Private health insurance in Sweden: a clash of cultures

As growing numbers of Swedes choose private healthcare, The Local's Clara Guibourg explores what's behind the trend and what it could mean for the quality of Sweden's public healthcare system.

• 'Medical mistakes kill 3,000 Swedes a year' (18 Apr 11)
• Government in new bid to fix health insurance (11 Apr 11)
• Swedish Left looks to halt privatised healthcare (2 Mar 11)

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.