Sweden explores increased state control over healthcare

Can a full or partial nationalisation of the health services be a cure for Sweden’s health care crisis? A Swedish parliamentary investigative committee is now trying to find an answer.

The health crisis has been fuelling a debate in Sweden for quite a long time over whether the state should reclaim the healthcare services mandate from the 21 regions that have been in charge since the 1980s.

The COVID pandemic only exacerbated the discussions.

“The pandemic put both the best and worst of Swedish healthcare in a clear spotlight,” Jean-Luc af Geijerstam, the president of the new Swedish parliamentary committee on full or partial state mandate of health care (Vårdansvarskommittén), told Euractiv.

Generally considered of good quality, the Swedish healthcare sector has faced some major problems as well.

“There are substantial inequalities in the care you get, in the doctors you see, and in outcomes of treatment across the country,” he explained.

The committee will now examine, on behalf of the centre-right government, whether full or partial nationalisation should take place in the coming years and, if so, what steps Sweden should take along the way.

Long waiting queues for treatment and other health issues were a top priority for the Swedish voters ahead of the 2022 general election – when the Christian Democrats also pushed hard for nationalisation.

The party later signed a political agreement at the Tidö castle with the Moderate party and the Liberals, who together form the government, and with the support of the right-wing, populist party, the Swedish Democrats. This agreement included setting up an investigation on increased state power over the healthcare system.

According to Jean-Luc af Geijerstam, also a doctor and the director general of the Swedish Agency for Health and Care Services Analysis, the government is frustrated with how the health crisis is being tackled by the regions today.

“The actual inequality in health care in the country is the most important issue for the government. And I also find it to be an important driving force among the political parties in the parliamentary committee,” he noted.

Results expected in June

The committee’s very first meeting was held in October and there is currently a period of open consultation.

But in June 2025, the committee will present a series of scenarios on whether the state should take over all or part of  the health care mandate or whether nothing should change.

The committee, said af Geijersam, will build a knowledge base on each of these scenarios, describing their feasibility, the constitutional consequences, and last but not least, how these scenarios will address the health crisis.

“Actually, there is already a lot going on in this perspective. Our impression in the committee is that the government is acting to regain more influence, for example, by granting many of the assignments to a state agency, instead of the regions’ own organisation, the Swedish Association of Local Authorities and Regions,” he said.

The committee will also compare the Swedish health system with those of other EU countries, especially those in Denmark, Norway, and Finland, which have all undergone structural reforms in recent years. In Denmark, for example,  the state has taken back the regions’ right to tax residents.

“Regardless of the model chosen, there are similarities when it comes to today’s challenges,” said af Geijerstam, who also revealed that the efficiency of healthcare production will be examined by the committee, whose work will be based on a problem-oriented perspective.

Asked whether some reforms need to be done more quickly, he explained that the government directive stipulates that the implementation will be gradual and long-term, “like 20-30 years ahead”.

Some healthcare issues also require a national response, for example, the implementation of the European Health Digital Data Space Directive, an EU framework for using health data for research, innovation, policy-making, regulatory activities, and personalised medicine.

“Sweden now has to decide on how to collect health data, and this cannot be done differently within the 21 regions,” he told Euractiv.  Today, the regions have their own systems and standards for collecting and recording patient data.

However, the Social Democrat’s health spokesperson Fredrik Lundh Sammeli, a committee member, told Euractiv that his party, which is leading the polls in Sweden now, does not believe in changing the mandate.

“Swedish health care should remain a regional responsibility. The challenges facing the health service will not be solved by a change in the mandate. The government should step forward and take responsibility for the health crisis it has created by not giving the regions the funds they need,” said Fredrik Lundh Sammeli.

Another committee member, Irene Svenonius of the Moderate Party, said that her party has not yet landed in “any system structure” and that she would like to see a “broad political compromise”.

“The most important thing for us is that the patients receive equal and good care wherever they live in Sweden,” she said.

Anders Åkesson, president of the Swedish Heart and Lung Association and one of the 25 selected experts on the committee, said they shared the government’s view that there was a lack of equality in Swedish health services which needed to be addressed.

“But we’re not sure if a full state takeover is the best idea, but maybe more state intervention in areas like highly specialised care, digitalisation, and skills provision. We also have to talk about money and resources and the need to take care of the most vulnerable patients first,” he told Euractiv.

[By Monica Kleja, edited by Vasiliki Angouridi/Zoran Radosavljevic]

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