How did Sweden arrive at this healthcare juncture?
The health care and social service sectors of Sweden's world-renowned welfare state were not too long ago wholly run, managed, and owned by the state. But in recent times, hospitals, health care clinics, emergency services, and elderly care facilities have slowly been transferred into private hands. How did Sweden arrive at this healthcare juncture?
When you hear the word privatization, what's the first thing that comes to mind? The answer to that question can vary greatly, depending on your point of view. We'll get back to this in a minute.
First, why ask the question? Well, when a privately owned elderly care company tries to save money by telling its employees to weigh patients' used diapers so they're not changed too frequently, it's only natural that the question comes up.
Let’s look first at how Sweden got to this point.
Gunnar Wetterberg is going to help us answer that question. He's a Swedish historian who has been a diplomat and worked at the Ministry of Finance. Today he's the head of Social Policy at the Swedish Confederation of Professional Associations.
Historically, Sweden has had a healthcare system that has been largely public-financed for all of its existence. At the outset of that system, doctors were allowed to work for the public hospital and at the same time run private health clinics. Then in the 1960's that practice was outlawed.
In the 1970’s, Sweden did something that was rather unusual for a Nordic country. “Sweden introduced a user fee that was only seven kroner,” says Wetterberg. “The basic financing for healthcare came from the county councils, but there was also a small user fee to top it up to deter people coming willy-nilly.”
Then came the great deregulation debates in the late 1970's and early 1980's in many western countries. “This debate influenced the Swedish debate and people started to say that we should have an amount of private providers to enhance competition, and competition would save money and also enhance quality,” he says.
In 1976, Sweden got its first non-Socialist government for many years. But the real change came in the early 1990’s when Sweden got a new non- socialist government under Carl Bildt. “That government opened the door to more private providers in almost all fields of the private sector,” says Wetterberg.
Now out of all of these fields, elderly care, both residential care and home help services, has been privatized at the fastest rate. According to research from Uppsala University, only 1 percent of this industry was owned by private providers in 1990. Now, private providers control 16 percent of the elderly care market. It was a drastic change. “Before 1990, basically all elderly homes were municipal institutions that were publicly financed and publicly run,” Wetterberg says.
And in the elderly care industry, it's more common to have large providers, like Carema, who are private companies that own and run many different elderly care facilities throughout the country.
Now back to the debate over privatization.
On one side of the spectrum, privatization means efficiency, better quality, and the rightful return of a public service or company that maybe was once public, but has now been put back into the hands of private individuals. In other words, all that's good and noble about the free market system. On the other extreme, privatization means cost-cutting and cutting corners to save money and boost profits, and it means the private robbery of services and companies that should be owned by, and serve the people.
Gunnar Wetterberg thinks this debate over privatization in healthcare and other sectors will remain with us for as long as we have healthcare, but he says he hopes that it becomes more nuanced. “One would hope it would move from the question of should Sweden have private healthcare companies or not, and more to how Sweden can regulate the private companies who do operate in order to protect patients.”