Response to interpellation 2025/26:371 on welfare crime and the law on choice systems
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
KD argues that the government prioritizes combating welfare crime and that Ivo receives increased appropriations 1 2. KD emphasizes that the regions have primary responsibility and that one must balance crime protection with not hindering serious actors 1 2. KD defends LOV as patients appreciate the freedom of choice and continuity 2. KD argues that the individual's right to choose a provider is important and should not be limited for ideological reasons 3 4. KD agrees that tax money should not go to criminals and that control should be increased 3 4. S wants to abolish mandatory LOV to steer care according to need rather than profit 5 6 7. S wants to change the system for better control over tax money and to reduce welfare crime 7. S considers that market solutions have been introduced without sufficient investigations and calls for listening to the Productivity Commission's conclusions 8. S argues that the government does not show a willingness to address the root problem with legislation that increases the risks of welfare crime 9.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Sjukvårdsministern Elisabet Lann (KD)
Mr. Speaker! Eva Lindh has asked me what measures I and the government intend to take in light of the Productivity Commission's assessment that LOV does not function in primary care, and whether I and the government are prepared to abolish or make it voluntary for the regions to apply LOV in primary care in order to reduce the risk of fraud, incorrect payments, and welfare crime.
First and foremost, I want to emphasize what we all agree on, namely that criminals and unscrupulous actors shall not be able to profit from our welfare. The government's work to combat welfare crimes, which includes countering both incorrect payments and instances where criminals themselves operate welfare activities, is a high priority.
The regions are obliged to establish freedom of choice systems in the form of care choice systems for the primary care for which they are responsible. In its capacity as the healthcare provider, each region decides on the specific design of the care choice systems within primary care based on local conditions. Applicable laws, for example the Health and Medical Services Act (2017:30) and procurement legislation, shall be taken into account.
In the development and follow-up of the conditions for private actors performing care on behalf of the region, it is crucial that these are designed so that the region can live up to its responsibility to offer primary care according to the Health and Medical Services Act. It should also be emphasized that the regions' principal responsibility for health and medical care always remains. It cannot be transferred to private actors.
Care providers are obliged to follow applicable law and must be able to guarantee patient safety regardless of whether healthcare is provided in a public or private capacity. The Government has initiated several proposals that limit criminal actors' opportunities to establish themselves within welfare. It is important to achieve a balance between the interest of, on the one hand, protecting welfare from criminal actors and, on the other hand, avoiding unnecessarily hindering serious actors from establishing themselves and conducting healthcare activities.
The Health and Social Care Inspectorate, Ivo, performs important work to identify and counteract unprofessional and criminal activities within healthcare. To further improve Ivo's conditions to carry out this work and simultaneously ensure a purposeful supervision in accordance with its mandate, the government decided in the budget bill for 2026 (prop. 2025/26:1) to strengthen the agency's appropriation with an additional 95.4 million kronor for 2026, 144.2 million for 2027, and 192.6 million kronor for 2028.
During the spring of 2025, the Government appointed an inquiry to review what measures are needed to strengthen patient safety and counter welfare crime within healthcare (S 2025:03). The inquiry shall, among other things, analyze and take a position on whether permit requirements, including ownership and management reviews, should be introduced within those parts of healthcare that are not currently subject to a permit requirement, map out the regions' ability to receive information from private healthcare providers, and take a position on whether a duty to provide information should be introduced for private healthcare providers towards the regions. The inquiry shall submit its report on October 12, 2026.
On 12 March 2026, the government submitted the bill Simplified supplier control in procurement (prop. 2025/26:177). In the bill, it is proposed that the provisions on the exclusion of suppliers in the Act (2016:1145) on public procurement, LOU, shall also primarily apply to the exclusion of applicants in the Act (2008:962) on choice systems, LOV.
A contracting authority shall therefore, with a few exceptions, be allowed to exclude a bidder on the directive-based grounds for exclusion that follow from LOU. The amendments mean that the grounds for when a supplier can be excluded will not differ depending on whether the service in question is procured or provided in a choice system. The legislative changes are proposed to enter into force on 1 July 2026.
In this context, it can be mentioned that the Competition Authority, on behalf of the government, has submitted proposals aimed at countering criminal and unscrupulous actors in freedom of choice systems. The report has been referred, and the final date for response is May 17. The government has also received the Competition Authority's proposals to increase the quality of public contracts, and the proposals are being prepared at the Government Offices.
In October 2025, the government decided on supplementary directives for the investigation Behovsstyrd vård (S 2024:05). In addition to the previous assignment, the investigator shall, among other things, analyze and submit proposals on how state governance shall be strengthened through a system with national principles for remunerations and fees within health and medical care. The final report shall be submitted to the government no later than June 18, 2026.
The Government received the final report from the Productivity Commission (SOU 2025:96) on 1 October 2025, and the report was out for consultation until 4 February 2026. The responses from the consulting bodies are currently being prepared at the Government Offices.
Eva Lindh (S)
Mr. Speaker! The Swedish welfare state and healthcare are based on a simple principle, namely that care and nursing shall be provided according to need and not according to wallet. Nor should profitability govern healthcare.
Today, however, we see a system where that principle is increasingly being sidelined, and an important explanation is the Law on Choice Systems. It is abbreviated as LOV, which is what I will consistently use in the debate – just as a clarification. When the law was introduced, the ambition was to increase efficiency, improve quality, and give people greater freedom of choice, but reality has shown that was not the case.
The government's own productivity commission states in its final report that LOV has not delivered the productivity and efficiency gains that were promised. On the contrary, the commission points out that the system has contributed to poorer cost control and opened up for risks of welfare crime.
In primary care, the problem is particularly clear. The regions are today obliged to use LOV within primary care, which means freedom of establishment for private healthcare providers. There is therefore no possibility for the regions to limit how many actors establish themselves or where they establish themselves.
I listened to the previous debate with the Minister for Health and Social Affairs, where the Minister for Health and Social Affairs very often referred to the fact that it is the regions that have and shall take the responsibility for healthcare, but did not mention particularly much about the government's or the state's responsibility. Here, it is very clear that the regions actually cannot even govern or take the responsibility, because that possibility is restricted by a mandatory LOV.
The consequence of this is that health centers are established where it is most profitable, not where the needs are greatest. This means over-establishment in areas where people are relatively healthy and under-establishment in rural areas or socioeconomically disadvantaged areas, where the needs are often greater. It is also precisely this that the government's own productivity commission directs clear criticism towards. It describes how corporate economic considerations, rather than medical needs, govern establishments. This is not just an efficiency problem; it is also an equality problem.
It is this that makes me and many others so upset: when healthcare is no longer to be governed by need, but by where the profits are greatest and most possible.
At the same time, this means, as has been said, that the regions' possibility to plan and manage healthcare is severely limited. It becomes difficult to use tax funds that are intended and meant for healthcare for exactly what they are supposed to be used for. In addition to this, we see a serious consequence, namely increased welfare crime.
The LOV system has in several cases not only shown itself to be vulnerable to being exploited by unserious actors or criminal exploitation, but it has also opened itself up to it. In that case, it is difficult to see that the government would prioritize this.
Markus Kallifatides (S)
Mr. Speaker! Thank you, Minister, for the answer to Eva Lindh's important interpellation!
I am participating in the debate both as an economist and as a Stockholmer. Let me say initially that it is remarkable that Sweden's Minister for Health and Social Affairs, as part of the government, in a previous interpellation debate with Karin Rågsjö and Sofia Amloh in some way tried to use a completely synchronized rise in inflation and interest rates in the world during the end of the previous term and a completely synchronized fall in inflation and interest rates in the world during this term as some kind of political argument to score points. It is remarkable.
Now to the topic, Mr. Speaker! The failed market experiments in Swedish welfare are many; we have learned this from major government inquiries such as a school commission, an equality commission, and most recently a productivity commission appointed by this government.
We Social Democrats have long drawn conclusions about the welfare system. We want to put a stop to the pursuit of profit, improve the management, give the staff the right conditions to do the job and secure the long-term funding. And that, Mr. Speaker, is what we want to do in the whole country.
In the Stockholm region, my home region, we perhaps struggle a bit extra with the failed market experiments in welfare. One example is Järfälla municipality, which recently concluded that there are too many irregularities in elderly care and therefore left the choice system and took back elderly care under its own municipal management.
Mr. Speaker! When it comes to the school, we Social Democrats in the City of Stockholm do everything we can to realize the intentions of the Education Act regarding education based on need, but we are hindered by current national legislation.
In Region Stockholm, after 16 years of conservative rule, we have 2,000 healthcare agreements and over 1,000 individual actors to keep track of. It is a very extensive administrative task.
Within primary care, we have another challenge. Here, forced LOV applies. In Region Stockholm, we have had problems with an uneven geographical distribution of care resources, that is, realizing care according to need also within primary care. But now, not least after strategic investments from the S-led government, it is rather about problems on both the financing and competence supply sides, and with unserious and, in the worst cases, criminal actors who are establishing themselves.
We Social Democrats have long held the view that mandatory LOV should be removed. It is a restriction on municipal self-government. It hinders the regions' conditions to provide primary care according to need in accordance with the intentions of the Health and Medical Services Act, and it increases the cost of care delivery, according to among others the government's own productivity commission. It opens up, according to the same commission, for unserious and in the worst cases criminal actors to even operate a health center.
My question, Mr. Speaker, is: How is it that the government and the Council of State cannot provide a clearer statement on the issue that Eva Lindh has raised?
It is about also giving us Stockholmers better conditions to receive care based on need, safeguarding our tax resources and keeping unserious and, in the worst cases, criminal individuals out of our health and medical care.
Sjukvårdsministern Elisabet Lann (KD)
Mr. Speaker! We completely share the anger, frustration and concern over both crime, over-exploitation and fraud within the welfare system.
This is a boil in our society that we must fight, and I dare say with quite great certainty that no government has done so much to fight just the fraud and the crime in the welfare system.
Mr. Speaker! Ivo, the Health and Social Welfare Inspection, has received an expanded mandate. The Government is allocating record-breaking appropriations. Ivo is hiring very many new employees right now. We are appointing a board because Ivo's mandate as an authority has become so much larger that a board is needed to take the ultimate responsibility for the operations and for the authority to succeed in its important mandate.
The cheating and fraud, the over-exploitation and the criminality are not only among private operators but also in other parts of the welfare system. Therefore, this is an incredibly important task. We are in complete agreement that criminal actors shall not conduct welfare activities – absolutely not! That is why the government is allocating so many resources to this.
One must also remember that some of the most popular health centers are private, often operated in a somewhat smaller scale. The staff also thrive better there because they have greater influence over their daily lives and can offer the patients better continuity. We know that LOV is appreciated by very many patients. It is an enormous number of the residents who actually choose a private health center. It is optional, and they make that choice.
On the left side of politics, people often talk about taking back democratic control over healthcare. It is a deceptive expression for the policy to decide over people's care in a way that bypasses the individual's opportunities to choose a health center and doctor based on their own wishes at a place where they feel safe and where there is an opportunity for continuity. I am not prepared to throw the baby out with the bathwater and make it impossible for people to choose the best health centers in the country.
On the other hand, we have appointed this investigation and are now looking at the received responses. The matter is being prepared. I will return to how we proceed with the investigation in detail; it is too early to do so at this stage. But I dare say that I will never put politicians' ideology and interests to rule over individuals over that very individual's opportunity and right to choose a secure care in their vicinity.
Eva Lindh (S)
Mr. Speaker! Let me begin by addressing the Minister for Health and Social Affairs' response to our questions.
We are not against freedom of choice. I have never said that a region could not introduce some type of freedom of choice system if they want to. What we are seeking is, firstly, to abolish compulsory LOV and, secondly, to review the legislation so that it does not produce these effects. It is not only us who criticize them, but also the government's own commission.
Let me start with the efficiency. The commission points out a lack of cost control and difficulties in directing resources where the needs are greatest. Are we not afraid for the tax money? Should the money not go to the care that people need? It is surely not the intention that we should have a system that implies that the whole becomes less efficient and that the money disappears to something else? We Social Democrats truly want to change this so that there is better control.
The second thing I want to bring up is welfare crime, the fraud. Many times it is also about criminal exploitation. Before we get back to what the left thinks or not: I am not against serious operators. On the contrary, we want to make it better for the serious ones, because as it is now, it is difficult for them to compete with those who cheat.
The Minister for Health and Social Affairs says that this is a high priority, but I do not see that. The Minister for Health and Social Affairs reads out a number of things, so it may seem that much has been done. But one has actually not done anything regarding what really matters to reduce welfare crime. I see that one is instead protecting the pursuit of profit and the lack of cost control. One is not doing enough to stop welfare crime.
I hear the minister say that she shares the anger over the deviations that exist, and it is good that we have a common view on what is right and wrong. But action is required. We know that the system can be exploited by unscrupulous actors, and when municipalities and regions begin to audit operations within LOV, they very often find extensive deficiencies.
As a municipal councilor in Linköping, I was responsible for elderly care, and one of the important decisions we made when we took power there was to begin auditing all LOV companies within elderly care. I don't remember if it was 16 or 18 companies, but it was in any case many companies that cheated or exploited the systems. After the audit, they were not allowed to continue. This is what one sees when you increase the control and truly audit these operations.
For us Social Democrats, the needs and conditions for staff and clients in elderly care take precedence over the pursuit of profit.
Markus Kallifatides (S)
Mr. Speaker! I thank the Minister for the previous answer and note that in this interpellation debate we will not receive any clear statement that compulsory LOV shall be abolished.
I thought that the Minister, in his answers to our questions, opened up to what we can call an ideological confrontation. Therefore, I respond in this way: We Social Democrats see that very many of the market solutions that exist within the common tax-funded welfare have been introduced without proper investigations and against the warning words of many referral bodies. In some cases, a mere napkin sketch has been voted through in the Swedish Riksdag.
Now there are substantial investigations of the consequences of 30 years of market experiments in Swedish tax-funded welfare. I therefore want to send an appeal to all of us: Let us now make use of the conclusions we get when we let knowledgeable people look at knowledge and proven experience regarding the effects of market models, such as forced LOV in primary care. Listen to the Productivity Commission!
Sjukvårdsministern Elisabet Lann (KD)
Mr. Speaker! I perceive that there is a desire to create a political conflict that does not exist. We are in complete agreement that not a single krona shall go to criminals, that we shall use tax funds in an effective manner and be careful with our common resources, and that we shall make welfare secure for the residents. That is our mission as politicians. We do, however, have different views on how much power should rest with the individual and whether one should be able to choose the provider for the most sensitive social services and a health center where there is a doctor one trusts, instead of being referred to what the politicians have decided.
It is said here that the Social Democrats are not against freedom of choice. That is good, and there are examples of when you stand up for freedom of choice. But there are also examples of you using serious and dedicated actors as a safety valve and pressure relief, and limiting and complicating it in a way that exhausts the most appreciated operations. I have seen it in Gothenburg. I am, by the way, glad that we share the experience of municipal elderly care, Eva Lindh. But it is deplorable to see how people in the last years of their lives are forced to move just because the Social Democrats, for ideological reasons, want to decide when it should be possible to choose and when it should not be.
LOV is about protecting the individual's right to choose, not politicians' right to decide whether freedom of choice shall exist or not. But LOV also means that politicians at the regional level have very large opportunities to design request documents so that they become sustainable for their own operations and so that tax funds are protected.
It was raised here how important it is to be able to conduct audits in order to reach unserious actors. We are in complete agreement here, and therefore the government is making major investments to increase the auditing so that tax funds are not paid out to criminals or unserious actors driven by profit interest instead of the patient's best interests.
Care shall be provided based on need regardless of who performs the care.
Eva Lindh (S)
Mr. Speaker! Yes, there is an ideological difference between us.
What all commissions have highlighted, most recently the government's own productivity commission, is a lack of cost control, difficulties in directing resources where the needs are greatest, and increased risks of welfare crime.
I think that when it becomes this clear, anyone should feel that one must do something about this. One should at least not force regions to use legislation that produces these effects.
I am upset when I see this. Now we know the effects; we have received them on paper. It is clear that this is how it is. Despite that, the government shows no will whatsoever to do anything about the fundamental problem that we have legislation that increases the risks of welfare crime. It cannot be okay that tax money intended for elderly care and healthcare goes to something else, that tax money is not used effectively for what it is intended for, and that one opens up for welfare crime. This is actually completely incomprehensible.
Here is the difference between what we Social Democrats think and what the government obviously thinks. A reasonable starting point should be to want an efficient and equal healthcare.
Sjukvårdsministern Elisabet Lann (KD)
Mr. Speaker! I thank the debaters for an important debate. We are in complete agreement that it is not okay for tax money to go to criminals and unserious actors. Therefore, it is a high priority for the government to combat the unserious actors, to increase control, and to give the Inspectorate for Health and Social Services additional tasks and resources to be able to do an effective job. It is very important.
But it is also important that those who have chosen some of the country's best health centers are not stripped of that security in their everyday lives because politicians are prepared to throw the baby out with the bathwater.
Let us go through the referral responses that have been submitted and make wise decisions moving forward to together tackle unserious actors and criminal elements in our welfare. But let us not circumvent the individuals' opportunity to influence services that come very close to their own lives, health, and care.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.