake of private insurance customers. Isn't it a bit absurd if they are to have the same doctors that I have? How much money does that generate for the companies? That is an interesting question.

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

Jesper Skalberg Karlsson (M)

Mr. Speaker! I can partly agree with the member that more cooperation would have been needed during the pandemic. In my role as acting chairman of the regional board on Gotland, I sat and examined whether we had a legal basis to close certain nursing homes to prevent the infection from gaining a foothold there. At the same time, the responsible Swedish authorities, who were subordinate to the government, were pondering: "What will happen now with the sports holiday? We probably won't do much about it."

We hear arguments that I and my party listen to individual companies when we prepare various proposals for decisions. That is not the case. I like entrepreneurship, but not necessarily individual companies. Companies are driven by making money, and they create value through competition. But I am in no way pro-business, rather I am pro-market. One needs to create value for people if one is to have a right to exist in a market and withstand competition.

On the subject of competition: It is sometimes mentioned that the Moderates want it like in the USA. I do not want it like in the USA. I want Sweden to be the world's best country to live in, and I want to be able to say that I was part of building that country. Then we must be better than the USA and better than everyone else. That is the starting point, not to compare ourselves with other countries in order to imitate them. We shall find the best way forward. I unfortunately do not believe that this proposal would have contributed to that if we had approved it.

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

Karin Rågsjö (V)

Mr. Speaker! Today we have a healthcare system that tends to become more and more market-oriented and unregulated. This happens to a very large extent on the market's terms. Patients with private health insurance go ahead in the queue and receive faster care, sometimes without having medical needs. This can be read about at Vårdanalys. One can also look at an article that DN wrote this spring about this after an investigation.

We want to remove this type of fast track. We must stop giving tax money to private healthcare companies that have agreements with the regions and have two entrances: one for those with private health insurance and another for those without private health insurance.

Some in this chamber are worried that the hospitals are being sold out to Australia and that more and more people are taking out a private health insurance and jumping the queue, while others do everything to try to stop the idea of equality that we promote in different ways.

We have debated this issue for eight years. Sometimes it can feel like one is rolling back through all the debates we have had. There are a number of parties that always oppose changes to this and wholeheartedly give their support to the private healthcare companies and insurance companies, namely C, L, M, KD and SD.

There is no evidence that private health insurance leads to patients with minor needs going before patients with greater needs, you say on the right. Oh, okay? You know that I live in Stockholm. Here, there is a plethora of private healthcare companies. When you call, they always have one question: Do you have health insurance or not? The interesting thing is that it is the same doctors who receive both me and those who have this insurance. Then one always wonders who goes first, and this can be read about at Vårdanalys. One can also, as said, Mr. Speaker, look at DN's investigation, which was very large.

The rejections from the right on the previous government's proposal, which we are talking about now, make the private healthcare industry rejoice. They were very happy. They are incredibly skilled at lobbying. They have worked with it for a very long time and are professional. In the insurance companies' lobby organization Svensk Försäkring, they are completely satisfied, and the private healthcare providers' organization states that the motion is a success for the healthcare companies' influence work. It is a matter of lobbying. Then I must say that I am becoming worried.

The new government, with the Sweden Democrats in its arms, promises a fantastic continued cooperation with healthcare companies and insurance companies - friends - and the market comes first. There are very many lobbying companies when it comes to various issues - everything from the eel lobby to the school lobby and, as said, the healthcare lobby. I think that one should have a rather closed door to these lobbying activities, but perhaps we have different views on that.

Sometimes it sounds like it is mostly construction workers who have these types of private health insurance policies. It is about Kalle with a bad knee, it is said. But if you look a bit closer, you see that it is not like that. It is also to a large extent people in high positions, for example within the financial world, mostly men, who have these types of insurance policies. It is also others, of course.

It also turns out that those who have this type of insurance receive rapid care, while the same healthcare company, as I have described earlier, lets the region's patients wait a bit longer. The healthier and wealthier tend to go first. I think that is a dangerous development.

I am worried. One might think it is silly that I mention the USA as a benchmark, but I am worried that we will get even more market influence on healthcare. We do not need that. Of course, one needs good cooperation between the private healthcare companies and the regions. One must consider where the money comes from and what the money generates. It cannot be that a private healthcare provider, a health center, has two different queues that use the same doctors and the same nurses. Think about that a little! What is it that we land on then? Who subsidizes whom? That is something one can think about.

I believe that private health insurance undermines our public care in the way I have described. Healthcare companies providing private care would not be able to do so if they did not have the agreements with the regions, if they did not have their premises and if they did not have money for the rest. Are we to subsidize it in this way? I am doubtful. We really need to use tax money in an effective and good way. I promise that one has two entrances to all the private healthcare companies that exist around in this region. It is very common.

There is, at a national level, a political resistance against reforms aimed at increasing equality, I must say. Instead, for example, LOV, the Act on Choice Systems, is praised. It sounds awfully nice – until one starts digging a bit into the right of free establishment and what it leads to.

Need-based care is a central part of the Health and Medical Services Act. That persons with private health insurance receive care faster than one receives through publicly funded health and medical services, which is not based on medical needs, contradicts the legislation. We believe that we must solve this in some way and increase the control of the regions' agreements with private healthcare providers. Since the basic idea with private health insurance is to bypass the Health and Medical Services Act and get care faster, perhaps that is not the only path we must take. Therefore, it should also not be permitted for the regions to enter into agreements with private healthcare providers who simultaneously have agreements with insurance companies regarding private health insurance. It is the same staff who take care of the whole, so to speak.

Legislation that regulates this in a corresponding manner should therefore be developed. The Government should return with proposals in line with the commission's proposals that the health and medical care that the region conducts on its own initiative may only be financed with public funds, and that tasks that have been handed over from the region to someone else shall only be financed with public funds and patient fees. For this reason, I move for the reservation number 2 to be granted.

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

Anders W Jonsson (C)

Mr. Speaker! We have a number of major problems in Swedish healthcare. I agree with Karin Rågsjö that one of them is inequality. Perhaps the biggest problem of all is the unequal distribution of health. It is often said that there is a ten-year difference in life expectancy here in the Stockholm area between the two endpoints of the red metro line. Regarding illness after illness, we know that they primarily affect those who are socioeconomically vulnerable, have a low level of education, are unemployed, or are born in another country.

This is a very serious problem in Sweden, and we must do something about it. This is primarily about measures that level the differences regarding education and give more people the opportunity to enter the labor market, but it is also about ensuring that there are good opportunities to, for example, use an interpreter when one visits healthcare.

Mr. Speaker! It is not just about differences in underlying health. An equally large problem is the differences in access to healthcare, I would say. I am not talking about the marginal phenomenon that we have debated for nearly an hour, namely the private health insurance, but that access to publicly funded healthcare is not equally distributed. If one seeks out the emergency room, one has significantly greater prospects of quickly receiving the correct care if one speaks good Swedish and has an academic education than if one is socioeconomically vulnerable. Nor is Sweden an equal country when it comes to access to specialist medical assessments, that is, what one is referred for.

We also have differences in that area. It is those who are well-educated and have jobs who have an easier time accessing the publicly funded and publicly produced healthcare. There we have a huge problem.

One might ask: What is the reason for this? It is largely free for anyone to seek healthcare. Yes, the serious problem in Swedish healthcare is, in fact, the queues. Regardless of whether it is bread queues in Leningrad or healthcare queues in Sweden, it is the one who has contacts or cash who makes their way forward.

I remember a visit to a medium-sized Swedish city where they had just started an emergency clinic in the evenings. It was based on the fact that you could come there, you paid 1,000 kronor, and then you got to see a doctor immediately. It was fantastic.

It was, of course, the doctors at the hospital who were working extra shifts at the clinic. I asked the person who ran the clinic: A thousand kronor for a doctor's visit, who is it that can afford to pay that? It must be those who live up there on the cream of the crop, who have high salaries and good fortunes.

No, no, said he who owned the clinic. The lawyer and the engineer always have good contacts with the chief physicians at the hospital. They have no problems getting through to the publicly funded care. The one who comes here is the single mother who has sat in a phone queue all day to get through with her three-year-old to the health center. It is she who does not get an appointment because of the queues. It is she who comes here and has to pay 1,000 kronor.

Mr. Speaker! One of the most important reasons why we have an unequal distribution of publicly funded and publicly produced healthcare is precisely the lack of accessibility. When it comes to queues, it is a matter of having contacts or cash to get ahead.

Instead of focusing on that, the left side now chooses to focus on a marginal phenomenon, I would like to say, namely the fact that there are a number of employers in Sweden who have chosen to take out private health insurance for their employees.

It is a misconception that it is wealthy people in Djursholm who take out their thick wallets and pay for such an insurance. It is definitely not that category. It is the employers who see that they cannot be without their employees for three, four, five, or six months while waiting for an operation. It is they who choose to sign this type of contract.

If, and I say if, the proposal from the previous government had gone through, it would not have reduced inequality in healthcare, but rather the opposite. It would have had the effect of making the queues longer.

It simply depends on the fact that we have a number of private healthcare units that have a greater capacity than the capacity they have contracted for from the public sector. The available capacity they have today, and have been able to use for many years back, can be used against the private insurance companies.

That, Mr. Speaker, reduces the queues. It is exactly as I previously took as an example. If someone in the queue to have their hip operated on in Gävle has those who stand ahead in the queue who have private health insurance, they disappear to Sophiahemmet. It makes it so that the person who does not have a private health insurance comes further forward in the queue and not the other way around.

That is why I have moved for the rejection of similar proposals in 2010, 2014, 2018, and now after the 2022 election. One is almost moved to tears when hearing Fredrik Lundh Sammeli describe the enormous investigative resources that the previous government spent on extracting the proposal. It was something that was solely intended to be used as a campaign pamphlet in the election to avoid discussing the healthcare system's truly major problems.

The first time I encountered it was the 2010 election campaign. Then, the then party leader Mona Sahlin tried to run a campaign stating that 2010, after four years with an alliance government, was the year when the worker's son no longer even got to sit in the same waiting room as the director's daughter. It was claimed to be so in one unit here in Stockholm.

I had to go there to see what it looked like where there was a waiting room for the director's son and another for the worker's daughter. Of course, it was not in that way. However, it was as Karin Rågsjö has pointed out several times in the speaker's chair, namely that at the private healthcare unit, one must keep track of who is to pay for the visit. Is it Stockholm County Council, as it was at the time, is it a private health insurance, or is it a foreign citizen who is to pay directly out of their own pocket? It is not that strange.

Once again, I move for the rejection of the government's proposal. It is good that we once again have a majority in the Riksdag to do so. My hope is that this must be the last time we discuss this form of pseudo-proposal.

It would be so good if we could use all the Government Offices' investigation resources to solve the real problems in Swedish healthcare. There are plenty of real problems to solve in healthcare, Mr. Speaker.

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

Karin Rågsjö (V)

Mr. Speaker! Anders W Jonsson and I have discussed this several times. Soon it is starting to feel like it is time for a tour around Sweden on this issue. But now, in all seriousness.

The Center Party sometimes conducts very good politics. But when it comes to this type of market issues, you are completely uncompromising and also a bit deaf, if I may put it that way, Mr. Speaker. That might have been a bit cheeky.

It must be more controlling, just as the member said here, of those health centers where a lot have two different doors with the same capacity. It is not my experience that there is an overcapacity. It sounds as if there are empty premises where the doctors sit and wonder what they should do. I have not encountered that anywhere, neither in Stockholm nor in Norrbotten.

For me, it is very strange that parties do not want to consider this regarding the health centers that are subsidized and have agreements with the regions. We subsidize the insurance patients who come there. I do not think it feels okay. One must look at it.

It is now quite many who have private health insurance. I can perhaps understand that given how the healthcare has developed. It cannot be said that it was the previous government's fault or anyone else's fault, but it is a number of issues that must be solved.

I am still wondering why the Centre Party, Mr. Speaker, cannot imagine a somewhat more stringent control, if I may put it that way, of those health centers that have open doors for the private health insurance patients and at the same time have funds from the regions. It becomes a great mix-up.

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

Anders W Jonsson (C)

Mr. Speaker! There is one thing that Karin Rågsjö and I actually agree on. Today, there are 700,000 patients in Sweden who have a private health insurance. We would both very much like to see that number be significantly lower. The question is how to reach that goal.

My way of reaching that goal is to ensure that we drastically reduce the queues in Swedish healthcare. A large part of the employers of those people have chosen to take out a private healthcare insurance because it is completely devastating for their companies that the employee should be away not just one, two or three but five, six, seven or eight months waiting for a visit to a specialist doctor or someone else.

I am happy to shake hands with Karin Rågsjö when it comes to measures to reduce the queues. One can speak with the four or five very large healthcare providers, who primarily do not have this type of patient, and ask them the question: Would you have the possibility to expand your capacity? Then one gets the answer from most: Yes, we could do that.

We could do it in a situation where we received long-term rules of the game so that we knew what applied not just for the next parliamentary term but for a long time ahead. Then we have the opportunity to do it depending on that we have the competence to provide healthcare in an efficient way. We have a relatively easy time attracting competent staff and so on. There we have an underutilized resource.

Mr. Speaker! It is not that we in the Center Party are uncompromising on the issue, or for that matter deaf. However, we see that this proposal would definitely not solve any problem. It would, above all, create a significantly larger problem.

All the private healthcare providers that have capacity today have patients from different sources of funding. They would not be able to have that, and the result would be less produced healthcare in the country. That is the last thing we need right now, considering that hundreds of thousands of people are in a queue.

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

Karin Rågsjö (V)

Mr. Speaker! I am glad that the Left Party and the Centre Party in the Stockholm region have a cooperation. Yesterday, 2 billion flowed in to acute care and primary care. That is something I cheer for, and the member can also cheer for it.

This is a question that is not just about available capacity, but this is about money - an enormous market. There is an incredible lobby organization. I know that after a number of meetings with Svensk Försäkring and the private healthcare providers' organizations. They are overjoyed that the proposal has been stopped. We can reflect on why they are so overjoyed. They say that this is a success for their influence work. It is largely what this is about, that is to say that there is an enormous capital when it comes to healthcare companies and insurance companies. These are no small operations, and they naturally want to increase their flow of money.

I am a bit surprised that just the Center Party took the bait so easily. This issue is surrounded by so much lobbying. When the issue surfaced before the election campaign, a thousand invitations immediately arrived to various contexts with healthcare companies and insurance companies.

There is something about this that feels a bit dangerous. The money and the market are pushing forward their positions more and more, and they are aligning themselves with politicians. Does Member Anders W Jonsson not see this as a problem?

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

Anders W Jonsson (C)

Mr. Speaker! I shall please Karin Rågsjö by telling her about my ideological basis. I would like to quote a representative who perhaps stands a bit closer to her than I do, namely the Chinese leader Deng Xiaoping. He once said that it doesn't matter whether the cat is black or white as long as the cat catches mice. It is the same attitude that I and the Center Party have regarding healthcare. It doesn't matter whether the healthcare is public or private as long as it is of high quality and it is easy to attract competent staff and, above all, as long as the patients are satisfied and receive good treatment. That is the guiding principle for the Center Party, not whether it is a limited company, a foundation, or a public administration. What matters is the care that is produced.

In the situation Sweden is in today, Mr. Speaker, we need as many as possible who can contribute to producing high-quality healthcare given the queues that exist and which yield devastating results, not least regarding increased class inequalities. There, Member Karin Rågsjö and I would find common ground – to reduce the inequalities in Swedish healthcare. One way is to reject the government's bill.

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

Dan Hovskär (KD)

Mr. Speaker! This is an interesting debate where different perspectives are pitted against each other. My and the Christian Democrats' perspective is to look at the individual's needs and develop different solutions. We simply have different needs. Therefore, freedom of choice is very important. We must not build up restrictions and walls in the way of organizing healthcare. At the same time, we must not compromise on quality but constantly work with development and diversity.

Christian Democratic policy is based on the premise that every human being is unique and that all persons have the same absolute and inviolable value. Solidarity-financed healthcare is the core of the welfare state, and those with the greatest need shall be given priority in care. Healthcare shall be characterized by dignity, quality, accessibility, and equality.

A fundamental part in the development of health and care is self-determination and freedom of choice. Self-determination strengthens the quality within healthcare and creates a more dignified care. Much has been done in recent years to design healthcare and care based on the individual person's needs. But more, not less, needs to be done in this area, and the patient's position needs to be strengthened.

Healthcare in Sweden is a public commitment where primarily the regions, but also the municipalities, are responsible for planning, organizing, and financing the care. The vast majority of healthcare is operated in-house in the current 21 regions, and the care provided is financed with public tax funds. There are also private healthcare providers that provide care on behalf of a region, where the region is always the principal for the care. This care is also publicly financed and paid for by the taxpayers.

What we hear in the debate from the left side and the Social Democrats is that they have a great focus on combating various private alternatives, that is to say the diversity and freedom of choice that has emerged regarding the provision of healthcare and elderly care in Sweden - all while the healthcare queues continue to increase. This results in many patients not receiving their care in a timely manner, which is not good.

The previous Social Democratic government has placed a very specific focus on working against private health insurance. Payment for health and medical care via private health insurance is estimated to amount to approximately 0.7 percent of the total health and medical care expenditures, which means that they do not constitute such a large part within health and medical care. At the same time, the most common way to obtain a health insurance is precisely through employer-paid group insurance. It is true as the Investigation on private health insurance states that issues concerning private health insurance are, in principle, largely unregulated.

We Christian Democrats, together with the other government parties and SD, share the investigation's view that there is a need to regulate, for example, the supervision that the Health and Social Care Inspectorate should carry out linked to issues concerning private health insurance. But the proposal for increased control shall only apply when regions enter into cooperation with healthcare providers that have multiple clients. High-quality and equitable care should, in our view, be pursued within all operations regardless of which clients the operation has or does not have.

It also does not appear in the investigation that there is a need for such a legislative change as proposed in the bill. Rather, the investigation's examination shows that there are generally good business relations between the regions and the private healthcare providers. Furthermore, it appears that the regions have great confidence in the private healthcare providers. There is thus no clear reason to suspect that the private healthcare providers make unfair or incorrect assessments regarding the ethical platform's ranking, which is based on the principle that those in greatest need of care should also be prioritized and given precedence to care.

With the new provisions on notification to the healthcare provider register that are proposed, which we support, there are good reasons to initiate an expanded monitoring effort. The bill states that there are several deficiencies in the current work, despite the notification obligation that exists under the current provisions. Here we believe that it must be ensured that the new provisions are followed to a greater extent than the current provisions have done.

This means that all the care performed within the health insurance would otherwise need to take place within the publicly funded care, and it would therefore result in longer care queues and that fewer patients receive care within the time limits specified by the statutory care guarantee.

The most common treatments that take place within the framework of the healthcare insurance are orthopedic.

Mr. Speaker! The long and growing healthcare queues make many feel worried that they will not receive their care in time when they have a right to it and need it.

Private health insurance should not be banned. However, we take seriously the fact that so many employers and trade unions in Sweden make the assessment that employees experience being forced to pay twice to receive care. They do not dare to trust that they will receive care in time when they need it.

Care should be of high quality and provided according to need and in a timely manner to all patients. If there is no doubt. The government's parties and SD have as a high priority to cut and remove the care queues.

I vote in favor of the committee's proposal.

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

Fredrik Lundh Sammeli (S)

Mr. Speaker! For me, this issue is about justice. It is about the foundation of trust in our jointly funded healthcare.

I have perceived that we in politics and here in the Riksdag have a broad consensus regarding the basic principles of care based on need and care on equal terms. But it is clear that today's development, with patients taking out private health insurance in order to get faster access to the jointly funded healthcare, truly challenges these basic principles. It means that the legislator's intentions are not being followed.

To address the deficiencies that exist in this area, a legislative proposal is presented here which ensures that patients with private health insurance shall not receive faster healthcare or better healthcare than all of us others who are involved in paying for healthcare. I cannot understand what is upsetting about that. If it is said that care shall be given based on need and on equal terms but there is a reality that causes it to be eroded, why is it then so controversial?

My question to the member is why it is so important to fight for that patients with private health insurance should be able to be prioritized before other patients with greater needs.

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

Dan Hovskär (KD)

Mr. Speaker! We do not need to build more walls, instead we need to see how more people can get access to healthcare.

Your proposal makes no improvement for the individual, but rather the opposite. It does not solve the problem we face. We have great challenges in healthcare in Sweden today, where it takes too long and many are standing in queue. With your proposal, more would have to stand longer in queue. I do not see that it would solve anything.

We Christian Democrats see that we should try to facilitate things for the individual. If some would then get to care faster, we do not see that as negative, because then more people disappear from the queue. We see that your proposal would not solve anything, on the contrary.

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

Fredrik Lundh Sammeli (S)

Mr. Speaker! I find it fascinating that one can stand and say that it is not a problem that we are all participating in and paying for a jointly funded healthcare system, but that some go ahead in the queue and receive better healthcare because they have private health insurance. "It is such a small problem, so we probably don't need to address it." It is deeply unfair, and it erodes trust in the collective.

I listened to Member of Parliament Hovskär and thought that I can agree with much in the speech. Freedom of choice is something fine and important, care should be given according to need, equal value, equality.

But all those words need to mean something in the end. It is not just that we say that these are important principles and then it just becomes as it becomes when we see a reality that runs completely contrary to what we in politics collectively say is important.

Then one can stand here and say that that is some left-wing project. It is the red-green parties, it is the Socialdemokraterna who time and again return with this bad proposal. Do not listen to us then! Listen to Läkarförbundet! Sweden's doctors are very clear that patients with private healthcare insurance should not be prioritized in public care over patients with greater medical needs. It should not be controversial, no matter how much one safeguards the market and freedom of choice.

My final question to Member Hovskär is this. What does the Member mean by a better regulation of activities that provide care, public care mixed with insurance-financed, in order to minimize these problematic priority conflicts where patients with private health insurance go first and receive better care?

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

Dan Hovskär (KD)

Mr. Speaker! Now, the problem in Sweden is not that we have too few people providing care. We see that there are queues and that it is difficult to access care. To make it so that more people have to wait longer at that stage, I do not see as something positive.

What I have also said is that those who have the greatest need shall be given priority to care. It is a fundamental principle that we work by.

But then it is the case that the proposal you are coming with implies that there would be several healthcare providers who would not be able to help and relieve and reduce the queues that exist in the public sector right now. Your proposals would rather increase the queues, and that is not what Sweden needs.

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

Ulrika Westerlund (MP)

Mr. Speaker and honorable colleagues! Miljöpartiet joined the government when this question began to be investigated, and it is a very important question. It is ultimately about the goal of Swedish health and medical care policy and what is stated in the Health and Medical Care Act, in our view.

In our joint position, the Social Democrats' and the Left Party's, regarding reservation 1 in today's debate, we note, among other things, the following:

The goal of Swedish health and medical care is good health and care on equal terms for the entire population. Care shall be provided with respect for all people's equal value and for the individual person's dignity. The person who has the greatest need for care shall be given priority to this.

The provisions in Chapter 3, Section 1 of the Health and Medical Services Act are based on two principles, namely the human dignity principle and the need and solidarity principle. These constitute the first two principles in the ethical platform that shall guide decisions on prioritizations in healthcare.

The principle of human dignity means that it shall be possible for everyone to receive health and medical care services on equal terms. The possibility of receiving care shall therefore not be influenced by age, gender, ability to take initiative, education, ability to pay, nationality, cultural differences, the nature of the illness, or the duration of the illness. Nor shall any waiting times be influenced by such conditions.

The principle of need and solidarity means that the person who has the greatest need for health and medical care shall be given priority to care.

Today's development, where patients can take out private health insurance for the purpose of obtaining faster access to jointly funded care, means in our opinion that the intentions of the legislation are not being followed. The system of private health insurance works in such a way that private healthcare providers who offer care on behalf of insurance companies guarantee patients a shorter waiting time than that which follows from the statutory healthcare guarantee. To the extent that the provider also receives publicly funded patients on behalf of a region, these patients are not guaranteed corresponding waiting times. The insurance-funded patients thus receive better access to healthcare, which is in conflict with the legislation's principle of human dignity. This is particularly problematic because, due to the insurance companies' requirements, it is not possible for the entire population to take out a private health insurance on equal terms.

To address these deficiencies, the previous government tasked a special investigator to propose measures ensuring that patients with private health insurance do not receive faster access to care or better care in the publicly funded health and medical care compared to patients without such insurance. The current bill from the previous government is based on the investigation's proposals.

The investigation proposed that the health and medical care that the region provides on its own initiative shall be financed with only public funds unless otherwise follows from law. At present, explicit rules on how health and medical care may be financed are lacking, and the government should return with proposals in line with the investigation's.

It should be important for all parties to ensure a regulatory framework that ensures the Health and Medical Services Act is followed and that those who have the greatest need for care are given priority. The proposal does not prohibit insurance in healthcare; rather, it is about the contracting authority in agreements clarifying how it can be ensured that the healthcare provider's other assignments do not negatively affect the tasks assigned to the region and how this shall be followed up.

It is worrying that this is not the case – that we are not in agreement on this issue. Anyone should be concerned about the development that is underway, where more and more people experience that they must take out insurance to receive care. It risks, of course, impoverishing the healthcare we have and the trust in our common healthcare system. It becomes a vicious spiral, where the erosion leads to more people believing they have no other choice than to sign a private health insurance policy.

We all probably consider that the queues in healthcare are a problem. It is our proposed solutions that seem to differ. Here we are debating the proposals in this proposition from the previous government, but many other measures would also need to be taken to ensure that the queues are shortened. For example, the public resources must be strengthened.

Miljöpartiet proposed in our budget motion that resources should be strengthened through a larger general grant to SKR, and we also proposed a reinforcement of the money that is to go specifically to staff within healthcare.

The principles of the Health and Medical Services Act must be the foundation, and the principle that those with the greatest need for health and medical care shall be given priority is something we must safeguard and adhere to. This also applies when choosing care choice models, reimbursement systems, and so on.

There are simply risks when private health insurance is allowed to use resources within the framework of publicly funded care. Those who have private health insurance should not be allowed to go ahead in public care or receive better care, and hospitals that are publicly funded should not have a fast track for private insurance patients.

It is very important that we do not see a development towards an A-team and a B-team in Sweden when it comes to healthcare. Everyone should be able to feel secure that welfare is accessible when they need it, regardless of what their private finances look like. This requires many different measures, significantly more than those we are debating here today.

I move for the approval of reservations 1, 3 and 4.

(Applause)

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

Lina Nordquist (L)

Mr. Speaker! It is good, I think, that the House today decides on an increased focus on rehabilitation. It is long-awaited and important.

It is also important that we ensure that Ivo really has the tools needed to put a stop to it when the care does not meet the standard.

Then there is another part in today's report which concerns when employers, together with trade unions, want to take out insurance for their employees. The largest professional group here is construction workers, but there are naturally a lot of other professional groups as well. There, I think some parties' positions become problematic. I am very grateful that the majority says no to the original proposals in this report.

We need, in fact, to take advantage of Swedish healthcare. All the care we can muster we need, Mr. Speaker, in order to be able to get help when we become ill. All good forces must be able to help and must be welcome. Every workplace where healthcare-trained people want to work we shall see as something positive.

People must be able to change jobs if they want to. More workplaces in healthcare were needed than just the public sector. We cannot have only a single workplace.

The proposal that we are saying no to today corresponds, I think, to me asking someone for help and simultaneously saying: I want your help, but while you are helping me, I also want you to clearly explain exactly in what way you are not going to help anyone else and then spend a lot of time following up to ensure that you really are not helping anyone other than me. I do not understand this.

In my opinion, the proposal that was put forward, but which will now be voted down, represents a roadblock for private alternatives, for the possibility of changing jobs and, ultimately, for the possibility of receiving care when one becomes ill.

In today's debate, references have been made here and there. References have been made to extensive investigations - and it is true that there is an extensive SOU - which, however, states that no reports on displacement effects could be found.

Reference has also been made to the Agency for Health and Social Care Analysis. There is such a report, yes. They could not show if patients were affected. They recommended independent research and thought that there were many opinions but not so much fact in this area.

Reference has been made to Läkarförbundet. Läkarförbundet points out exactly what I just said, namely that in the investigation which forms the basis for this, there is not a single example of finding any displacement effect.

I simply cannot help but think that parts of today's debate are about the classic Soviet trick of promising to build bridges where there is no river. And I do not think that is something we should be doing.

Even the Council on Legislation states that it is difficult to assess what the purpose of the law actually is, and what problems may arise cannot be predicted, the Council on Legislation notes.

So we say no to this proposal but yes to the committee's proposal on care regardless of provider and yes to the proposal on a clear focus on rehabilitation.

The deliberation was hereby concluded.

(Decisions were made under § 12.)

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