2023-01-252022/23:SoU5 · p.1SoUHealth & social services
Conditions when regions enter into agreements with private healthcare providers
Transparency requirements when regions contract with private healthcare providers
What's at stake: The decision concerns how private healthcare providers that also hold contracts with insurance companies are monitored when they also treat publicly funded patients, affecting waiting times and equal access to care for all patients, regardless of whether they hold private health insurance.
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 law should be amended so that contracts between regions and private healthcare providers with other principals must state how the provider's other assignments will not negatively affect the delegated tasks, or whether the law should remain unchanged in this respect.
Yes Yes — the committee proposal
The committee proposes that parliament reject the new provision on contract terms for private healthcare providers with several principals, arguing that the government has neither shown that the proposal would improve how private health insurance functions nor demonstrated that there are problems with medical prioritization or crowding-out among independent providers, and that the Council on Legislation found it difficult to assess both the proposal's purpose and its application.
No No — the reservations
Reservation 1 (S, V, MP)
The dissenters want to adopt the government's proposed new provision, arguing that the current arrangement with private health insurance gives insured patients faster access to care in conflict with the principle of care based on need, and that tighter contract regulation is needed to counter this.
Summarised from the committee report. Party labels in the summary come from the report, not from the vote.
What do the votes mean here?
Yes The committee proposal: Riksdagen avslår regeringens förslag till lag om ändring i hälso- och sjukvårdslagen (2017:30) i de delar det avser 15 kap.
No Backing the counter-proposal: reservation 1 by S, V, MP.
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.
| Plan | Vote | Confidence | Evidence | ||
|---|---|---|---|---|---|
| V | No | No 0/21/0/3 | follows the plan | confidence: high | explicit |
| S | No | No 3/90/0/14 | follows the plan | confidence: high | explicit |
| MP | No | No 0/16/0/2 | follows the plan | confidence: high | explicit |
| C | Yes | Yes 21/0/0/3 | follows the plan | confidence: medium | derived |
| L | Yes | Yes 15/0/0/1 | follows the plan | confidence: medium | not addressed |
| KD | No | Yes 17/0/0/2 | departs from the plan | confidence: medium | not addressed |
| M | Yes | Yes 59/0/0/9 | follows the plan | confidence: medium | not addressed |
| SD | Yes | Yes 64/0/0/9 | follows the plan | confidence: medium | not addressed |
Broke with the party line
| SAlexandra Völker (S, Stockholms län) | Yes — party line: No |
| SLawen Redar (S, Stockholms kommun) | Yes — party line: No |
| SMirja Räihä (S, Stockholms kommun) | Yes — party line: No |
MPs whose vote differs from their party's majority position in this division. Marked with a dark ring in the chamber view.
Committee proposal
Parliament rejects the government's proposal for a law on amendments to the Health and Medical Care Act (2017:30) in the parts concerning Chapter 15, Section 2 and point 2 of the entry-into-force and transitional provisions. Thereby Parliament approves the motions 2022/23:5 by Camilla Waltersson Grönvall et al. (M, SD, KD, L) and 2022/23:8 by Anders W Jonsson (C) and rejects Bill 2021/22:260 point 2 in this respect.
Original (Swedish)
Riksdagen avslår regeringens förslag till lag om ändring i hälso- och sjukvårdslagen (2017:30) i de delar det avser 15 kap. 2 § och punkt 2 ikraftträdande- och övergångsbestämmelserna. Därmed bifaller riksdagen motionerna 2022/23:5 av Camilla Waltersson Grönvall m.fl. (M, SD, KD, L) och 2022/23:8 av Anders W Jonsson (C) samt avslår proposition 2021/22:260 punkt 2 i denna del.
Riksdag decision: Parliament rejected the government's proposal on changed conditions when regions enter into agreements with private healthcare providers that also have insurance companies as clients. The government's proposal concerns amendments to the Health and Medical Care Act and means that it shall be stated in the agreement how it is ensured that the private healthcare provider's other assignments do not have a negative impact on the care provided on behalf of the region. Parliament approved the proposal in the Health and Medical Care Act that rehabilitation shall be included in primary care's core assignment. Parliament approved the proposal to amend the Patient Safety Act, which means that the Inspectorate for Care Services (Ivo) shall be able to issue a föreläggande (binding order), that is, instruct, a healthcare provider that has not registered itself with Ivo's healthcare register to do so. Such a föreläggande may be accompanied by a vite (penalty fee), that is, a fine. The amendments to the Patient Safety Act come into force on 1 July 2023. The amendment to the Health and Medical Care Act comes into force on 1 January 2024.
Counter-proposals
- The counter-proposal wants to maintain the principle of equal healthcare on equal terms for everyone regardless of agreements with private healthcare providers. (S, V, MP) — Reservation 1
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.
The plan establishes that your insurance or position in society shall not determine what care you get and that no one should need to solve a private health insurance to get good care.
Plan documents: 2022 manifesto
Reasoning and quotes
The plan establishes that your insurance or position in society shall not determine what care you get and that no one should need to solve a private health insurance to get good care. Care shall be given according to need and taxpayers' money go to operations, not to companies' profits. Stricter contract regulation against insurance patients getting priority lies therefore in line with the plan.
Original (Swedish)
Planen slår fast att din försäkring eller position i samhället inte ska avgöra vilken vård du får och att ingen ska behöva lösa en privat sjukförsäkring för att få bra vård. Vård ska ges efter behov och skattemedlen gå till verksamhet, inte till företagens vinster. En skärpt avtalsreglering mot att försäkringspatienter går före ligger därför i linje med planen.
- care according to need, not insurancedecisive»Din försäkring eller position i samhället ska inte avgöra vilken vård du får.« (2022 manifesto ↗)“Your insurance or position in society shall not determine what care you get.”
- no to private health insurance»du ska inte behöva lösa en privat försäkring för att få en bra sjukvård och tandvård eller en trygg förlossning« (2022 manifesto ↗)“you should not need to solve a private insurance to get good medical care and dental care or a secure childbirth”
- needs-driven care»Vård måste ges efter människors behov och inte efter kapaciteten i felaktigt konstruerade system.« (2022 manifesto ↗)“Care must be given according to people's needs and not according to capacity in incorrectly constructed systems.”
- solidarically financed care»En vård och omsorg som är solidariskt finansierad av skattemedel och där pengarna går till verksamhet och inte till företagens vinster är en grundförutsättning för att uppnå en jämlik vård i hela Sverige.« (2022 manifesto ↗)“Care and support that is solidarically financed by taxpayers and where money goes to operations and not to companies' profits is a basic prerequisite for achieving equitable care throughout Sweden.”
The plan explicitly establishes that those with a private health insurance shall not be able to get better or faster help in publicly financed healthcare.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The plan explicitly establishes that those with a private health insurance shall not be able to get better or faster help in publicly financed healthcare. The counter-proposal's demand to adopt the provision on contract terms is precisely that instrument which prevents such cream-skimming. The plan also believes that increased private insurance in the welfare field creates unacceptable differences between people.
Original (Swedish)
Planen slår uttryckligen fast att den som har en privat sjukvårdsförsäkring inte ska kunna få bättre eller snabbare hjälp i den offentligfinansierade vården. Motförslagets krav på att anta bestämmelsen om avtalsvillkor är just det instrument som motverkar sådan gräddfil. Planen anser också att ökade inslag av privata försäkringar skapar oacceptabla skillnader mellan människor.
- ingen gräddfil via försäkringdecisive»Den som har en privat sjukvårdsförsäkring ska inte kunna få bättre eller snabbare hjälp i den offentligfinansierade vården.« (2022 manifesto ↗)“Those with a private health insurance shall not be able to get better or faster help in publicly financed healthcare.”
- privata försäkringar skapar klyftor»Det ökade inslaget av privata försäkringar på välfärdsområdet skapar oacceptabla skillnader mellan människor.« (party programme ↗)“The increased use of private insurance in the welfare field creates unacceptable differences between people.”
- vård efter behov»Tillgången till skola, vård och omsorg får aldrig avgöras av marknadens prismekanismer och utbudet får aldrig bestämmas av enskilda producenters intresse av egen vinst.« (party programme ↗)“Access to school, healthcare and social care shall never be determined by market mechanisms and supply shall never be determined by individual producers' interest in profit.”
- stoppa sönderprivatiseringen»Det är dags att ta tillbaka den demokratiska kontrollen över välfärden och att stoppa sönderprivatiseringen.« (2022 manifesto ↗)“It is time to take back democratic control over welfare and to stop the dismantling of public services.”
The party programme states that welfare services shall be offered to all on equal terms and according to need, that care shall be distributed according to need and that the most seriously ill shall receive care quickly, and that commercially oriented actors should be removed from welfare.
Plan documents: party programme
Reasoning and quotes
The party programme states that welfare services shall be offered to all on equal terms and according to need, that care shall be distributed according to need and that the most seriously ill shall receive care quickly, and that commercially oriented actors should be removed from welfare. Private health insurance that gives the insured faster care violates the needs principle. The plan therefore supports stricter contract regulation.
Original (Swedish)
Partiprogrammet slår fast att välfärdstjänster ska erbjudas alla på lika villkor och efter behov, att vården ska fördelas efter behov och att de svårast sjuka ska få vård snabbt, samt att kommersiellt inriktade aktörer bör bort från välfärden. Privata sjukvårdsförsäkringar som ger försäkrade snabbare vård bryter mot behovsprincipen. Planen stöder därför en skärpt avtalsreglering.
- care on equal termsdecisive»Välfärdstjänster inom vård, skola och omsorg ska« (party programme ↗)“Welfare services in care, school and social services shall”
- care according to need»fördelas efter behov och« (party programme ↗)“distributed according to need and”
- medical prioritization»De svårast sjuka ska få vård snabbt.« (party programme ↗)“The most seriously ill shall receive care quickly.”
- limit commercial care actors»få bort de kommersiellt inriktade aktörerna« (party programme ↗)“remove commercially oriented actors”
The plan's decisive commitment is that choice should be defended in healthcare and care, that more care providers should be admitted and that people beyond the public commitment should have great freedom to invest in their own health.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The plan's decisive commitment is that choice should be defended in healthcare and care, that more care providers should be admitted and that people beyond the public commitment should have great freedom to invest in their own health. Tightened contract regulation that excludes care providers with multiple commissioners goes against this. Care should be based on need rather than ability to pay is a counterweight, but the plan weighs choice more heavily.
Original (Swedish)
Planens avgörande åtagande är att valfriheten inom vård och omsorg ska försvaras, att fler vårdgivare ska släppas in och att människor utöver det offentliga åtagandet ska ha stor frihet att själva investera i sin egen hälsa. En skärpt avtalsreglering som utestänger vårdgivare med flera uppdragsgivare går emot detta. Att vård ska ges efter behov och inte betalningsförmåga är en motvikt, men planen väger valfriheten tyngre.
- defended choice in healthcaredecisive»Vi vill försvara valfriheten inom vård och omsorg och bedriva verksamheten nära vårdtagarna.« (2022 manifesto ↗)“We want to defend choice in healthcare and care and conduct activities close to patients.”
- freedom to own health investments»Samtidigt ska människor ha stor frihet att, utöver det offentliga vård-, omsorgs- och välfärdsåtagandet, själva investera i sin egen hälsa och sin egen utveckling.« (party programme ↗)“At the same time, people should have great freedom to, beyond the public healthcare, care and welfare commitment, invest in their own health and their own development.”
- more care providers»Vi vill öppna upp för fler vårdgivare och öka valfriheten så att patienter tillsammans med sin läkare kan välja vårdgivare och tid då operation eller behandling passar bäst utifrån patientens behov.« (2022 manifesto ↗)“We want to open up for more care providers and increase choice so that patients together with their doctor can choose care provider and time when surgery or treatment is best suited based on patient needs.”
- care based on need»att snabbt få vård i den offentligt finansierade sjukvården ska ges efter behov och inte efter betalningsförmåga.« (party programme ↗)“quick access to care in publicly financed healthcare should be provided based on need and not ability to pay.”
The plan requires that patient choice and establishment freedom shall apply throughout the country for those who meet quality requirements and that private and public providers operate on equal terms.
Plan documents: party programme
Reasoning and quotes
The plan requires that patient choice and establishment freedom shall apply throughout the country for those who meet quality requirements and that private and public providers operate on equal terms. A new provision that conditions regions' agreements with private providers who have multiple employers narrows that space. The plan's requirements for equal healthcare according to need qualify the assessment, but do not support regulation targeted at the diversity of providers.
Original (Swedish)
Planen kräver att vårdval och etableringsfrihet ska råda i hela landet för den som uppfyller kvalitetskraven och att privata och offentliga utförare verkar på lika villkor. En ny bestämmelse som villkorar regionernas avtal med privata vårdgivare som har flera uppdragsgivare snävar in det utrymmet. Planens krav på jämlik vård efter behov kvalificerar bedömningen, men bär inte en reglering som riktas mot mångfalden av utförare.
- patient choice and establishment freedomdecisive»Vårdval och etableringsfrihet ska råda i hela landet för den som lever upp till kvalitetskraven.« (party programme ↗)“Patient choice and establishment freedom shall apply throughout the country for those who meet quality requirements.”
- equal terms for providers»Privata och offentliga utförare ska verka på lika villkor« (party programme ↗)“Private and public providers shall operate on equal terms”
- diversity of providers»En mångfald av utförare ökar valmöjligheterna för individen och ger en bredare arbetsmarknad« (party programme ↗)“A diversity of providers increases individuals' choice options and provides a broader labour market”
- equal healthcare according to need»Vården ska vara jämlik.« (party programme ↗)“Healthcare shall be equal.”
The counter-proposal wants to adopt the provision on contractual terms, because private health insurance gives insured faster care in conflict with the principle of care according to need.
Plan documents: party programme
Reasoning and quotes
The counter-proposal wants to adopt the provision on contractual terms, because private health insurance gives insured faster care in conflict with the principle of care according to need. The party programme establishes that the solidarily financed care is the heart of welfare and shall be needs-driven, and that demand-driven care violates the principle of human dignity. The plan therefore supports the demand, while it values the patient's free choice of care provider.
Original (Swedish)
Motförslaget vill anta bestämmelsen om avtalsvillkor, eftersom privata sjukvårdsförsäkringar ger försäkrade snabbare vård i strid med principen om vård efter behov. Principprogrammet slår fast att den solidariskt finansierade vården är välfärdens kärna och ska vara behovsstyrd, och att en efterfrågestyrd vård bryter mot människovärdesprincipen. Planen stöder därför kravet, samtidigt som den värnar patientens fria val av vårdgivare.
- needs-driven caredecisive»Den solidariskt finansierade hälso- och sjukvården är välfärdens kärna och ska vara behovsstyrd.« (party programme ↗)“Solidarily financed health and medical care is the heart of welfare and shall be needs-driven”
- rejects demand-driven care»efterfrågestyrd hälso- och sjukvård bryter mot principen om alla människors absoluta och okränkbara« (party programme ↗)“demand-driven health and medical care violates the principle of all human's absolute and inviolable”
- free choice of care provider»Medborgarna ska ges frihet att själva välja vårdgivare.« (party programme ↗)“Citizens shall be given freedom to themselves choose care provider”
flags: konflikt_behovsprincip_mot_valfrihet
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.
The counter-proposal wants to adopt stricter contracting rules that limit private healthcare providers with insurance contracts.
Plan documents: party programme · 2022 manifesto
Reasoning and quotes
The counter-proposal wants to adopt stricter contracting rules that limit private healthcare providers with insurance contracts. The plan builds instead on choice and that welfare combines public and private, and promises patients the right to turn to another provider when care is delayed. Queues, not independent providers, are in the plan's view the failure. The requirement is therefore rejected.
Original (Swedish)
Motförslaget vill anta en skärpt avtalsreglering som begränsar privata vårdgivare med försäkringsuppdrag. Planen bygger tvärtom på valfrihet och att välfärden kombinerar offentligt och privat, och den lovar patienter rätt att vända sig till en annan vårdgivare när vården dröjer. Köer, inte fristående vårdgivare, är i planens ögon misslyckandet. Kravet avvisas därför.
- public and private in welfaredecisive»välfärdssamhälle kombinerar offentligt och privat i såväl utförande som finansiering.« (party programme ↗)“welfare society combines public and private in both provision and financing.”
- patient's right to choose provider»Införa en förstärkt vårdgaranti för cancerpatienter – om inte vården kan ges inom angivna tidsgränser ska patienten ha rätt att vända sig till annan vårdgivare och bli ersatt för de merkostnader detta innebär« (2022 manifesto ↗)“Introduce a strengthened care guarantee for cancer patients – if care cannot be provided within stated time limits the patient shall have the right to turn to another provider and be compensated for any additional costs this entails”
- queues are the failure»Köer till välfärdstjänster är ett misslyckande« (party programme ↗)“Queues for welfare services are a failure”
- choice in welfare»För Moderaterna är valfrihet en central del av den svenska« (party programme ↗)“For the Moderate Party, choice is a central part of the Swedish”
The counter-proposal wants to adopt stricter contractual regulation that limits regions' ability to contract with private healthcare providers who also have insurance operations.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The counter-proposal wants to adopt stricter contractual regulation that limits regions' ability to contract with private healthcare providers who also have insurance operations. The plan instead wants to increase healthcare capacity through cooperation agreements with healthcare providers, both public and private, and places no value in who operates the care as long as queues are shortened. That care shall be given according to need is an opposing principle in the plan, but the decisive line is to utilize all available healthcare capacity.
Original (Swedish)
Motförslaget vill anta en skärpt avtalsreglering som begränsar regionernas möjlighet att avtala med privata vårdgivare som också har försäkringsuppdrag. Planen vill i stället öka vårdkapaciteten genom samverkansavtal med vårdgivare, offentliga och privata, och lägger inget egenvärde i vem som driver vården så länge köerna kortas. Att vården ska ges efter behov är en motstående princip i planen, men den avgörande linjen är att utnyttja all tillgänglig vårdkapacitet.
- cooperation with private healthcare providersdecisive»Vårdgarantikansliet bör också ta fram underlag och upprätta samverkansavtal med olika vårdgivare, offentliga och privata, svenska och utländska, för att kunna öka vårdkapaciteten inom såväl behandling som operation och rehabilitering.« (2022 manifesto ↗)“The Care Guarantee Office should also prepare grounds and establish cooperation agreements with various healthcare providers, public and private, Swedish and foreign, to be able to increase healthcare capacity in both treatment and surgery and rehabilitation.”
- neutral view of operational form»Vi lägger inget egenvärde i vem som driver sjukvården« (party programme ↗)“We place no value in who operates healthcare”
- shorter healthcare queues»Avskaffa vårdköerna och införa en riktig vårdgaranti« (2022 manifesto ↗)“Abolish healthcare queues and introduce a true care guarantee”
- care according to need»hälso- och sjukvården ska vara solidariskt finansierad via skattsedeln, ges efter behov« (party programme ↗)“healthcare shall be funded in solidarity via taxation, provided according to need”
Share and embed
Sources and documents
- The committee report on riksdagen.se (2022/23:SoU5)
- Committee report full text (HA01SoU5)
- Per-MP voting data (API)
- Case status (API)
Documents under consideration
- Motion 2022/23:2 — med anledning av prop. 2021/22:260 Ökad kontroll i hälso- och sjukvården av Karin Rågsjö m.fl. (V)
- Motion 2022/23:5 — med anledning av prop. 2021/22:260 Ökad kontroll i hälso- och sjukvården av Camilla Waltersson Grönvall m.fl. (M, SD, KD, L)
- Motion 2022/23:8 — med anledning av prop. 2021/22:260 Ökad kontroll i hälso- och sjukvården av Anders W Jonsson (C)
- Proposition 2021/22:260 — Ökad kontroll i hälso- och sjukvården
Source: The Swedish Parliament