More value for money and less political control

- Organising for better healthcare and dental care across the country.

Swedish healthcare is among the best in terms of quality and outcomes in international comparisons. However, accessibility, participation and patient-centred care need to be improved. Care queues are too long and need to be reduced. More health-promoting and preventive care would benefit both patients and taxpayers.
To meet the population's healthcare needs for common diseases, primary care needs to be significantly expanded and adapted to our population size.

To get some perspective on Swedish healthcare, we can compare primary care in Sweden and Denmark. Denmark has around 3200 specialists in general medicine in primary care, with a population of around 6 million inhabitants. Sweden has fewer specialists in general medicine in primary care than Denmark, despite having a population of 10.6 million. The basis for primary care should be health promotion and prevention. This is to avoid unnecessary medicalisation of symptoms caused by the environment and life circumstances. Due to the undersized primary care system, this is not the case today.

State control of health care provides more equal care and better monitoring

There is a broad political consensus that primary care should be the hub of Swedish healthcare. Primary care is not only resource efficient. Well-developed primary care also results in lower mortality from cardiovascular diseases, cancer and respiratory diseases, as well as higher life expectancy in the population than with more specialised healthcare.
18 billion has therefore been set aside by the government since 2018 for a transition to more healthcare being provided in primary care.

A report by the Swedish Agency for Health and Social Care Analysis 2025 summarises the results:

”Our overall picture is that the transition work is ongoing in regions and municipalities, primarily at a strategic level, but also through various projects and limited initiatives. We can also conclude that none of the government's transition targets have been met so far, although we see some glimmers of light. The conditions for primary care have not been strengthened in the form of increased resource allocation or improved skills supply, which we believe is the main reason why we are not seeing clearer results from the transition. We also do not see clear changes in patients” experiences of care."

18 billion has thus not benefited primary care and patients.

The money has been spent on a strategic level.

One of the the main problems in Swedish healthcare is the management and governance of health care.
It is not primarily the governance of patient care that is lacking - but the governance and monitoring of the health care bureaucracy.
Nationalised health care would provide opportunities to build a national system for financial management and monitoring.

The National Audit Office could be tasked with scrutinising exactly how health care money is spent. Accountability systems for regions and health administrations must be put in place. It should not be possible for 18 billion to just disappear into the administrative spheres of the healthcare bureaucracy.

Knowledge- and experience-based healthcare and accountability

State control of health care via the regions also offers the opportunity for major rationalisation of health care bureaucracy.
The National Board of Health and Welfare could then be responsible for coordination, knowledge development, training of health professionals and quality monitoring of care nationally.

Healthcare needs to work more like the Swedish Transport Administration, i.e. evidence-based and with risk/benefit analyses that ensure that the money is spent where it does the most good.
The management and governance of health care should be predominantly carried out by health professionals with long experience. Officials and decision-makers at all levels of the healthcare bureaucracy should be legally equated with healthcare professionals and be as personally accountable for their work as healthcare professionals are for their work, and thus also subject to scrutiny by the IVO.

Healthcare is, and should be, evidence-based. The exchange of experience between different organisations' statistics and results is an important part of the development of healthcare.
However, if there is too much focus on measuring healthcare data and statistics, there is a risk that patients' treatment will be overly driven by the incentive to achieve good figures for the organisation. In addition, many of the comparisons of statistics and benchmarking between different organisations are not scientific. They do not take into account various factors that affect the statistics, such as the fact that different organisations may have completely different types of patients. Conditions are different in a health centre in Rinkeby - with a large non-European population that has a low level of education and poor language skills, compared to conditions in a socio-economically prosperous area. There is a big difference between treating diabetics in Östermalm compared to treating homeless, addicted, psychiatrically ill patients with diabetes.

Brakes on a cost-driving bureaucracy

One reason why healthcare administration is growing at the expense of patient care is that officials are writing new regulations and introducing new requirements for processes, certifications and quality assurance. Analyses of risk, benefit and cost from a patient safety perspective are often absent. There needs to be a cost brake on healthcare bureaucracy, just as there is on the direct, patient-related costs of healthcare.

Specialists in risk analysis need to be employed to help officials and decision-makers make reasonable risk assessments. The health care bureaucracy also needs to take cost responsibility for the regulations and requirements it imposes. Otherwise, there is no incentive to make reasonable judgements, and the motto ”more quality assurance and regulation is always better” will continue to apply.

New regulations, processes and quality assurance should be required to have demonstrated a clear benefit for patients, not just a theoretical benefit. We don't need more bureaucrats telling healthcare professionals how to work, but more hands doing the actual work of caring.

Care queues and high care needs

In order to address current healthcare queues, more specialists need to be trained in areas such as neurology, psychiatry, general medicine, cardiology and ear, nose and throat. Special funds need to be allocated directly to orthopaedic clinics for knee and hip operations, as well as other targeted initiatives directly to healthcare providers with long waiting lists.

To prevent billions being lost in the health bureaucracy, like the government funds for primary care, it is important that payments are made directly to operating clinics and the healthcare providers where investment is needed.

A national care guarantee office needs to be set up so that patients can be referred to other care providers if their own health region cannot fulfil the care guarantee. Long-term planning and coordination across the country is also needed to prevent long queues from arising again.

More nurses need to be trained and the nursing assistant programme needs to be reformed and more stringent requirements need to be set for graduating as a nursing assistant. This would be the equivalent of returning to the previous requirements for the nursing assistant degree, which could provide a significant skills boost to the healthcare system. Many tasks could then be taken over from nurses in areas such as home care - while maintaining patient safety. A practical, vocational, two-year (YH) nursing programme could also be introduced for assistant nurses who have worked in healthcare for three years with good grades. Not all nurses need to have a research-orientated, theoretical undergraduate degree.

Home care is transferred to municipalities throughout the country. Funds for home care are allocated by the central government to the municipalities to ensure a high standard of care throughout the country. The state will employ the doctors needed for home care. All in all, this would mean greater efficiency, with patients not having to have so many different people/staff in their homes. Home health care and home care services can then coordinate their tasks and doctors can work more efficiently.

Over-medication causes suffering, illness and more deaths than road traffic

Pharmaceutical treatment is an important part of healthcare. Medicines can alleviate and cure serious medical conditions and are a prerequisite for operations, intensive care and effective pain relief in acute conditions.
But adverse drug reactions are also a common cause of death. Exact figures on this are unclear, as under-reporting is high. Even for serious side effects and death, only 1-10% of cases are reported. The healthcare system needs better data to make the use of medicines more rational and efficient.

Adverse drug reactions (ADRs) are responsible for one tenth of emergency hospitalisations of older people in Sweden. Most adverse drug reactions in older people are not even recognised; they resemble and are interpreted as symptoms of disease or signs of ageing.

Better and safer drug treatment, with more patient involvement, requires more and clearer risk-benefit assessments of different treatments. In particular, when the number of medicines a patient takes is the single biggest risk of side effects.
Achieving more appropriate and reasonable drug treatment also requires a change in the way healthcare is managed, particularly in primary care. Today, more and more care programmes are generating a doctrine for primary care that means patients should have more and more medicines, based on each disease the patient has. This is not a reasonable development. To change this, two things are required:

1. Better care programmes, which clarify the benefits and risks of a treatment - including the mortality rate of patients treated with a medicine compared to patients who did not receive the medicine.
   Communicating benefits as a relative risk reduction, as is currently the case, is not enough, as it gives both doctors and patients an unreasonable amount of confidence in the effects of treatment.
   (If the initial risk is 2 cases/1000 and the risk is reduced to 1 case/1000 with a drug, then the relative risk reduction is 50%.
   However, the absolute risk reduction for the disease for a patient treated is only 1/1000, or 0.1%).
   Similarly, the risks of a treatment must be made clear.
   Care programmes must show the overall mortality rate between the treated and the untreated group of patients.
   For example, if intensifying blood pressure treatment towards lower blood pressure guidelines (130/80) reduces the risk of stroke and heart attack, but also leads to more deaths from hip fractures due to dizziness and treatment instability (so that the overall mortality in both groups is the same), then patients and doctors need to know.
2. Evaluating the quality of care provided by organisations is not based on how many medicines the patient collects from the pharmacy, as prescribed in the care programmes.
   Such ”quality follow-ups” will inevitably steer healthcare towards treating with more and more drugs and reduce the possibility of individualised, reasonably balanced drug treatment where the patient has also been involved in decision-making.
   You will inevitably get what you measure. As long as the statistical systems that measure quality of care focus on patients having received all the medicines prescribed by the care programmes for each disease, patients will receive more and more medicines.

Preventive public health work in health care

Preventive interventions are important to reduce unnecessary suffering, but also to reduce the overall burden and costs of healthcare.

Prioritised areas to work on:

• Childbirth services across the country need sufficient resources to provide women in labour with the security and confidence in their own ability to give birth.
  Unplanned home deliveries or deliveries in the car due to long distances are not patient-safe obstetric care.
• There needs to be a paradigm shift in premature and newborn care. Care should endeavour to avoid separation of mother and baby, as this is a major risk factor for poorer development and higher mortality of preterm babies. Separation also negatively affects full-term babies.
• Information on breastfeeding and breastfeeding support for women who need it.
  Breastfeeding provides major health benefits for the baby and the mother in both the short and long term. Breast milk stimulates and supports the young baby's undeveloped immune system and reduces the risk of serious infections and sudden infant death syndrome. Later in life, it also reduces the risk of obesity and diabetes.
  Breastfeeding reduces the risk of breast cancer, ovarian cancer and type 2 diabetes.
• Trying to find the reasons why a patient has developed a disease, such as type 2 diabetes, high blood pressure, tension headaches, anxiety, migraines and depression. In the first instance, healthcare professionals should help the patient address the cause, for example through problem analysis, stress management, sleep management, dietary changes, smoking/snuff cessation and physical activity - before doctors consider drug treatment.
• Environmental adaptations, parental support, school support and information for ADHD in children to reduce the use of medication for children with neuropsychiatric disabilities, (but also for children who have difficulties for other reasons).
• Reduce drug treatment of older people to promote better health and quality of life.
  Ageing brings with it changes in the metabolism of medicines, increased sensitivity to medicines and to multi-drug therapy.
  The number of medicines is the single most important risk factor for adverse events. Increased support and resources are needed to enable primary care to cope with this work.

Teeth are part of the body

Oral health is crucial for the health of the whole body, but Swedish dental care is currently significantly more expensive for the patient than medical care is. Ambition Sverige believes that dental care should, as far as possible, be covered by the same conditions as other medical care. Therefore, we want both the treatment fee and the high-cost coverage for dental care to be equalised with that of medical care.

The conditions for private dentists should be equalised with those for private doctors. Unreasonable supervision and connection fees for private dentists should therefore be abolished.

Priorities

At present, there is a need to delimit the digital ”care apps”. They increase the accessibility of healthcare, but also drain the healthcare system of staff and resources.
Private health insurance schemes risk undermining the legitimacy of the solidarity-based financing of health care. Controls are therefore needed to ensure that the public health system is not used to give preference to insured patients.

Ambition Sverige will work for:

• Streamlining and reducing the number of government agencies through mergers and the creation of a Health Services Board (HSS) with an expanded remit for the National Board of Health and Welfare. This would allow for a substantial reduction in healthcare bureaucracy both nationally and regionally.
• Radically reducing bureaucracy within the regions and increasing the autonomy and influence of healthcare units and their staff.
• Reducing unnecessary prescribing of medicines through better care programmes that do not measure quality of care based on the number of medicines dispensed for each disease.
• Bureaucrats should also take responsibility for the increased costs that new requirements bring to the organisation. The healthcare budget is not infinite. Money should be spent on what is most beneficial for patients.
• Reducing waiting lists through more resources, better coordination and increased efficiency. More beds, a care guarantee with real incentives and more patient time per doctor. Money should go directly to the activities for which it is intended, not detoured through the health administration bureaucracy.
• Taking greater national responsibility for training specialist doctors and nurses. More nurses need to be trained and nurse training should be improved.
• Regions to facilitate more private, physician-led options. Public and private care should be treated equally.
• Increasing knowledge about complex adverse drug reactions. This will help reduce misdiagnosis and unnecessary hospitalisation, especially among the elderly.
• Swedish dental care should be subject to the same fees and coverage as medical care.