Response to interpellation 2023/24:627 on the situation in healthcare and effects on the health insurance
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
1 S argues that healthcare queues are a result of the government's failed policy 1 and that the healthcare crisis leads to staff being under-insured and dismissed 2. 1 3 S criticizes that the government provides 6 billion kronor to the regions while simultaneously lowering taxes for high-income earners 1 3. 3 S believes that the government wants to dismantle the welfare society through a creative policy where they blame inflation to lower taxes for the richest 3. 4 S argues that inflation is supply-driven and that the government has failed in the fight against inflation 4. 4 S also criticizes the government's decision to reduce housing construction and make energy production more difficult 4. 3 M argues that the government and SD are driving a policy that worsens both healthcare and sickness insurance 1 3. 3 M argues that changes in sickness insurance have increased calls about suicide to Försäkringskassan 3. 3 M argues that the state dumps expenses on the municipalities by having people end up on social assistance 3. 5 M argues that the government has announced an increased subsidy to the regions so they can focus on the core task and that productivity should be increased through incentives to shorten the queues 5. 5 M emphasizes that the government is not abandoning welfare 5.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Statsrådet Anna Tenje (M)
Madam Speaker! I have been asked how I will act so that the situation in healthcare does not hit people who risk falling out of the health insurance because care could not be provided in time.
During the covid-19 pandemic, there was a temporary provision in the sickness benefit regulations which meant that the assessment of work capacity after day 180 in the rehabilitation chain could be postponed due to the effects of the pandemic. The provision was introduced in April 2020, when the need for powerful prioritizations within health and medical care meant that non-urgent care interventions had to be postponed, and it applied until December 31, 2023.
The link between healthcare queues and the covid-19 pandemic is decreasing increasingly. The circumstances that led to the exception for postponed healthcare are no longer persisting in the same way. It is also worth noting in this context that the exception, according to Försäkringskassan, was applied to a relatively limited extent.
The Government is aware of the strained situation within the regions. This is primarily due to inflation and entails higher costs for the regions' operations. Against this background, the Government intends to inject an additional 6 billion kronor to the regions in the spring budget revision for 2024.
Ola Möller (S)
Madam Speaker! Thank you for the answer, Minister! I can calmly state that no answer is also an answer. Not much is said in that.
I do not quite understand the presentation of the covid exemption. I believe the minister has misunderstood why I mentioned it. I am not wondering how it worked, but I am wondering why, during a healthcare crisis, one does not let the exemption remain. It could ensure that people are not affected by the government's and the Sverigedemokraternas harsh blows against both the health insurance and the healthcare.
It was, after all, the S-government that acted to introduce such an exception in the event of a certain crisis. Now we see another form of crisis management, where people are to be punished out of the sickness insurance.
Approximately 172,000 people are in a healthcare queue, of whom 50,000-60,000 have been in the queue longer than they should have to according to the healthcare guarantee. It is a direct result of the government's failed policy. The healthcare queue is growing under the leadership of the Minister for Social Insurance and her colleagues in the government.
In that situation, one chooses to present major deteriorations in the sickness insurance. People do not get the care they are supposed to get. Then, they are also to be thrown out of the sickness insurance. The Kristersson line is that one should not only deteriorate the rules, but one should also push forward the old bottleneck. People shall be tested against fake jobs, made-up jobs. Someone says "You have work capacity," but the state is not obliged to tell you what you shall work with. Those proposals are now on the table.
I wonder how the logic works. One actively worsens healthcare by letting it run at a deficit year after year, while simultaneously lowering taxes for those with the highest incomes. Furthermore, one is to worsen the insurance that people shall be in when they are not healthy enough to work. It is funny that people are to be punished for something for which they themselves do not bear the blame.
Then the minister says that 6 billion should be enough. It is very good that 6 billion is coming. No one questions that. But I can inform the minister that my home region Skåne last year went into the red by 4 billion. This year it is 2 billion.
It is very good that 6 billion is coming. If Skåne receives the 6 billion, it will make a difference. But the problem is that it is not only Skåne that is supposed to have the money. Now we can read that the SD-led Region Blekinge is introducing a hiring freeze. And in Värmland, every tenth employee in healthcare will leave.
How are people supposed to get care when it is that policy the government is pursuing? Then, on top of that, they throw them out of the health insurance with the argument that if you are a bit poorer, it is easier to work.
600 people are to be laid off at Sus, the university hospital in Lund and Malmö. 50 nursing assistants are to leave in Helsingborg. The argument from the Christian Democrat chairman of the healthcare board is that they are not of any use to the patients.
That is how reality looks. And it has been created by the Sweden Democrats and the government. I do not understand how one can then think that, in that situation, one should worsen the health insurance.
I know that healthcare is not the Minister's area of responsibility. I understand that she cannot take responsibility for it and perhaps does not fully understand the consequences in healthcare of these deficits and how many people are suffering from this. I instead pose a question regarding the Minister's area.
Does the Minister have any forecast for how many will fall out of the sickness insurance due to the cuts in healthcare when the changes that are now on the table are implemented? How many fewer will be covered by the sickness insurance because healthcare is deteriorating?
Marianne Fundahn (S)
Madam Speaker! Compared with many other countries, Sweden has a relatively strong protection in the event of illness. We have high employment and at the same time historically low and stable sickness absence. There are many factors that affect sickness absence: the conditions in working life, the work environment and the employment conditions. Rising employment rates and the fact that more and more people work longer also have an impact, according to Arbetsrapport 2023:2 Swedish sickness absence in a European perspective, 1995 - 2022.
Sweden is spending less and less money on those who are too ill to work. The portion of GDP that goes to social insurance is the lowest in 40 years. I cannot blame this government alone for this, but also a number of previous governments. At the beginning of the 90s, the expenditures for social insurance accounted for almost 10 percent of GDP. This includes sickness benefit, parental leave, child allowance, sickness compensation, and dental care. Last year, they had shrunk to 4.1 percent, thus more than a halving. This is shown in the report Socialförsäkring en i siffror 2023 from Försäkringskassan. In large part, the entire saving has been made on those who are ill.
We have a healthcare crisis in the whole country, for the most part, and many employees risk losing their jobs. This will mean that the long healthcare queues will grow, healthcare queues that today many times are linked to staff shortages.
Madam Speaker! Some of those standing in the healthcare queues are healthcare staff from both the healthcare sector and the municipalities, who are exhausted in body after many years of hard work in streamlined organizations. That is how it looked before I entered the Riksdag in 2014, when I worked a lot with rehabilitation cases at my workplace. Skilled employees were laid off when they stood in healthcare queues or waited for rehabilitation. The consequence was that they were dismissed and referred to Arbetsförmedlingen. Competent professionals were forced to leave the workplace that was in great need of their competence.
I can tell you about a physiotherapist who got a herniated disc, was signed off sick, and waited for surgery and then rehabilitation. She was terminated and dismissed and had to seek another job. I know quite a few people who were affected by carpal tunnel syndrome, a fairly common illness when one has worked many years in healthcare. They were signed off sick to see if offloading could help, but when it didn't help, they received a referral to a specialist doctor with a few months' waiting time and thereafter a referral for surgery with additional waiting time. After the surgery, it was time for rehabilitation, but by then it was too late – they had already been terminated and dismissed. They suffered not only physically but also mentally and had a much longer path back to the labor market than they would have had if they had been signed off sick until they became healthy and could return to their regular job.
An operation for carpal tunnel syndrome takes 10-20 minutes, but the waiting time is incredibly long. The waiting time for many other operations in Region Skåne is up to a year.
Does the Minister think that those who are in a healthcare queue should be punished because the healthcare system does not have the conditions to fulfill its mission?
Statsrådet Anna Tenje (M)
Madam Speaker! I can begin by stating that Member Möller is mistaken. The Government has not at all presented any proposals regarding the sickness insurance. I have, however, received an investigation from an investigator who has presented a number of different proposals, which are now to be referred. A member of the Swedish Riksdag should and ought to know that these are two completely different things.
To return once again to the issue at hand, it is obvious that the sickness insurance shall provide compensation for loss of income due to illness and rehabilitation. People should feel secure that there is a sickness insurance that provides financial compensation if they become ill and cannot work.
At the same time, we have a problem with long healthcare queues. I am the first to sign on to the fact that long healthcare queues are an absurdity that not only causes people to wait, with great suffering as a consequence, of course, but also and above all that the rehabilitation becomes longer for the person who has stood in the queue for a longer time. For that very reason, it is a priority issue for this government to shorten healthcare queues and find incentives so that this shall occur.
The government has now announced 6 billion extra in the autumn budget revision for the regions. These resources will be directed entirely towards the regions' health and medical care. The background is that inflation has obviously driven up the cost increases for daily operations and activities, but also that the regions' pension costs have increased.
This reinforcement occurs against the background that the government had already earlier, in the autumn budget, announced that it would allocate 40 percent of the budget space to welfare specifically, of which 10 billion is in a permanent increase of the general government grants and almost 6 billion more compared to what was previously calculated in targeted government grants. This included a sector grant of 3 billion specifically for the regions' healthcare, precisely given their tough situation.
From the side of the Swedish people and also the government, there is a great expectation that these substantial supplements will lead to the avoidance of unnecessary layoffs, but above all that the funds will go to the core activities, which in large part consist of providing healthcare and performing operations.
The Government has, in connection with the extra addition in the autumn budget, also presented a structural action package, which includes, among other things, an efficiency delegation for health and medical care, the purpose of which is to support the regions in the implementation of structural measures that can streamline these operations through state funds. The regions that need support to develop their operations will be able to apply for funds from the efficiency delegation.
The scrutiny and evaluation of the regions is strengthened by establishing a special function tasked with auditing the regions' economic situation with a focus on expediency, resource utilization, cost-effectiveness, and potential for efficiency.
This may seem administrative, system-oriented and so on, but it is, in short, about focusing taxpayers' money on the core of welfare and ensuring that queues are shortened and welfare is delivered.
My hope is, of course, that these measures, together with the supplement of 6 billion, will be implemented wisely and responsibly so that healthcare staff are not reduced - so that people who are in need of care will also receive it in time. It is, however, important to remember that it is ultimately the regions' responsibility to ensure that the money is used for exactly this.
Ola Möller (S)
Madam Speaker! The Minister is trying to lecture a member of the Swedish Riksdag who wonders why the Minister is standing at a press conference together with an investigator and presenting proposals on how to worsen the health insurance; the Minister claims that this would be a lie.
The Minister's own head of government sat on TV4 a few weeks ago and promised that no one would be laid off in Swedish healthcare. Then comes 6 billion, and what do we see now? Layoffs, hiring freezes, cuts, and gigantic deficits. And then one is supposed to lecture members of the Swedish Riksdag with a stern tone. I think that one should perhaps be a bit careful with that when one has a Prime Minister who deliberately tells falsehoods. And not only does he tell falsehoods regarding the reality of the outcome, he also denies that he would have given the promise. It is, therefore, a double lie.
The calls about suicide to Försäkringskassan increased by 3,000 percent the last time the minister's party implemented changes to the sickness insurance. We do not know how many committed suicide because of these changes, but the calls increased by 3,000 percent. This is what happens when you start throwing people out of the sickness insurance and do what the minister calls strengthening incentives and the like. These are the consequences.
Or one pushes the costs onto the municipalities, which already have major problems with 22,000 people who are too healthy to be covered by the sickness insurance but too sick to work. They will become even more numerous.
One of the reasons why the number of people receiving social assistance is now historically low is that the sickness insurance actually has room for them. It did not have it under the Alliance government, but then it was social assistance that applied. I was a municipal councilor at that time and saw the influx of people. The minister must have seen it as well, as she has also been a municipal councilor.
When people are not in the right insurance system, they end up in the municipalities' lap instead. Then the municipalities cannot prioritize "the core of the welfare," school, health care and elderly care, because they must pay out social assistance as the state dumps expenses on them. These people will increase in number due to the healthcare crisis, which the minister and her government colleagues and coalition parties are actively driving forward.
Last year, the regions clearly signaled that they needed help. Then, the choice was made to lower the tax for high-income earners by 10-12 billion. This year, they are doing the same thing, despite the regions screaming. We need 24 billion, they have said. Now, 6 billion is coming. It is an active policy to worsen both healthcare and people's opportunity to be covered by the social insurance.
If one has an agenda that is about wanting to privatize and remove the welfare state and does not want strong social security protections, it is clear that this is a logical development. That is what we must be well aware of and everyone who listens to this debate must see.
This is not about increasing any incentives for work. It is about wanting to tear down the welfare society that we have. It is an active and very creative policy. They blame inflation – it is inflation's fault. No, it was not inflation that lowered the tax for the richest. That is where your responsibility lies, Minister. Take it!
Marianne Fundahn (S)
Madam Speaker! In the investigation on sickness insurance in transition, it is considered that doctors write sick leave for their patients all too easily. But it is the doctor - and not Försäkringskassan - who, with their medical competence, is an expert on what the patient needs. Försäkringskassan does not intervene and have opinions on which medications the doctor prescribes. Sick leave is also a part of the treatment.
One also thinks that the patient's experience of their symptoms is given too much space. But how is the doctor supposed to be able to make a diagnosis if the patient is not allowed to describe their symptoms?
The investigation notes that Försäkringskassan currently does not penalize doctors who systematically abuse their opportunity to issue medical certificates. A system must be established to ensure that doctors act in accordance with the purpose of the sickness insurance, the investigation proposes.
I believe that the doctors would rather follow the Läkarförbundet's ethical rules, which contain fundamental values within medical ethics, than the investigation's mistrust of sick people.
I wonder if the Minister shares the investigation's views that doctors issue sick leave for patients too easily and that Försäkringskassan should be given the opportunity to penalize them.
Statsrådet Anna Tenje (M)
Madam Speaker! I am becoming a little confused. Is this interpellation debate about the interpellation written by Member Ola Möller? Or is it actually about another interpellation, which perhaps is not yet written, concerning the investigation that I received earlier this week regarding a health insurance in transition?
I choose, Madam Speaker, to address and discuss the interpellation that I am actually here today to answer.
I have just explained that the government, both in the autumn budget and now regarding the spring budget amendment, has signaled an increased supplement to the regions precisely so that they do not have to cut back on healthcare staff and so that they can focus on their core task. It is also necessary, with the help of various incentives stipulated in the spring budget amendment, to work with productivity increases, efficiency increases, and other measures so that, in the long run, the queues can be shortened. It is urgent to shorten the healthcare queues to reduce human suffering. Above all, the rehabilitation should not be made unnecessarily long.
It is about those who are in need of care receiving care and that they should quickly enter rehabilitation so that they can return to work. That is the focus we have from the government's side, and it is what underlies the investments we have made.
I know that my colleague Minister for Health and Social Affairs Acko Ankarberg Johansson is doing a great job and is engaged in both health and healthcare issues as well as the important skills supply issues - they are not insignificant in this regard either.
The regions today have economic challenges that are primarily due to inflation and the high pension costs. The current conditions are not comparable to the extraordinary circumstances that prevailed during the pandemic and which led to the changes in the health insurance system that we then made decisions on.
In this context, I want to remind that those who have a reduced capacity for work in a normally occurring job have the right to sickness benefit under these circumstances. It is important that we have a well-functioning sickness insurance that provides security during illness and rehabilitation. But it is also important that care and other interventions for a rapid return to work function.
I return to the 6 billion that we have now chosen to add to the supplementary budget. Furthermore, the Government is taking a number of measures to specifically assist and help the regions with, among other things, efficiency, shortening healthcare queues, and supporting healthcare staff. These are important measures to get the finances in order, but also in the long term to be able to shorten the healthcare queues.
We see now that our policy has actually had an effect. Inflation fell back during the whole of 2023, even though there was a small upward tick in the inflation curve in January. We in the government have been clear that we are not abandoning the welfare state. As we now see in our supplementary budget, we also deliver when it comes to this.
Ola Möller (S)
Madam Speaker! Why is it then that tax cuts for the wealthiest are prioritized for approximately 20-24 billion when the deficit in healthcare is approximately 20-24 billion? Furthermore, the minister stands here and says that it is a problem. This is what becomes incomprehensible.
They blame inflation – it is inflation that is the problem. How can one then lower the tax for those with the most money? It increases demand. The government's analysis is that it is demand-driven inflation. It is not. It is supply-driven.
If one wanted to fight inflation, why did one reduce housing construction? It is completely crazy, because it impairs mobility in the labor market. One worsened labor market policy and education policy. It impairs mobility in the labor market. Why did one reduce this?
Why did they make energy production more difficult by adding connection fees for offshore wind power? Now they are also saying no to offshore wind farms in Östergötland's moderate municipalities. Why are they doing this? It is completely insane.
One lowers, as said, the tax for those with the most money. How can one refrain from making investments for the least well-off in this society? They take out consumption loans, which increases the indebtedness of those with the fewest resources. How can one do this if one now wants to fight inflation?
We have lagged behind in the fight against inflation. In Spain, for example, they were very clear with price caps. They made clear prioritizations when it came to the more vulnerable households. Yes, they stopped inflation much earlier. The government's and Sweden's fight against inflation has lagged behind that of the eurozone and the rest of Europe. It is not sustainable.
The Minister may elaborate on this. The Minister blames inflation – it is the root of all evil. How, then, has it been possible to pursue this policy?
ANDRE VICE TALMANNEN
I want to remind that the debate is about the situation in healthcare and the effects on the health insurance.
Statsrådet Anna Tenje (M)
Madam Speaker! Thank you very much for that clarification! I just want to point out that this government managed to grant permits for more wind farms during its first eight months than the Social Democratic government, with the support of V and MP, managed to do during its eight years. I have made my point.
That people in need of care receive high-quality care in a timely manner must be the first and most self-evident priority. Just as I have pointed out several times before, Madam Speaker, this government is now adding 6 billion extra beyond the 10 billion plus 6 billion in targeted state grants we provided earlier this autumn. We are doing this precisely to manage the tough economic situation we find ourselves in, which is largely due to inflation.
Regarding Försäkringskassan's continued work, we have worked hard on processing times and decisions so that people do not have to wait longer than necessary for their notices from the agency. It is a task that I myself follow very closely.
We in the government have followed the economic situation in the regions and have been prepared to act. That is what we have also done. We will, of course, also continue to follow this issue.
Many thanks for the debate and many thanks for the opportunity to speak!
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.