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Private health insurance in Sweden: a clash of cultures

Published: 10 Oct 2011 10:59 GMT+02:00

Private healthcare insurance plans have grown a whopping 400 percent in a decade and critics argue that the development could threaten the efficient provision of public healthcare.

Eva-Lisa Krabbe, political secretary at the Swedish Association of Health Professionals (Vårdförbundet), a union for Swedish healthcare workers, is among those dismayed by the trend.

"We think healthcare should be available through the public system. If we have a public system that covers people's needs, there's no need for insurance," she argues.

While Sweden has long taken pride in its public healthcare system, lengthening queues and at times inconsistent care have prompted many Swedes to opt for private healthcare with many gaining the benefit through insurance policies offered by employers, currently responsible for 80 percent of healthcare insurance market.

Kent Andersson, Nordic manager of healthcare insurance at Swedish insurance giant Trygg-Hansa, argues that while he recognises the risk that "willingness to pay for the public system will drop" he said that the trend reflects a change in consumer habits.

”People today want to invest more money in their health. It has to do with a shift in values, as more people want to prioritise their own health, rather than material things,” he explains.

With health insurance facilitating the move to private healthcare, some are concerned that Sweden's public healthcare system may suffer if too many Swedes select a private option.

In reality the distinction between the public and private in the Swedish healthcare system in Sweden has become blurred.

All but a very select few of the private options in Swedish healthcare are run by private operators, but still affiliated with tax-funded healthcare.

This means that the primary distinction emerges when it comes to payment. A visit to a privately-owned, tax-funded clinic, can thus be paid for either by the county, the patient's healthcare insurance plan, or patients themselves.

Prices also vary depending on the treatment.

But Andersson argues that traditional objections from egalitarian Swedes to a two-track healthcare system are diminishing as people's priorities shift.

“Nobody questions if I use 25,000 kronor ($3,600) to go to Thailand on vacation. Not everybody can afford to do that, either. But if I use that 25,000 to buy knee surgery, it’s suddenly something bad.”

Andersson furthmore argues that health insurance policies, and the private healthcare options they make accessible, may actually have some direct benefits for the public system.

“If you use private healthcare, you’re giving your spot in the public healthcare queue to the person behind you. So in that sense, healthcare insurance does relieve the system,” he says.

Indeed, Göran Hägglund, Sweden’s minister for health and social affairs, and Filippa Reinfeldt, Stockholm county’s health service commissioner, have previously touted the benefits of private healthcare as a way to relieve stress on the public system.

“Instead of viewing private alternatives suspiciously, we must find ways to ensure they can relieve public healthcare, and fill out its deficiencies,” the pair wrote in an opinion article in Svenska Dagbladet (SvD) in 2008.

But Eva-Lisa Krabbe disagrees with this view, pointing out that neither the total number of hospital beds nor the number of healthcare professionals increases as more Swedes opt to go private.

"Today we've got a shortage within most healthcare professions, so we'll hardly get more healthcare simply because some public employees choose to go over to the private sector," she argues.

The idea behind private health insurance is simple enough: those put off by the idea of heading to publicly funded clinics and hospitals can purchase a policy through an insurance company and instead enjoy speedy medical attention with private doctors.

Of course, the option doesn't come cheap.

While the public system will set a patient back no more than 350 kronor per visit ($52), regardless of the procedure, and this fee is capped at a total of 900 kronor annually, insurance policies can run into thousands of kronor, depending on how much or how little is covered.

“We’ve got several different premiums to choose from, but the standard one costs about 4,000 kronor per year,” says Andersson.

Despite the cost, as many as 500,000 Swedes are now estimated to be using private healthcare insurance, up from 100,000 only ten years ago, according to a recent report from daily newspaper Dagens Nyheter (DN).

And a flawed public system is often cited as the cause of the rapid expansion.

“It’s a question of people not being satisfied with the accessibility of today’s public healthcare,” explains Andersson.

“I don’t think it’s the quality of public healthcare that’s mistrusted, but the feeling of not being well looked after.”

Long queues are one of the main complaints for consumers of Sweden's public healthcare services, with patients sometimes forced to wait as much as fifteen times longer for treatment compared to private options.

Insurance company IF, for example, offers insurance policies which guarantee specialist care within two days, while patients can wait at least a month to see a specialist in the public system.

Long wait times have been a long-standing problem with the Swedish healthcare system and one that the government has attempted to address.

The Healthcare Guarantee (Vårdgaranti), a reform implemented in 2007, was supposed to ensure patients can visit a doctor and receive treatment within specific time frames.

Despite much fanfare at the time, the reform's results have been limited, according to Andersson.

“The Healthcare Guarantee isn’t a guarantee,” he explains.

“If you don’t receive care within the promised time, there are no sanctions, and you don’t get any compensation.”

As a result, private healthcare remains in demand, despite some objections that the development results in a two-track system in which wealthy, employed patients receive better, faster care.

But with more and more Swedes opting for private healthcare, Andersson is hopeful that Swedish healthcare can evolve into a system where public healthcare is capable of offering good care for all, and private insurance becomes an extra option for those who wish to invest more.

“For that to happen, we have to be clear about what the public commitment is – what can I expect to get in return for my tax money? When I know that, I can make an informed choice if I want to buy extra services," he says.

Clara Guibourg (clarabara@hotmail.com)

Your comments about this article

11:46 October 10, 2011 by bronc
Don't mimic the US system, please. If you can learn anything from the failure of the US healthcare system is for-profit insurance companies are about their profits, not the people they insure. You end up with a 2 tiered system - the system for the rich, which guarantees the best care you can afford, and then the bare minimum care system for everyone else, which is often plagued by incredibly long waits and sub standard care.

This is a dangerous and slippery slope. Keep $$$ out of health care!
11:55 October 10, 2011 by Mib
I believe it is a general dissatisfaction with the current healthcare provision. My Daughter had lots of problems getting the right expertise, which led us to eventually arrange a private consultation atGreat Ormond Street. That money was more than worth it and they also pointed us to people they knew in Uppsala who had the experience.

I've read how great the Swedish system is and in general just like the NHS it provides an excellent service above 90%, but you make judgements on your experiences and when it concerns your children, then for me it's a no brainer.
11:59 October 10, 2011 by Borilla
Don't kid yourself. The commentators are right about the US system. Anyone who is honest can tell you that the myth of eliminating the queues with "private" healthcare is just that. Emergency rooms full of people with and without health insurance and multi-hour waits for internists, orthopedists, etc. are the norm. So, you can have a choice: wait as you do now through the Swedish system or pay 4000SK plus a year and wait just as long or longer. Given her track record to date, an endorsement from Filippa Reinfeldt is not something to be coveted.
12:36 October 10, 2011 by occassional
The Pareto principle at work here and while it is fine for those who use it the most to talk about how great health care is and should be, those who contribute most to it see it rather differently.
12:37 October 10, 2011 by Abe L
If I only you could opt-out for the public healthcare and stop paying so much bloody tax for it. This is a very good thing, you can stop paying for EVERYBODY ELSE'S healthcare, especially if you're never needing it yourself.

A lot of people already get private healthcare through their employer, simply so they do not have to use the public system and can get proper care and get back to work much faster.

The better we kill of the generalized system the better, so they can focus on getting rid of spending tax money on free education.
22:38 October 10, 2011 by Zoro2011
Welcome to USA, where the insurances decide your treatment. I preferred Sweden. Hej då
01:36 October 11, 2011 by bulletts67
@Abe L

Don't kid yourself, at some point in life we will all need health care. And, healthcare through your employer is fine, until you lose your job. You should come to the USA, where we have a private health care system...where one third of our premiums go to insurance company stockholders as profit instead of being used for patient care, and their CEO's are paid hundreds of millions of dollars in compensation. It's a wonderful system where phrases like pre-existing conditions, and lifetime limits on coverage are all used to make sure that when you are sick and needing care, your insurance company can walk away from you and let you die.
07:27 October 11, 2011 by karex
I think that what we more or less established with previous comments is that the two extremes don't work: the Swedish or the American. It's part of human nature not to like something and as a result go in the entire opposite direction. The middle ground is almost always the best solution. I would jump at private healthcare if I could afford it or if my employer offered it. Simply because I don't want to be refused treatment for not "booking an appointment" for an emergency room at a hospital (personal experience) or die waiting for an ambulance which never arrives. On the other hand I also don't want to spend a better part of my earnings paying for health insurance only to find out that I can't get needed open heart surgery because of a pre-existing in-grown toenail. The problem is that most politicians introduce concepts, not working models. Entire systems are put in place without an infrastructure to support it. Then it obviously cannot work in practice. There will always be greedy SOBs that's also human nature. So put strict controls in place and even stricter sanctions to combat it. If you want to look heroic implementing a "free for all" system, then make sure it is free and make sure it will work.
16:31 October 11, 2011 by johnoleson
Winston Churchill quoted well "The inherent vice of capitalism is the unequal sharing of blessings; the inherent virtue of socialism is the equal sharing of miseries".
17:24 October 11, 2011 by Shibumi
My Swedish company just signed us all up for private health insurance and guess what... pre-existing conditions are not covered. Even the USA is trying to eliminate this absurdity from their system... way to go backwards Sweden!
01:18 October 12, 2011 by waffen
You will rue the day one thousand times over should you elect to go the Fascist route like that of the United States.

You do not know what misery is until you start paying thousands of dollars every month and still end up with sub-standard care.

The insurance companies do not care about the person, all that they care about is the money.

When they can allow you to die, they would prefer doing that to spending any money on your care. They have thousands of ways to delay, deny, cancel, and lie about doing anything that would provide you wilh care.

Beware.
05:07 October 12, 2011 by t64
@waffen

Oh foolish mortal, you don't have a clue.

#1 How is the business of insurance companies fascism?

#2 Healthcare USA does have provision for the uninsured, relying on government care in the form of medi-care for the old, state sponsored medical care for the poor, and emergency hospital services mandated by law to turn no one away. Those with no money do not pay. The insured are generally well covered with certain minimal coverages required by law.

#3 When purchasing individual policies often times existing ailments aren't covered but group policies(the type you get through an employer) usually cover existing.

#4 The weakness is the inequality and high price, not the lack of care critics love to trumpet.

#4 What you don't understand is the majority in the USA fear Obamacare, for the expectation that it will cost more than they pay now and will result in care similar to what Sweden endures.
14:21 October 12, 2011 by Addendum
Swedish health care is garbage, and it's disgusting that people are forced to pay twice for health care - once through taxes, and then when you see that they leave you to die, then you pay again for private care. Bitch all want about the U.S., but the quality of U.S. health care does not exist in Sweden. And for your information, the government is just as greedy as insurance companies. You often don't have access to treatment or medicines. It's a dictatorship. The U.S. system may need work, but it's stupid and deadly to replace it with this murdering garbage machine.
15:01 October 14, 2011 by Vikingbill
I'm sorry people but you are being mislead about U.S. Healthcare. It is so easy to cite one example to defend an example of any problem. Believeme, most people in the U.S. are very satisfied with our Healthcare System. Why do people from all over the world fly to the U.S. for our doctors? And finally, I have been to Sweden many times and I laugh when my dear Swedish friend tells me how all Swedes get such teriffic care for so little money! ....and then we go to the grocery store and buy a loaf of bread for 35,000 SEK!!....It's real simple...everybody pays a lot! Some just pay it somewhere else!
07:56 October 15, 2011 by Puffy Taco
Those who are so ready to criticize every aspect of US life should really take a year and go live in the country they think is so wonderful. My father was a Swede and I love Sweden but wouldn't trade my US healthcare for theirs for anything. I agree with the last three posts, plus, did anyone mention choice? If I don't like one doctor or office I find a better one. Surgery is scheduled promptly. My aunt, in Sweden, is a radiologist--still had to wait 6 months for knee replacement. My other aunt had to wait as long for a mastectomy! And yet another aunt died in the hospital with rather "interesting" explanations. Who do you appeal to when you're dealing with "the Government"

By the way, I have lived largely in "other countries" -- that's why I love and appreciate the US, in spite of her flaws, lumps and bumps.

When "the Government" owns your healthcare, THEY OWN YOU!
10:39 October 15, 2011 by Jinx
Values and an enviable system made Sweden famous and admired around the world. The assasination of Olof Palme was also the demise of the welfare system in this country. Eversince, the country has been slowly but surely moving towards a capitalist system in its entirety.

The rich have grown richer and the average Swede has not done too bad either. Why? Because now there is another group of people that fill the lower ranks...the immigrant!

Most immigrants, if lucky to find a job, make no more than 16000kr per household. Since most came here with nothing their salaries are all they have. So they have no reserves to fall back on.

The average Swede on the other hand makes 30000Kr and has subtantial savings and assets.

This disparity in incomes and personal wealth is the breeding ground of many evils; least among them is the faltering healthcare system.

Which some argue is deliberate as is the need for paying goodwill money for housing.

Similarly, the school system is being ignored. In areas with high immigrant population schools lack everything from amenities to teachers.

In a recent survey of quality of life in Western Europe Sweden stood 9th out of 10 with the lowest expenditure on healthcare.
10:00 December 4, 2012 by just do it
According to WHO organization Sweden is in the 23rd rank between countries in terms of Best Health Care System.

Between many countries, me and my family were living because of work duties...we find Sweden should not be even in the 23rd place.

It's meaning less to find my daughter sick and sleepless for two nights and with a cool answer:" Sorry, it's fully booked for couple of days" when I approached the Vårdcentral who is using Try & Error system to treat patients.

I respect the pride of leading the system among countries. But such system must be upgraded to follow your rank & people needs.

Regardless dental care, when I contacted them last June and till now no answer back!!!

For those people who still believe such system is Ok, I advice to read & see other systems then rank yourself.

Finally, Please stop having silly criticizes about US & immigrants...we never faced such long waiting time in US like we are having here and Sweden is so much in need for immigrants, but I do agree that Sweden shall have to evaluate immigrants before allowing them in.
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