2024-10-162024/25:SoU2 · p.1SoUHealth & social services

Certain matters regarding governance of and oversight over pharmaceutical prescriptions

State governance and oversight of medicine prescribing

What's at stake: The outcome affects how efficiently the state's resources for medicines are used and whether misuse of the medicine subsidy - for example incorrect prescribing - can be stopped more quickly, while also determining whether patients across the country get more equal and cost-effective access to medicines.

Case texts and AI reasoning are AI-translated from the Swedish originals; the Swedish text is authoritative.

What the vote decides

The question is whether the government's ongoing and announced measures for governing and overseeing medicine prescribing are sufficient, or whether a new, broad inquiry is needed into matters such as the state subsidy for medicine benefits and clearer timelines for follow-up.

Yes Yes — the committee proposal

The committee notes that the question of the state subsidy is being handled within the Government Offices and that the government is already reviewing oversight of the medicine subsidy and the handling of workplace codes, including through a recently decided review of documentation, limitations and oversight; it considers that the Riksdag should not preempt this work and therefore rejects the motions.

No No — the reservations

Reservation 1 (S)

The reservation (S) wants a new medicines inquiry to be set up to review, among other things, the state subsidy for medicine benefits and how medicines are provided to patients, care providers and pharmacies, calls for a clearer timeline for the government's announced measures, and wants workplace codes to be revoked more easily when the medicine subsidy is misused, for example through incorrect prescribing.

Summarised from the committee report. Party labels in the summary come from the report, not from the vote.

VSMPCLKDMSD
YesNoAbstainAbsent

What do the votes mean here?

Yes The committee proposal: rejecting the motions (keeping things as they are).

No Backing the counter-proposal: reservation 1 by S.

Abstain The party marks a position of its own that is not one of the two final alternatives.

What each plan points to — and how the party voted

For each party: the vote its own election manifesto and party programme point to in this case, next to how the party actually voted. A plan can only point to Yes or No; a party can also abstain.

PlanVoteConfidenceEvidence
VNoAbstain 0/0/20/4departs from the planconfidence: mediumnot addressed
Sown reservationNoNo 0/92/0/14follows the planconfidence: mediumnot addressed
MPNoAbstain 0/0/15/3departs from the planconfidence: mediumnot addressed
CNoAbstain 0/0/20/4departs from the planconfidence: lownot addressed
LNoYes 13/0/0/3departs from the planconfidence: lownot addressed
KDNoYes 16/0/0/3departs from the planconfidence: mediumnot addressed
MNoYes 59/0/0/9departs from the planconfidence: mediumnot addressed
SDNoYes 62/0/0/10departs from the planconfidence: mediumnot addressed

Committee proposal

The Riksdag rejects the motions 2023/24:2868 by Fredrik Lundh Sammeli et al. (S) points 1 and 2 as well as 2023/24:2878 by Anders W Jonsson et al. (C) points 1-3.

Original (Swedish)

Riksdagen avslår motionerna 2023/24:2868 av Fredrik Lundh Sammeli m.fl. (S) yrkandena 1 och 2 samt 2023/24:2878 av Anders W Jonsson m.fl. (C) yrkandena 1-3.

Riksdag decision: The Riksdag has considered a statement concerning the National Audit Office's report: Pharmaceutical prescribing – state governance and supervision. The report shows that the National Audit Office's overarching conclusion is that the state's governance of and supervision over pharmaceutical prescribing is not effective. Among other things, the National Audit Office points out the difficulties in the state's attempts to govern health and medical care so that the entire population has access to equitable care, while municipal self-governance requires coordination to reduce regional cost differences in pharmaceutical use. The Government is recommended to, among other things, transfer the state grant for pharmaceutical benefits to the general state grant for regions within the appropriation for municipal economic equalization. Regarding the recommendation to change the state grant's construction, the Government considers that the matter needs further analysis. Regarding the National Audit Office's other recommendations, the Government intends to return with proposals for measures in the area. The Government agrees in principle with the National Audit Office's observations and assessments. The Riksdag placed the statement among its records, that is, closed the matter.

Counter-proposals

Plan vs actual vote

Every party, in chamber order: what its own plan pointed to, how it voted, and the reasoning behind both. Highlighted rows are where the two differ — but a vote that follows the plan is a result too, so the reasoning is there for every party.

VVänsterpartietNoAbstaindeparts from the plannot addressed

The plan wants the state to own pharmacies and build up its own medicine production and that costs for healthcare and medicines shall be affordable for all.

Plan documents: party programme · 2022 manifesto

Reasoning and quotes

The plan wants the state to own pharmacies and build up its own medicine production and that costs for healthcare and medicines shall be affordable for all. A new inquiry into the state grant for medicine benefits and how medicines are provided to patients, healthcare providers and pharmacies aligns with that ambition. The plan also sees pharmacy privatization as a problem and wants to stop healthcare resources leaking away, which speaks for enhanced oversight and easier revoked workplace codes when the subsidy is misused.

Original (Swedish)

Planen vill att staten äger apoteken och bygger upp egen läkemedelsproduktion och att kostnaderna för vård och läkemedel ska vara överkomliga för alla. En ny utredning av statsbidraget för läkemedelsförmånerna och av hur läkemedel tillhandahålls till patienter, vårdgivare och apotek ligger i linje med den ambitionen. Planen ser också apoteksprivatiseringen som ett problem och vill stoppa att vårdresurser läcker bort, vilket talar för skärpt tillsyn och lättare indragna arbetsplatskoder när subventionen missbrukas.

  • state-owned pharmaciesdecisive»Vi vill att staten äger apoteken och bygger upp en egen kapacitet« (party programme ↗)“We want the state to own pharmacies and build up its own capacity”
  • affordable medicine costs»Kostnaderna för vård och läkemedel ska vara överkomliga för« (party programme ↗)“Costs for healthcare and medicines shall be affordable for”
  • criticism of pharmacy privatization»Privatiseringar har lett till dyrare elpris, att apoteken flyttar från landsbygd till städer och från fattiga till rika områden« (2022 manifesto ↗)“Privatizations have led to higher electricity prices, pharmacies moving from rural areas to cities and from poor to rich areas”
  • healthcare resources according to need»Det är inte acceptabelt att stora resurser, som behövs till människor med komplext eller långvarigt behov av vård istället går till nätläkartjänster för att behandla vanlig snuva och andra mindre åkommor hos friska människor.« (2022 manifesto ↗)“It is not acceptable that large resources, which are needed for people with complex or long-term care needs, instead go to online doctor services to treat common colds and other minor ailments in healthy people.”

The plan takes no explicit position on what the committee actually decided — often because the committee's reason was procedural. The stance is derived and fully cited, but it does not show the party broke a commitment.

SSocialdemokraternaNoNofollows the plannot addressed

The election manifesto promises that healthcare oversight shall be intensified and that fraud with joint funds shall be stopped.

Plan documents: 2022 manifesto · party programme

Reasoning and quotes

The election manifesto promises that healthcare oversight shall be intensified and that fraud with joint funds shall be stopped. The counter-proposal's requirement for stricter control of pharmaceutical subsidies, more easily withdrawn workplace codes for abuse and a new review of state grants is in line with that commitment. The plan however says nothing about the preparation procedure in government.

Original (Swedish)

Valmanifestet lovar att tillsynen av sjukvården ska växlas upp och att fusk med gemensamma medel ska stoppas. Motförslagets krav på skärpt kontroll av läkemedelssubventionen, lättare indragna arbetsplatskoder vid missbruk och en ny utredning av statsbidraget ligger i linje med det åtagandet. Planen säger däremot inget om beredningsordningen i regeringen.

  • strengthened oversight of caredecisive»Tillsynen av sjukvården ska växlas upp för att garantera kvaliteten.« (2022 manifesto ↗)“Oversight of healthcare shall be intensified to guarantee quality.”
  • stop welfare crime»Skattefusk, välfärdsbrottslighet och penningtvätt ska stoppas.« (2022 manifesto ↗)“Tax fraud, welfare crime and money laundering shall be stopped.”
  • transparency in care and welfare»Offentlighetsprincipen ska gälla även privat vård och omsorg.« (2022 manifesto ↗)“The principle of public access shall apply also to private care and welfare.”
  • equal access to care»Skola, vård och omsorg har en central roll för fördelningen av möjligheter i livet.« (party programme ↗)“School, care and welfare have a central role in the distribution of life opportunities.”
MPMiljöpartietNoAbstaindeparts from the plannot addressed

The plan requires that all publicly funded activities are under supervision that can ultimately stop what does not meet standards, and that tax money is used for its intended purpose.

Plan documents: party programme · 2022 manifesto

Reasoning and quotes

The plan requires that all publicly funded activities are under supervision that can ultimately stop what does not meet standards, and that tax money is used for its intended purpose. It also sees pharmaceutical consumption as a patient safety problem. Reviewing the state subsidy and pharmaceutical supply and being able to more easily withdraw workplace codes for misused subsidies therefore follows from the plan's demands for control and quality. The procedure does not concern the plan.

Original (Swedish)

Planen kräver att all offentligt finansierad verksamhet står under en tillsyn som ytterst kan stoppa det som inte håller måttet, och att skattemedel används till avsedd verksamhet. Den ser också läkemedelskonsumtionen som ett patientsäkerhetsproblem. Att se över statsbidraget och läkemedelsförsörjningen och att lättare kunna dra in arbetsplatskoder vid missbrukad subvention följer därför av planens krav på kontroll och kvalitet. Beredningsordningen berör planen inte.

  • strong public oversightdecisive»All verksamhet ska vara underställd tillsyn av en offentlig myndighet som ytterst« (party programme ↗)“All activities shall be under the supervision of a public authority that ultimately”
  • reduced pharmaceutical use»läkemedelskonsumtionen i dag är ett problem både« (party programme ↗)“pharmaceutical consumption today is a problem both”
  • quality and properly used tax money»Det som är viktigt är kvaliteten på välfärden« (party programme ↗)“What is important is the quality of welfare”
  • accessible care according to need»korta köerna till behandling i hela landet.« (2022 manifesto ↗)“shorten queues for treatment across the country.”

The plan takes no explicit position on what the committee actually decided — often because the committee's reason was procedural. The stance is derived and fully cited, but it does not show the party broke a commitment.

CCenterpartietNoAbstaindeparts from the plannot addressed

The plan does not address the state grant for pharmaceutical benefits, but it demands that public funds be used sparingly and that control against misuse of public systems be strengthened.

Plan documents: 2022 manifesto

Reasoning and quotes

The plan does not address the state grant for pharmaceutical benefits, but it demands that public funds be used sparingly and that control against misuse of public systems be strengthened. That work codes more easily can be withdrawn when pharmaceutical subsidies are misused, and that measures have a clear timeline, follows from that commitment. The conclusion is derived from the plan's principles of orderly use of taxpayers' money, not from an explicit commitment on pharmaceutical provision.

Original (Swedish)

Planen behandlar inte statsbidraget för läkemedelsförmånerna, men den kräver att skattemedel används sparsamt och att kontrollen mot missbruk av offentliga system skärps. Att arbetsplatskoder lättare ska kunna dras in när läkemedelssubventionen missbrukas, och att åtgärderna får en tydlig tidsplan, följer av det åtagandet. Slutsatsen är härledd ur planens principer om ordning i användningen av skattebetalarnas pengar, inte ur ett uttryckligt åtagande om läkemedelsförskrivning.

  • prudent use of public fundsdecisive»Politiken ska hushålla med skattebetalarnas pengar.« (2022 manifesto ↗)“Policy should make prudent use of taxpayers' money.”
  • strengthened control against misuse»Sverige ska bli ännu mer transparent. Vi vill inrätta en antikorruptionsmyndighet, skärpa regler mot korruption och införa ett lobbyregister.« (2022 manifesto ↗)“Sweden shall become even more transparent. We want to establish an anti-corruption agency, strengthen rules against corruption and introduce a lobby register.”
  • reduced administration in healthcare»Den administrativa bördan inom vården måste minska, bland annat med hjälp av digitala verktyg som är användbara och efterfrågade av medarbetarna.« (2022 manifesto ↗)“The administrative burden within healthcare must be reduced, partly through digital tools that are useful and sought after by staff.”

The plan takes no explicit position on what the committee actually decided — often because the committee's reason was procedural. The stance is derived and fully cited, but it does not show the party broke a commitment.

LLiberalernaNoYesdeparts from the plannot addressed

The plan requires state supervision based on nationally established quality standards and that those guilty of serious deficiencies lose their license in the welfare sector, which bears the requirement that workplace licenses more easily can be revoked when medicine benefits are misused.

Plan documents: party programme

Reasoning and quotes

The plan requires state supervision based on nationally established quality standards and that those guilty of serious deficiencies lose their license in the welfare sector, which bears the requirement that workplace licenses more easily can be revoked when medicine benefits are misused. A new investigation of government grants for medicine benefits aligns with care being steered on a scientific basis. The plan however does not address medicine benefits, so the support is weak.

Original (Swedish)

Planen kräver statlig tillsyn utifrån nationellt fastställda kvalitetsnormer och att den som gör sig skyldig till allvarliga brister mister sitt tillstånd i välfärdssektorn, vilket bär kravet på att arbetsplatskoder lättare ska kunna dras in när läkemedelssubventionen missbrukas. En ny utredning av statsbidraget för läkemedelsförmånerna ligger i linje med att vården ska styras på vetenskaplig grund. Planen behandlar dock inte läkemedelsförmånerna, varför stödet är svagt.

  • state supervision with quality standardsdecisive»Tillsynen ska ske i statlig regi utifrån nationellt fastställda kvalitetsnormer.« (party programme ↗)“Supervision shall be conducted under state control based on nationally established quality standards.”
  • sanction for serious deficiencies»skyldig till allvarliga brister ska inte ha tillstånd att bedriva verksamhet inom välfärdssektorn.« (party programme ↗)“guilty of serious deficiencies shall not have the right to conduct activities within the welfare sector.”
  • care on a scientific basis»Vård, behandling och rehabilitering av fysiska och psykiska sjukdomar ska ges på vetenskaplig« (party programme ↗)“Care, treatment and rehabilitation of physical and mental illness shall be provided on a scientific”

The plan takes no explicit position on what the committee actually decided — often because the committee's reason was procedural. The stance is derived and fully cited, but it does not show the party broke a commitment.

KDKristdemokraternaNoYesdeparts from the plannot addressed

The party programme requires that care financed through social solidarity is fit for purpose, cost-effective and evidence-based, and that evaluation and cost monitoring are important political tasks.

Plan documents: party programme · 2022 manifesto

Reasoning and quotes

The party programme requires that care financed through social solidarity is fit for purpose, cost-effective and evidence-based, and that evaluation and cost monitoring are important political tasks. Abuse of drug subsidies and incorrect prescribing go against this and against the requirement that all regulatory violations are prosecuted. A new drug investigation and easier withdrawal of workplace codes thus align with the plan.

Original (Swedish)

Partiprogrammet kräver att den solidariskt finansierade vården är ändamålsenlig, kostnadseffektiv och evidensbaserad, och att utvärdering och kostnadsuppföljning är viktiga politiska uppgifter. Missbruk av läkemedelssubventionen och felaktig förskrivning strider mot detta och mot kravet att allt regelbrott beivras. En ny läkemedelsutredning och lättare indragning av arbetsplatskoder ligger därför i planens linje.

  • cost-effective and evidence-based caredecisive»Den solidariskt finansierade hälso- och sjukvården ska vara ändamålsenlig och kostnadseffektiv, säker för patienterna och baserad på kunskap och beprövad erfarenhet, det vill säga evidensbaserad.« (party programme ↗)“Care financed through social solidarity must be fit for purpose and cost-effective, safe for patients and based on knowledge and proven experience, that is evidence-based.”
  • monitoring and control»medborgarnas intresse. Utvärdering, kostnadsuppföljning och kvalitetskontroll är därför viktiga politiska« (party programme ↗)“citizens' interest. Evaluation, cost monitoring and quality control are therefore important political”
  • abuse must be prosecuted»Alla brott ska effektivt och utan undantag beivras« (party programme ↗)“All crimes must be effectively and without exception prosecuted”
  • care is prioritized»Vi prioriterar vården, för alla dem som lider i väntan på vård.« (2022 manifesto ↗)“We prioritize care, for all those who suffer while waiting for care.”

The plan takes no explicit position on what the committee actually decided — often because the committee's reason was procedural. The stance is derived and fully cited, but it does not show the party broke a commitment.

MModeraternaNoYesdeparts from the plannot addressed

The plan's strongest commitment in the area is to stop waste of tax money and fraud that every year drains welfare, and that agencies' processing should be pressurized with clear time limits.

Plan documents: 2022 manifesto · party programme

Reasoning and quotes

The plan's strongest commitment in the area is to stop waste of tax money and fraud that every year drains welfare, and that agencies' processing should be pressurized with clear time limits. The counter-proposal's demand that workplace codes more easily should be revoked when medicine subsidy misuse occurs and for a clearer timetable for announced measures aligns with that line. However, medicine benefits' steering is not mentioned, so coverage is derived.

Original (Swedish)

Planens starkaste åtagande på området är att stoppa slöseriet med skattepengar och fusket som varje år dränerar välfärden, och att myndigheters handläggning ska pressas med tydliga tidsgränser. Motförslagets krav på att arbetsplatskoder lättare ska kunna dras in när läkemedelssubventionen missbrukas och på en tydligare tidsplan för aviserade åtgärder ligger i den linjen. Läkemedelsförmånernas styrning nämns dock inte, så täckningen är härledd.

  • stop wastedecisive»Statens utgifter ska minska – vi ska stoppa slöseriet med skattepengar« (2022 manifesto ↗)“State expenditure should decrease – we shall stop the waste of tax money”
  • stop fraud with public funds(2022 manifesto)
  • time limits for agencies»Korta myndigheternas handläggningstider genom en bortre tidsgräns« (2022 manifesto ↗)“Shorten agencies' processing times through an outer time limit”
  • combat public waste»Offentligt slöseri i alla former ska bekämpas.« (party programme ↗)“Public waste in all forms shall be combated.”

flags: citat_ej_verifierat

The plan takes no explicit position on what the committee actually decided — often because the committee's reason was procedural. The stance is derived and fully cited, but it does not show the party broke a commitment.

SDSverigedemokraternaNoYesdeparts from the plannot addressed

The plan requires that fraud and systems that encourage fraud are countered and that welfare crime is stopped, which carries the requirement that workplace codes should be more easily revoked when pharmaceutical subsidy is abused.

Plan documents: 2022 manifesto

Reasoning and quotes

The plan requires that fraud and systems that encourage fraud are countered and that welfare crime is stopped, which carries the requirement that workplace codes should be more easily revoked when pharmaceutical subsidy is abused. The plan's demand for clear results and time-bound commitments for public expenditures also supports a new inquiry with a clear timetable for the state grant. The plan therefore supports the demand in substance.

Original (Swedish)

Planen kräver att fusk och system som lockar till fusk motverkas och att välfärdsbrottsligheten stoppas, vilket bär kravet på att arbetsplatskoder lättare ska kunna dras in när läkemedelssubventionen missbrukas. Planens krav på tydliga resultat och tidsatta åtaganden för offentliga satsningar stöder också en ny utredning med tydlig tidsplan för statsbidraget. Planen stöder därför kravet i sak.

  • counter fraud in the systemsdecisive»Både fusk och sådana system som tenderar att locka till fusk och korruption ska motverkas.« (2022 manifesto ↗)“Both fraud and such systems that tend to encourage fraud and corruption shall be countered.”
  • strong measures against welfare fraud»Skärpa straffen för fusk inom välfärdssystemen« (2022 manifesto ↗)“Toughen penalties for fraud within welfare systems”
  • stop welfare crime»Stoppa välfärdsbrottsligheten inom socialförsäkringen« (2022 manifesto ↗)“Stop welfare crime within the social insurance system”
  • results requirements and follow-up»Begära tydliga resultat för varje offentlig satsning« (2022 manifesto ↗)“Require clear results for every public expenditure”

The plan takes no explicit position on what the committee actually decided — often because the committee's reason was procedural. The stance is derived and fully cited, but it does not show the party broke a commitment.

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Sources and documents

Documents under consideration

Source: The Swedish Parliament