• Sweden edition
 
'Citizens shouldn't pay for costs of long healthcare waiting times'

'Citizens shouldn't pay for costs of long healthcare waiting times'

Published: 10 Dec 2012 17:00 GMT+01:00
Updated: 10 Dec 2012 17:00 GMT+01:00

There is a surprising lack of constructive debate regarding the future of the Swedish welfare state. At least this is the case when it comes to the Achilles’ heel of the publicly funded systems, namely long waiting times.

Sweden indeed has high welfare ambitions. But the system cannot live up to the promises of equal access, safety, and efficiency since many have to wait weeks, months or even years to take advantage of various public services.

As discussed in my new book I väntan på välfärden ('Waiting for welfare') it is possible to improve the system considerably, by focusing on constructive and pragmatic reforms.

A few years ago Kjell-Olof Feldt, former Social Democrat finance minister, talked of his own personal experiences of the healthcare system.

“If you come over the threshold and enter the system, then I guess the Swedish healthcare system is better or comparable to most other systems, both historically and internationally. But I have friends who have also been affected. They do not trust the Swedish healthcare system.”

The reason for the mistrust, according to Feldt, as welfare had begun rationing services through queues, resulting in that long waiting times.

Indeed bureaucratic delays characterize a number of areas of welfare in Sweden. Many have to wait for months or years for operations that could improve their quality of life dramatically.

And those who reach out to the elderly care system in the final stages of life can be forced to wait.

In the average Swedish municipality, the wait time for elderly care is almost two months. In some parts of Sweden elderly in need of aid have to wait on average 150 days.

Behind the statistics lies an even more disturbing reality. Municipalities do not like to report long waiting times. Therefore officials can delay the process of actually registering applications for elderly care, as well as other welfare services.

Waiting times for welfare services reduce the security that the high taxes in Sweden ought to create.

Interestingly they also recreate the inequality that tax-financed systems aim to decrease. International research shows that those with higher education in Sweden, those who are better at pushing their will through when in contact with the cumbersome bureaucracy, wait only half as long in the publicly funded healthcare lines as those without any post-secondary education.

Long waiting times exist in most public systems, including social safety nets. Of those who requested assistance for sickness insurance in 2010 for example, fully six percent waited more than 180 days for the public bureaucracy to reach a decision on whether they were entitled to coverage or not.

Surprisingly, 2010 was an exceptionally good year. Five years earlier, almost a third of applicants had to wait more than six months for the bureaucrats to answer!

Even those seeking unemployment benefits and social assistance can wait for weeks and months.

Waiting times are not explained by a lack of resources in welfare systems. Every year, the Swedish state gathers some 170,000 kronor ($25,400) in tax revenues for each citizen. And total tax revenues have grown rather than diminished despite tax cuts pushed through by the centre-right Alliance coalition government.

So there is plenty of money in the system, so why the long waiting times?

Part of the answer can be explained by inefficiencies in government systems. Another key explanation is that when publicly financed services are launched the demand for them tends to increase to higher levels than originally intended. Since the participants pay nothing or very little for the services, demand increases over supply.

The point of the welfare state is to balance supply and demand by judging who really needs a particular service, such as healthcare, and who is over-utilizing the system. However, politicians and bureaucrats are not good at this task.

The solution therefore becomes allowing long queues to develop. Many who wait will get tired and stop seeking aid. And the demand for services will decline due to the expectation of long waiting times.

Long waiting times not only reduce the benefits of various welfare systems, but they also create massive economic costs. For example, patients who wait for healthcare are less likely to get rehabilitated and back to work, increasing their risk of becoming permanently dependent on public benefits instead. Their health might also deteriorate while waiting for care, which in turn increases the costs of healthcare once it is given.

Research and experience shows that it is possible to reduce the problem considerably, as long as the willingness for change exists.

Although the public system as a whole is hampered by long waiting times, specific budget areas benefit by creating ques. For example, a local hospital can reduce expenses by having patients wait in line. The direct cost of waiting almost always lands on the citizens themselves rather than the public system.

To pave the path for improvement, the roles ought to be reversed. When parts of the public system create long waiting times, they should directly bear the cost, for example by being fined when doing so.

Waiting times arise mainly due to central planning and public monopolies. One advantage of having privately-owned players in the welfare system is that they directly benefit from offering various services to patients, and therefore have an incentive to reduce waiting times.

Recently a survey was conducted of a reform in the Stockholm region which increased patient’s choice. The reform, which included the establishment of more private alternatives, was shown to lead to significant efficiency gains.

Thus, more healthcare was made available without raising costs. And patients with high healthcare needs increased their utilization.

Besides opening up for more competition from private players and fining the public system when unreasonable waiting times arise, it is important to clearly establish what rights citizens have.

If a municipality does not give a patient treatment in time, they should have to pay for alternative care that sought elsewhere, even abroad. Such a system already exists in health care, but is rarely utilized.

The healthcare guarantee in Sweden means that a patient can wait 90 days for seeing a specialist and an additional 90 days for the actual treatment to take place. Only after this contract has not been fulfilled can you seek help abroad – 180 days after initially seeking treatment.

In neighboring Denmark, by contrast, patients only have to wait one month until the limit of the healthcare guarantee has been reached. After that they are given the right to choose alternative treatment in public, private and foreign hospitals, to be paid for by public means.

Guarantees can also be extended to other parts of the system, such as applying for sickness benefits or unemployment benefit. After a patient has waited for two months, for example, the systems should be forced to automatically entitle him or her to compensation until the benefits application is actually reviewed.

The public sector should bear the cost of excessive waiting times, and the citizens should be given the opportunity to choose alternative solutions.

By adapting this approach, whilst opening up for more private competition, it would be possible to radically reduce the waiting times and thus clearly improve the welfare services offered in Sweden.

Nima Sanandaji is a Swedish author, who recently published his new book I väntan på välfärden ('Waiting for welfare') for liberal Swedish think tank Timbro.

Don't miss...X
Left Right

Your comments about this article

11:03 December 12, 2012 by RealProfessor
The Brits tried this with their rail system. The result was a dramatic decrease in performance and a similarly dramatic decrease in safety. Read Granta: Jack, I.The Crash that Stopped Britain. London: Granta, 2001.

The mantra of free-markets and 'choice' is rather stale.
15:46 December 14, 2012 by glenp
So, govt. supplied goods and services aren't the UTOPIA you expect. Neither are they economical. Why do you continue to follow, over and over, the same failed path and expect different results? That is the definition of insanity.

I shall use this article as an "I told you so" to rub in the face of our own American Socilaist morons cheering "Obamanocare"----hopefully I will live long enough to be able to do this.

Just remember, SOCIALISM has FAILED everywhere it has been instituted, no matter how lofty the intentions and goals stated for its need.
Today's headlines
Motorists in sticky drama after jam spill

Motorists in sticky drama after jam spill

Drivers in western Sweden were forced to jam on the brakes after a van shed its load of preserves and juices which led to major traffic problems. READ  

Property of the Week
In Pictures: The Local's Property of the Week
Photo: Fastighetsbyrån

In Pictures: The Local's Property of the Week

Why settle for owning a house when you can own part of the island it is located on? This week's property allows you to get your money's worth of solitude while spending some time with your closest neighbour - the sea. READ  

Saab buys Swedish submarine shipyard
File photo: TT

Saab buys Swedish submarine shipyard

Swedish defence and aeronautics group Saab said Tuesday it had completed the acquisition of German heavy industry giant ThyssenKrupp's submarine shipyard in southern Sweden. READ  

Opinion
'The Danish narrative on Sweden is based on a lie'
File photo: Shutterstock

'The Danish narrative on Sweden is based on a lie'

There is a popular narrative that in Sweden people bite their tongues while in Denmark they speak their minds; political commentator Brian Esbensen debunks this, arguing that Danes simply find it easier to criticize others. READ  

Swedish cops elect not to shoot 'angry elks'

Swedish cops elect not to shoot 'angry elks'

After reports that wandering elks were scaring the public, police on the island of Frösön have decided not to open fire on the animals, but have urged locals to exercise caution instead. READ  

Swedish funds to tackle female genital mutilation
Sweden's Minister of International Development Cooperation Hillevi Engström with Foreign Minister Carl Bildt. File photo: TT

Swedish funds to tackle female genital mutilation

Sweden has earmarked 48 million kronor ($7 million) of its development aid budget to a United Nations programme to tackle female genital mutilation. READ  

Swedish leaders speak out on Gaza crisis
Photo: TT

Swedish leaders speak out on Gaza crisis

Swedish foreign minister Carl Bildt believes Israel is interested in negotiating a ceasefire with Hamas while Social Democrat leader Stefan Löfven has stood by his comment about the Israelis having a right to defend itself. READ  

New alcohol retail rules threaten micro-breweries
File photo: Systembolaget

New alcohol retail rules threaten micro-breweries

Swedish micro-breweries have reacted with concern to new distribution regulations being imposed by the state controlled alcohol monopoly Systembolaget, which they fear may put them out of business. READ  

ABB and Volvo in electric buses tie-up
Volvo hybrid bus. Photo: Volvo Buses

ABB and Volvo in electric buses tie-up

Swiss-Swedish engineering group ABB and Volvo Buses of Sweden have announced a joint project to develop a system for electric buses to recharge their batteries fast when at bus stops. READ  

'First ever' heat warning issued for Sweden
Photo: TT

'First ever' heat warning issued for Sweden

Swedish weather agency SMHI has issued its first ever warning for high temperatures with the many areas set to bask in plus 30C heat. READ  

RECEIVE OUR NEWSLETTER AND ALERTS
Gallery
People-watching Båstad
Business & Money
Sweden falls to third in global innovation index
Society
Swedish ornithologists keep webcam watch
Photo: Andreas Nordström/Image Bank Sweden
Gallery
Top ten Swedish beach hot spots
Tech
Swedish Wiki vet sets new content record
Blog updates

22 July

PROTECTING GIRLS FROM ABUSE OF THEIR RIGHTS (The Diplomatic Dispatch) »

"Today (22 July) my Prime Minister, David Cameron, and UNICEF, are hosting the world’s first #GirlSummit in London. The Summit’s aim is to mobilise domestic and international efforts to end the appalling practices of Female Genital Mutilation (FGM) and Child Early Forced Marriage (CEFM). This is a high priority for the UK government and the Prime..." READ »

 

18 July

Starting over (Around Sweden in a kayak) »

" I’ve now been off the water for almost 14 days. At first I was totally gutted being forced into a rest period, I had Stockholm in my sights and apart from the pain and discomfort in my shoulder, spirits were high and I was starting to gain some momentum. The news hit me fairly hard and..." READ »

 
 
 
Photo: Fastighetsbyrån
Lifestyle
In Pictures: The Local's Property of the Week
Photo: Finest.se
Gallery
People-watching July 15-16
Photo: Ola Ericson/Image Bank Sweden
Society
What's On in Sweden
Photo: Lisa Mikulski
National
Hope springs eternal for expat pet shop owner
Gallery
Princess Estelle steals limelight at mum's birthday
National
Swedes risk infants' lives by covering up prams
National
Swede runs for office just using Bitcoin funds
Gallery
People-watching July 11-13
National
Malmö mayor slams Danish beggar ban
National
Swedish anti-abortion midwife sues county
National
Swede's salary chopped for Facebook use
National
Northern Sweden warmest in 90 years
Gallery
'Victoria Day': Crown Princess Victoria turns 37
Politics
Mona Sahlin to fight extremism in Sweden
National
EU tells Sweden to cover up snus flavours
Society
Swede snags assassin role in Tom Cruise film
Lifestyle
Top ten ways to spend a few days in Malmö
Gallery
Swedish summer tourism highlights
Sponsored Article
Introducing... Your finances in Stockholm
Sponsored Article
Introducing... Housing in Stockholm
Latest news from The Local in Austria

More news from Austria at thelocal.at

Latest news from The Local in Switzerland

More news from Switzerland at thelocal.ch

Latest news from The Local in Germany

More news from Germany at thelocal.de

Latest news from The Local in Denmark

More news from Denmark at thelocal.dk

Latest news from The Local in Spain

More news from Spain at thelocal.es

Latest news from The Local in France

More news from France at thelocal.fr

Latest news from The Local in Italy

More news from Italy at thelocal.it

Latest news from The Local in Norway

More news from Norway at thelocal.no

691
jobs available
Swedish Down Town Consulting & Productions
Swedish Down Town Consulting & Productions is an innovative business company which provides valuable assistance with the Swedish Authorities, Swedish language practice and general communications. Call 073-100 47 81 or visit:
www.swedishdowntown.com
If you want to drink, that’s your business.
If you want to stop, we can help.

Learn more about English-language Alcoholics Anonymous in Sweden. No dues. No fees. Confidentiality assured.
AA-EUROPE.ORG/SWEDEN
PSD Media
PSD Media is marketing company that offers innovative solutions for online retailers. We provide modern solutions that help increase traffic and raise conversion. Visit our site at:
http://psdmedia.se