Association of Private Care Providers

Håkan Tenelius

This is Vårdföretagarna

•2000 member companies

•93 000 employees

•600 healthcare member companies

•a party in collective agreements

•strive for freedom of choice and to

demonstrate to the public the importance

of variety in care provision

That private healthcare

center is really bad. The

doctors are incompetent,

the nurses are lazy and

the medical equipment is

out of date.

Thank God I never had to

visist it.

Swedes about the right to

choose…

Elderly care Health care Welfare services

for elderly people Schools

But swedes distrust the

development of welfare

60 %:

It is getting worse

Two principal models…

…for exposing publicly financed activities to competition:

• The contract model involves activities undertaken by actors being purchased in accordance with the provisions of the Public Procurement Act.

• The choice system may be used when exposing individual services to competition.

The choice system means that competition takes place in the market, as opposed to competition over the market.

2010: Moderate-liberal Government introduces

The patient choice of

health care services • Choises must be possible in all of

Sweden

• The patient can choose

healthcare centre, and some

specialist care

• Freedom of establishment for

healthcare providers who live up

to the county council´s

requirements

Göran Hägglund, former Social minister

Why the reform?

•Good care, but low accessibility

•Lack of patient power

•Few innovations

•Lack of doctors with competence in

general medicine

Why do private care providers

promote the reform?

• Providers compete on quality, not price

• The best, most popular providers will survive

• It´s a long-term system – the provider can continue as long as the patients will choose her

What was the outcome?

•200 new healthcare centers

• Better accessability

•Patients like the new alternatives

•Easier to attract general medicine doctors

• Innovations - att least a few

•More care to the same cost

•Equal care for all?

Increased accessability and

diversity – In major cities as

well as on the countryside

New private healthcare centers on the countryside since 2010

1 % has to travel more than 20 minutes

by car to the nearest healthcare center

80 % have to travel less than five

minutes

What do the patients think?

Over all impression

Reception

Participation

Confidence

Information

Would recommend

Accessibility

Perceived benefit

Average private

Average public

Source: National patients survey

Share of patients waiting longer than 90 days prior to surgery/action in

the field of otorhinolaryngologist – Stockholm county council

Telephone availability in the primary health care compared

to private caregivers

Share stating getting

telephone contact with ease

Share of private caregivers

10 counties with the

best telephone

availability

9 counties with the

worst telephone

availability

Wästerläkarna: A special geriatric

care center for elderly people

Bergsjöns vårdcentral

”When we started there were no healthcare

centers in this part of the city. In fact there

was only one healthcare center for the whole

of east Gothenburg, which has approximately

42 000 recidents.”

Number and cost of hip- and knee prosthesis, Stockholm County council

Cost per patient (tkr) Number of surgical

procedurs

What didn´t happen?

•The innovations (or are they invisible?)

•Too less of exchange of ideas and

experiences

•The welfare systems are still distrusted –

and the distrust focuses on the private

care providers

What are the misstakes

(according to us)

• No national legislation of uniformity – different

systems in 22 counties – what happend to the

equality?

• The legislation is to unclear – still possible to

favoring the public providers

• Some local governments use the model to

reduce costs

Analysis from the Swedish National

Audit Office - Riksrevisionen

• The reform has improved opportunities for

contacting the care services

• The number of healthcare centres has increased

• The reform has benefitted patients who were not

reliant on care

• And those with a higher socio-economic status

…was critised by resarchers

Anders Anell and Clas Rehnberg:

• The opinion was based on a selective choice of

results an references

• The reform represents a positive development in

several aspects – increased accessibility, greater

freedom of choice, more confidence among

patients and an interest in new establishments

…but the Audit Office suggests

• Make the county council´s patient choice system

more alike across Sweden

• Make the financing system as simple as

possible, focusing on ethical principles of

healthcare

• Do not formulate primary healthcare mandates

too broadly and make mandates more uniform

The future

•The Government and the Left Party: Let

the county councils decide themselves

whether they should apply the reform.

•The Parliament: No such government bill is

desired.

Tack så mycket! hakan.tenelius@almega.se

www.vardforetagarna.se