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PRESENTED BY INVEST STOCKHOLM

Stockholm marches at the front of the health tech revolution

Sweden’s health service is world-renowned for the level of care it provides from the cradle to the grave. Now the nation is pioneering the development of health tech with many of the life-changing services being created and implemented in the Nordic start-up capital of Stockholm.

Stockholm marches at the front of the health tech revolution
Photo: Coala Life. /Creative Commons

Swedes are among the healthiest people in the world and are living longer as a result. While the nation’s health service is envied around the globe, longer lifespans are increasing the strain on medical professionals.

Health tech provides people with the ability to take better care of themselves using technology and is a complement – not a threat – to existing healthcare, say the developers of Swedish success story, Coala Life.

The Coala health monitor is a device that syncs up to your smartphone to record your heart sounds and ECG in under 60 seconds. It has won rave reviews and awards as well as $12m in funding. Despite this, the founders have encountered resistance from physicians who are still too attached to the old-fashioned stethoscope.

Embracing the new opportunities provided by health tech is vital. For example, the Coala device was used by one of Sweden’s largest healthcare providers to assess patients with palpitations and arrhythmia. And the result? Specialist referrals decreased by 40 percent.

Find out more about investment opportunities in Stockholm

Photo: The Coala health monitor/Creative Commons

Health Tech is here for the long-term and is state sponsored in Sweden where the government has pledged to become global leaders in e-health by 2025. With national backing, health tech is now big business that is attractive to investors both in Sweden and further afield.

“Stockholm is really the center point of the fast moving digital health hurricane that is working to transform healthcare. We’ve had great success in attracting local funding as well as a world-class team including hardware-developers, designers, clinicians and go-to-market champions. Many countries and companies follow the trends, innovations and best-practices that arise out of Stockholm, and I’m proud that Coala Life is one of the key contributors of this unique ecosystem,” says Philip Siberg, CEO of Coala Life (pictured right).

Stockholm, which was christened ‘the unicorn factory’ by the Financial Times back in 2015, earned that moniker for being home to multiple companies that are valued at more than $1bn. And with the health tech industry growing at a rapid speed in the city, it is attracting interest as well as investment from overseas.

Take Swedish-based company Bonzun for example. Since being founded in 2012, the virtual midwife app, which provides free expert advice for expectant parents, has gained a significant foothold in China where 82 percent of wealthy Chinese people do not have a GP.

Photo: My Pregnancy App by Bonzun

Bonzun has proven to be a hit among Chinese women; its My Pregnancy app has been downloaded millions of times in China since it was rolled out in 2012. China’s e-health market was valued at $2bn in 2017, and Bonzun’s CEO and Founder, Bonnie Roupé, is keen to increase her company’s presence there. Thinking big is the way to go says the Swede.

“In Sweden there are 120,000 pregnant women a year. In China it is 22 million. We see that there is a gap in the market everywhere for the service we offer. Although maternal care is different in other countries, the questions that pregnant women have are the same,” says Roupé.

Roupé has big ambitions for her app, which is already available in English, Swedish and Chinese, with other languages in the pipeline. Stockholm is the ideal starting point for pioneering advances in health tech, she says.

“In Sweden we have reached a level of comfort in terms of free access to healthcare that we are able to create ideas for how to improve it. Stockholm has people from all different backgrounds working together to create new technology.”

Find out more about investment opportunities in Stockholm

Prosilico is a medtech firm with its origins in Stockholm. The firm has developed a unique AI-based in-silico prediction methodology platform that is used in the pharmacokinetics sector. The service has been successful in Scandinavia and the founders, two ex-AstraZeneca researchers, are keen to expand abroad and get a piece of the global market, which grows 10 percent annually and attracts backing from pharmaceutical giants.

“We are the first company to objectively demonstrate that it is possible to predict human clinical pharmacokinetics of drug molecules directly from chemical structure just as accurately as is done in the laboratory,” says Urban Fagerholm, CEO of Prosilico

He adds, “What we are doing is a paradigm shift away from the traditional methods such as animal testing and narrow-range test tube-studies for this kind of research. Our validated technology has great potential since it is faster and more cost-efficient than going to a lab, and gives our customers ethical advantages and an opportunity to get reliable data and to optimize at the drug design stage.”

The firm collaborates with a drug discovery company in Spain and will soon launch a unique, validated web-based prediction platform.

Stockholm is of course home to the world famous Karolinska Institutet, which has a long history of producing doctors and researchers. Neighbouring city Uppsala also enjoys a similar reputation. Such deep resources of knowledge and expertise in the region make Stockholm an obvious hub for the burgeoning health tech sectors, says Fagerholm.

“The Stockholm region, with many former AstraZeneca scientists and top-ranked universities, is a natural place for research within this field.”

Even in a country with a world-class health service such as Sweden, it can still sometimes take a while to get an appointment with your GP and even longer to meet a specialist. Many Swedes live in rural locations that are many miles away from their local healthcare centre, which can make it problematic to see your doctor at short notice.

Photo: MediCheck

Fortunately, Sweden has broad internet penetration across the country; 94% of the population are online. The developers of MediCheck have been quick to spot that Swedes are both health and web savvy. MediCheck users can consult with specialist doctors via video calls or instant messaging simply by using their smartphone, tablet or computer.

With multi-lingual specialists from all fields of medicine, MediCheck is shaking up the traditional doctor/patient relationship by making it virtual and more accessible.

“By providing access to the right specialist and virtual specialist teams we empower the patient’s ability to control their personal wellbeing where ever they live. If you, for instance, suffer from arrhythmia, we can help you manage your disease by monitoring your heart with a Coala and at the same time give specialist advice based on your history and Coala data,” says Christian Tärnholm, CMO of MediCheck.

He adds, “Stockholm is a great place to be as a young company. The start-up community in Stockholm is really supportive and there are several good incubators and acceleration programs from players like Sting, Connect, SUP46 and more.”

This article was produced by The Local Client Studio in partnership with Invest Stockholm.

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HEALTH

EXPLAINED: What to do if you face a long wait for healthcare in Sweden

Sweden theoretically has a "healthcare guarantee" limiting your wait to see a GP to three days, and to see a consultant to three months. The reality is somewhat different. Here's what you can do if you face a long wait.

EXPLAINED: What to do if you face a long wait for healthcare in Sweden

What is Sweden’s ‘healthcare guarantee’? 

Sweden’s “National Guaranteed Access to Healthcare” or vårdgaranti, is a right to care, protected by law, that has applied in Sweden since 2005. You can see the latest version of the relevant laws here and here. Here is a summary of the guarantee on the website of the Swedish Association of Local Authorities and Regions (SKR).

Under the system, all patients are guaranteed:

  • contact with a primary care centre by phone, in-person, or by video-link on the day they seek care 
  • an appointment with a doctor, nurse, physio, or psychotherapist within three days of seeking help 
  • an appointment with a specialist doctor or consultant within 90 days of seeking help 
  • treatment or operation within 90 days, if the specialist considers this necessary 

Does the guarantee mean I have a right to treatment? 

No. If the doctor at the primary care centre, after examining you and questioning you, decides that there is no reason to refer you to a specialist doctor, they do not need to do so. 

Similarly, if the specialist doctor, after examining you, decides that no treatment is necessary, then your case is considered completed.  

Can the waiting times to see a specialist or to get treatment be longer than 90 days? 

Absolutely. In fact, they very often are. 

According to the Swedish Association of Local Authorities and Regions (SKR), in February, 32 percent of patients had been waiting 90 days or more to see a specialist, and 43 percent of those who had seen a specialist had been waiting for treatment for more than 90 days.  

The situation in primary care was a little better, with 80 percent of those seeking care in contact with their primary care centre on the same day, and 83 percent having their case assessed by a doctor or nurse within three days. 

In addition, if you agree with your specialist doctor that you are willing to wait longer for an operation, then that wait doesn’t get counted in the statistics. 

So what can I do if I’ve been waiting longer than the guaranteed time? 

In reality, it’s actually less a guarantee than a target.

In primary care, there is no way for individual patients to complain that they have had to wait too long to see a doctor or nurse, or to cut their waiting times by citing the guarantee. 

“There’s no system for enforcing that guarantee,” says Emma Spak, the primary care doctor who doubles as section chief for SKR’s healthcare division. 

It would make no sense to set up a complaints line for those who have had to wait too long for phone contact with their primary care centre, she points out, when they could instead talk to patients seeking a primary care appointment in the first place. 

“It’s more of an incentive system for the regions,” she explains.

Every primary care unit and every region reports their waiting times to the national waiting time register, and then as part of the access agreement between SKR and the government, the regional health authorities receive a bonus if they meet their waiting times goal, or if they improve their waiting times. “That’s one way of sort of enforcing this guarantee,” she says. 

When it comes to specialist treatment, though, patients do have the right to demand to be examined or treated by an alternative specialist or hospital if they’ve had to wait longer than 90 days.

If your primary care centre issues you a referral to a specialist, and the specialist cannot then offer you an appointment within 90 days, the specialist, at the same time as offering you a later appointment, will often put you in contact with a unit at the regional health authority who will offer to find you an alternative specialist, either within the region or elsewhere in Sweden. 

The regional health authority will then have to reimburse any extra travel or hotel costs incurred by the patient.  

Similarly, if after examining you, a specialist cannot offer you treatment within 90 days, they will normally put you in contact with the same unit. 

Some regions have a phone line for people who have been waiting too long, or else you can contact your specialist or primary care centre and ask for information on seeking an alternative specialist. 

What happens if I don’t want to travel to see a specialist or get treatment? 

If your regional health authority offers you an alternative specialist, either within your region or in another region, so that you can get treated within the 90 day period, and you are unwilling to travel, then you lose your rights under the guarantee. . 

“If you’re in Gothenburg, and they say you have to go to Stockholm to get your treatment, and you say, ‘no, I want to go here, then then you’ve sort of forfeited your right, and you have to take what’s on offer,” Spak says. 

What happens if I agree with my specialist to wait longer? 

If your specialist says that they can treat you in four months, but also offers you treatment elsewhere within the guaranteed 90 days, and you choose to be treated by your specialist, then that counts as a patient choice, which will not then be counted in the statistics. 

“The specialist might say, ‘I don’t think you will get any worse for waiting two months extra, and if you wait five months, then I can make sure that you get your surgery done here, and we can make sure that you get all the aftercare and everything here as well,” Spak says. 

But these patient decisions are also counted in the statistics, and if a region sees a sharp rise in patients choosing to wait, SKR will tend to investigate. 

“If some region all of a sudden has a lot of patients choosing a longer waiting time, then we will call them and ask what’s going on here, because patients don’t tend to want to wait extra,” Spak says.  

Can I get financial compensation if I’ve been waiting too long? 

No. 

What other ways are there of speeding up the wait for treatment? 

Don’t underplay your symptoms

When drawing up their timetable for treatment and assessment, specialists will tend to give different patients different wait times depending on the urgency of their case.

For this reason, it’s important not to underplay your symptoms when visiting a primary care doctor, as they will tend to include a few lines on the urgency of your case when they write their referral. 

Stress your flexibility 

If you are unemployed, a student, retired, or have a very flexible job, it is worth telling your primary care doctor about this, because they may write in your referral that you are able to make appointments at very short notice. The specialist may then put you on their list of people to ring if one of their patients cancels. 

“Sometimes I write in my referrals that this patient could easily come at short notice, so please put the patient on the list for people you can call if there’s a time slot available,” Spak says. 

If you haven’t told your primary care doctor this, it’s not too late. You can ring the specialist yourself and tell their receptionist that you are very flexible, and ask to be put on the back-up list. This is particularly useful if you’re waiting for a scan, but you could also potentially work even if you’re waiting for heart surgery or a hip replacement. 

“If they’ve accepted you as a patient, and they’ve made sure that you fulfil the criteria for having that scan or whatever, then you can call them and say, ‘I have a really flexible job, I can come anytime if you have a gap,'” Spak says.

“A lot of people do that, because they can have [back-up] waiting lists. If you tell them ‘I work around the corner and I only need 15 minutes to be there’, then they might call you if someone doesn’t show up.” 

Ring up your specialist 

The queue system tends to be quite ad hoc, with no strict rules over who should be treated first, so it is often possible to reduce your wait by ringing up your specialist a few times a month, just to bring your case to their attention. Sometimes the receptionist will remember a slot that has just come free and bring forward your treatment while you are still on the telephone. 

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