Response to interpellation 2025/26:518 on LOV in primary care
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
1 KD considers LOV to be an important basis for patients' freedom of choice and diversity in primary care 1. 2 KD argues that the patient perspective, self-determination, and participation are the most important 2 and does not want to withdraw the possibility for popular health centers under other management 2. 1 KD emphasizes that the regions are responsible for their agreements and reimbursement systems 1. 3 S argues that LOV has not delivered the promised productivity gains but has led to worsened cost control and risks of welfare crime 3. 3 S considers that the system opens for over-exploitation of tax funds 3. 4 S wants LOV to be replaced with entirely new welfare legislation 4. 5 S considers that the current system opens for welfare crime and over-exploitation because no permit is required to start health centers 5. 6 S argues that the government is not prepared to cease mandatory-LOV, which threatens to become an extensive waste of tax funds and prevents resources from going to the burning healthcare needs 6. 5 S considers that the legislation must be changed to stop the waste and welfare crime 5. 7 KD argues that the government does not accept fraud and crime in welfare and has taken initiatives for stronger gatekeeper functions 7. 8 KD is prepared to make changes in the legislation to secure the patient's freedom of choice and ensure that tax funds are not drained 8.
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 if I and the government intend to take any measures in light of the deficiencies that the Productivity Commission has pointed out regarding cost control and governance in the application of the Act (2008:962) on choice systems, LOV, in primary care. Eva Lindh has also asked if I and the government intend to make it voluntary to apply LOV in primary care, if I intend to take any initiatives to ensure that the establishment of health centers shall be based on healthcare needs rather than profitability, and if I intend to take any measures to strengthen the control over public funds within the choice systems for healthcare in order to counter fraud, incorrect payments, and welfare crime.
Let me begin by underlining what we completely agree on: Care shall be provided based on need. The goal of health and medical care is good health and care on equal terms for the entire population. It is clear in the portal paragraph of the Health and Medical Services Act (2017:30) that the person who has the greatest need for care shall be given priority in care. The regions, as principals and responsible for the medical care, are responsible for which agreements they choose to sign with private healthcare providers, what requirements are set, and what compensations shall apply.
We need a system where the compensation follows the patient's needs. The Government considers that today's system of compensations and fees in the regions needs to be developed and coordinated, not least to steer resources to a greater extent to patients with greater care needs. A special investigator will therefore shortly submit proposals on how the state's governance should be strengthened through a system with national principles for compensations and fees within health and medical care (supplementary directive to the investigation Behovsstyrd vård, S 2024:05). This shall apply regardless of whether the patient is treated in their home region or in another region and regardless of whether the healthcare visits are physical or digital. The final report was to be submitted to the Government by June 18, 2026 at the latest – and I can inform that it was submitted today.
Regarding the question of making LOV voluntary in primary care, the government's view is that LOV constitutes an important basis for patients' ability to choose a healthcare provider and for the diversity in primary care. According to statistics from Sveriges Kommuner och Regioner, SKR, privately run health centers constitute approximately 48 percent of all health centers in Sweden.
Our focus lies on providing the regions with better conditions for control within the system. On behalf of the government, the Competition Authority submitted in December 2025 proposals aimed at countering criminal and unscrupulous actors in choice systems (Fi2025/02401). The report New gatekeeping functions in LOV has been referred, and the proposals are currently being prepared in the Government Offices.
Regarding the risks from unserious actors and lack of control, the government has several initiatives aimed at limiting criminal actors' opportunities to establish themselves within the welfare system. Tax funds should go to healthcare, not to welfare crime or over-exploitation. It is a prerequisite for the legitimacy of our entire jointly funded system.
The Health and Social Care Inspectorate, Ivo, performs important work to identify and counter unserious and criminal activities within healthcare. The Government has given Ivo several assignments to strengthen and develop the authority's work in this area.
Through an amendment to the instructions to Ivo, it has been clarified that the authority shall both prevent and counteract crime. 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 authority's appropriation with an additional 95.4 million kronor for 2026, 144.2 million for 2027, and 192.6 million kronor for 2028.
The Government appointed during the spring of 2025 the Inquiry on measures to strengthen patient safety and counteract welfare crime within healthcare (S 2025:03). The inquiry has an important mandate to analyze and take a position on whether a permit process should be introduced, as well as how supervision and follow-up can be strengthened. This also applies within the framework of the care choice systems. The inquiry shall submit its report by October 12, 2026, at the latest.
When it comes to concrete measures here and now, I want to highlight the regions' responsibility. The regions have significant opportunities within LOV to design compensation systems, establishment requirements, and follow-up so that they better support equitable care. It is important that these opportunities are fully utilized.
Eva Lindh (S)
Mr. Speaker! Healthcare is incredibly central, and it is also the voters' most important issue. It is not strange, as it is a fundamental security to hopefully know that one receives care and treatment when one needs it.
This is being challenged, and one of the reasons for that is the legislation we are talking about now, namely the law on choice systems, LOV. When it was introduced, it was intended to increase quality, strengthen freedom of choice, and create better efficiency through competition. Now, two decades later, we know that none of this has become a reality.
I mean that the government – Sverigedemokraterna, Moderaterna, Kristdemokraterna and Liberalerna – has ideological blinkers when it comes to health and medical care and specifically when it comes to the Act on Choice of Care, LOV.
As we heard here, the government knows that there are criminal and unserious actors in the freedom of choice system. The government and the cabinet know that it is so, and they are trying to patch and repair. They are introducing new gatekeeper functions. They say that tax money should go to healthcare, not to welfare crime or over-exploitation, and that they will prevent and counteract crime.
One has, therefore, a system that obviously opens up for welfare crime and over-exploitation of tax funds, and where tax funds do not go to the care, that is, to what the money is intended for. That one then does not act is completely incomprehensible to me. It cannot be about anything other than ideological blinkers.
Furthermore, the Minister says in his response that a position should be taken on whether a permit process should be introduced. At regular intervals, I speak about the laws on choice systems and the problems with them. When I tell them that a permit was not even required to establish an operation, few people believe their ears. It seems completely unreasonable that one is allowed to provide health and medical care without a permit being required. It is good if the government takes a position on that.
In any case, we know now that this is how it is. The government's own productivity commission has drawn a clear conclusion in its final report: LOV has not delivered the productivity and efficiency gains that were promised. On the contrary, the commission points to worsened cost control, difficulties in directing resources where the needs are greatest, and increased risks of welfare crime.
For us Social Democrats, healthcare is most important; it is number one. Preventing there from being criminal and unprofessional actors in healthcare is crucial. Therefore, I ask the Minister for Health again: Can the government consider at least removing the requirement for the regions to have the Act on Choice Systems when it comes to primary care? That is something one could at least look at.
Markus Kallifatides (S)
Mr. Speaker! Thank you, Eva Lindh, for the opportunity to participate in this debate! Thank you, Minister, for the previous answers!
In the final report from the Tidö Government's own productivity commission, we can read the following on page 519:
Few patients seem to make active decisions regarding which health center they should be registered at or base their choices on the medical quality of the care. The provider determines what care a patient should receive and thus plays a central role in rationing healthcare resources, while the provider having a profit interest risks creating significant goal conflicts in the principal-agent relationship between purchaser, provider, and patient. There is, for example, a risk that providers segregate the patient base and provide care for simpler conditions, so-called cream skimming. This can lead to healthcare units performing larger volumes of interventions for simpler conditions than the purchaser or the legislator wants or what is medically justified. A sign of this is that the proportion of doctor visits for simpler diagnoses has increased.
Mr. Speaker! In the introduction to a brand new article in Läkartidningen, the five authors write the following, with reference to the Swedish National Audit Office: ”The goals of health and medical care are good health and care on equal terms for the entire population, with statutory priority for those with the greatest need since 1997. In practice, this needs-based management has been difficult to realize, as the basic commitment is often perceived as unclear, open prioritizations are rare, and initiatives for increased accessibility often clash with guidelines for medical prioritizations.”
After an empirical study of primary care data from Region Skåne, following the introduction of choice of care in primary care, the authors argue that the results "raise important questions about the management of primary care and to what extent it is needs-based – something which, given the expected demographic development and the ongoing expansion of choice of care models, justifies further research".
Mr. Speaker! It is good that steps are now being taken to keep directly unsuitable or purely criminal actors away from the health centers in our country, even though we Social Democrats would have liked to see even more steps and that LOV, the Act on Choice Systems, be replaced with entirely new welfare legislation.
My question, Mr. Speaker, is: How does the Minister view the issue of resource use and resource distribution and the, for me completely obvious, risk of misallocation or misdistribution of healthcare resources in conflict with the intentions of the Health and Medical Services Act, and should the state really force regions to maintain the choice of care system within primary care when the government's own productivity commission clearly points to the risk of extensive waste of our tax money?
Sjukvårdsministern Elisabet Lann (KD)
Madam Speaker! It feels a bit like déjà vu to stand here and talk about LOV in primary care. I believe it was two months ago that we did it last time, and it was almost exactly the same question then. I do not know how much I can vary my answers so that it does not become tedious for potential viewers or for the interpellor.
I am still a bit surprised when the interpellator claims that the goal of freedom of choice has not been achieved with LOV. The fact is that 48 percent of all health centers are operated under other management. Many are small and doctor-run.
It is also the case that when patients are asked to comment on their health centers, the answers show that a large majority of the most popular health centers are run under different management and are not publicly run. I am not prepared to pull the rug out from under so many very popular and well-liked serious health centers around the country that meet the residents' needs for care just because unserious actors and crime have crept into the welfare system.
This is not unique to welfare. It is not unique to healthcare. It is a development in society that crime sneaks in and nests itself everywhere. Therefore, this government is working broadly to combat organized crime and tackle welfare fraud on all fronts. Unfortunately, this is also reflected in the priorities we are forced to make. It is extremely unfortunate. But the purpose is to move away from this, which for decades has been allowed to spread to the extent we see today. We should never have let it go that far. But, again, this is not unique to healthcare.
Just as the interpellor stated, healthcare is important. It is the most important thing for the interpellor's party. I would say that healthcare is also the most important issue for my party.
What possibly differs slightly between us is that for my party, the patient perspective is the most important. The most important thing is not to give power to regional politicians who can choose where patients should receive care, but it is to give the patient power, self-determination, and participation in that which lies so close to the patient's health and well-being. It is important.
That it is also important for the patients, we see from the outside by the fact that so many choose a different health center than a publicly run one. There are plenty of examples of people who actually actively register a fairly long way from home because they know that there is good primary care a bit further away and that they have the opportunity to get a fixed doctor contact with high continuity there.
That this opportunity shall remain is so important that one cannot easily enable regions to short-sightedly withdraw it from the patients. If LOV becomes a question of parliamentary terms, if it becomes four-year conditions for the possibility of providing care somewhere, it does not benefit long-term, responsible actors. It benefits those who can imagine starting up new companies every now and then, and so I think that we do not want that in healthcare.
Eva Lindh (S)
Madam Speaker! It is unfortunate that the Minister for Health feels it is like déjà vu. I think it is about commitment to an issue. That is also why we want the debate again, because we are committed. We believe in the importance of healthcare being provided based on need.
What we are saying is that the intentions of this legislation have not been fulfilled because one has actually not achieved what was the intention of the legislation.
What we are also saying is that it is possible to find another type of legislation that does not open up for welfare crime or over-exploitation. It is our task as politicians to see the challenges. When a system does not work, one must be prepared to back down and say that we must redo this, for in what other activity would one accept that cheating and criminal exploitation of a system is occurring where money is supposed to go to healthcare?
We have seen time and again how municipalities and regions that carry out audits discover incorrect billing, overcharging, lack of quality, and sometimes outright fraud. In another debate with the Minister for Health and Social Affairs, I gave the example from my own municipality. When we audited the home care companies, we had to terminate 16 providers within elderly care because we found inaccuracies. Sundbyberg, Södertälje, Norrköping – the municipalities are many. Those who have actually audited have found these problems.
The problem in the regions is that the regions cannot opt out. They cannot say no to someone who wants to establish an activity even if one does not have a permit to provide care, because one does not need it.
Authorities such as the police, the Swedish Tax Agency, and the Swedish Economic Crime Authority warn that organized crime is increasingly seeking its way into the welfare sector. Health and medical care is identified as an area where the risks are great and increasing. How can one accept that?
The defense is always that we need to increase the control. It increases the costs for an administration that just keeps growing and growing. I think the money should go to something else. On the other hand, I like control, so I am not against it. But we are building up a system that becomes like a large monster because one has to audit all these actors so much. And it is very difficult to terminate those contracts, even when one finds inaccuracies. What is being said is that it is not possible to control away this, but we need to change the system.
My question remains. Does one still want this, despite the Productivity Commission pointing out that this is precisely what the legislation has led to, and despite authorities saying that organized crime is taking over the welfare sector?
I actually do not think that the serious actors within the welfare sector want this. I believe that one needs better legislation, better control and better regulation.
Markus Kallifatides (S)
Madam Speaker! Thank you, Minister for Health and Social Affairs, for the previous answer!
I perceive a rather clear answer to my question, Madam Speaker. This government and the Minister for Health are not prepared to cease the flagrant infringement on the regions' autonomy that forced LOV entails. They are not prepared to fully accept the clear conclusions that forced LOV causes major problems in directing healthcare resources – our common tax funds, Madam Speaker – to the most burning healthcare needs. They are not prepared to cease that which threatens to be a comprehensive waste of tax money.
I perceived that the Minister for Health clearly illustrated that she and the government are not prepared to release a completely false contradiction between freedom of choice for patients and opportunities for control and steering towards needs.
Let me quote further from the Productivity Commission: ”In some cases, the individual's interest in being able to choose a healthcare provider is equated with the application of LOV.” According to the Productivity Commission's assessment, this is a misconception.
As noted by, among others, Vårdanalys, there are several other ways for the regions to organize the healthcare provision so that patients have the opportunity to choose a healthcare provider while competition between providers is maintained. The regions can, for example, let patients choose among private healthcare providers procured according to LOU or among operations run in public hands – such as well-functioning health centers.
This is one of many good reasons to change the government. Forced LOV should be abolished, and we must protect our tax funds!
Sjukvårdsministern Elisabet Lann (KD)
Madam Speaker! I want to be very clear on some areas, if I haven't been already.
No, this government does not accept cheating and crime in the welfare system. That is why the government has taken a number of initiatives in this area. This did not happen during previous parliamentary terms, which I regret, because then we would not have had to be where we are today.
I received an investigation today which, for example, proposes that the out-of-county fee should be abolished. The consultation period for the investigation expired on May 17. I have so many initiatives ongoing at the same time that my time is not sufficient to list them – but it concerns, for instance, stronger gatekeeper functions against criminal and unscrupulous actors.
We have given clear reinforcements to Ivo with a number of assignments also to them. We have given several authorities a mandate to cooperate. It is a concerted effort against organized crime in the welfare sector that shall lead to and contribute to more and faster decisions being made regarding, for example, revoking permits.
The investigation on permit review will be presented in October, and I know that there are politicians who have all the answers in advance. I personally prefer to work in a way where I first want to listen to the investigations that have analyzed the issue in depth and come back with proposals. Hence my earlier formulation that the government will consider whether permit review should be required based on what the investigation comes back with. We think it is a good way to work now that we have appointed this investigation.
We have, as we have said, taken a number of initiatives to strengthen control and tackle crime in the welfare sector precisely because it is so important that we address this, so the accusations that we accept fraud and crime in the welfare sector are very misleading given how highly we prioritize this and have done so throughout the entire mandate period.
Eva Lindh (S)
Madam Speaker! I have forgotten to thank the Minister for the answer, so I would like to do that! I think it is good that we can have such a debate and discussion, as we have desired, where we clarify differences and sometimes similarities.
It is large, important, principled issues we are talking about. My view on the matter – our view on the matter – is that we must do everything we can to stop the waste of taxpayers' money. We must stop the welfare crime, and we must ensure that the resources that are to go to healthcare actually go to healthcare.
I hear what the Minister for Health and Social Affairs says, and I hear what the government says. However, we mean that what is being done – if one now strengthens the so-called gatekeeper functions – is merely scratching the surface of a system that actually does not work. That is the difference.
I hear that there is a will to stop welfare crime, but if one is truly going to uproot it, one cannot just nibble at it or only do something about the worst that becomes visible. This is actually a system that opens up for welfare crime and over-exploitation. It is a system where no permit is required to start, for example, health centers.
We know through the authorities that have examined this that there is criminal exploitation and fraud occurring. That is the difference, and that is why I assert once again that there are ideological blinkers in this issue. If one seriously wants to address the over-exploitation, the fraud, the criminal exploitation, and the waste of our tax money and wants them to go to what they are intended for, one should do something about this legislation.
I ask therefore again: Does the Minister for Health and Social Affairs intend to do anything more?
Sjukvårdsministern Elisabet Lann (KD)
Madam Speaker! The last question is very simple to answer, that is, whether I am prepared to do anything more. The answer is yes, and work is indeed ongoing! I just stated that the investigation on the permit requirement will be presented in October. This did not happen during the two parliamentary terms when the Social Democrats were responsible for healthcare, and the work continues.
We are, therefore, prepared to make changes in the legislation to ensure that we can both safeguard the patient's right to choose good care for themselves and their loved ones, and ensure that tax revenue goes to healthcare and is not drained or, in the worst case, goes to crime.
This government has done more than has ever been done before in this area to stop the criminal actors and address the welfare fraud. I am, therefore, prepared to do more – absolutely!
I would also like to take this opportunity to thank you for the debate and wish you a nice summer!
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.