2024-05-022023/24:SoU8 · p.3SoUHealth & social services
The design of the care guarantee
The design of the care guarantee
What's at stake: The scope of the care guarantee determines which parts of the care chain patients have a statutory right to within a set time. Broadening it to cover more steps could strengthen the patient's position, but the question is whether that should be decided now or as part of the government's ongoing review.
Case texts and AI reasoning are AI-translated from the Swedish originals; the Swedish text is authoritative.
What the vote decides
The vote concerns whether parliament should already spell out how the care guarantee should be redesigned - for instance to also cover diagnostic work-ups, the total waiting time, and assistive devices - or whether the design should await the government's ongoing review.
Yes Yes — the committee proposal
The committee agrees there is a need to review the effectiveness of the care guarantee in order to strengthen the patient's position and the guarantee's role as a policy instrument, but notes that active work on this is already under way. The committee therefore holds that parliament should not pre-empt that work with its own statement on the guarantee's design, and recommends rejecting the motion.
No No — the reservations
Reservation 6 (MP)
The reserving member welcomes the government's review of the care guarantee but wants the direction set now: the guarantee should cover diagnostic work-ups and examinations, both previously known and new health problems, the total time from first care contact to treatment, and assistive devices along with the high-cost protection scheme.
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: rejecting the motions (keeping things as they are).
No Backing the counter-proposal: reservation 6 by MP.
Abstain The party marks a position of its own that is not one of the two final alternatives.
The decision would have held
Explicit commitments that contradicted the vote: LLiberalerna, SDSverigedemokraterna
Ja 258–13Ja 185–86
Counterfactual: the parties above are moved to the position their own documents explicitly point at, carrying their whole contingent present. Every other party keeps its real figures, including dissenters and absentees.
How the AI parties would have voted
For each party: what its own plan – election manifesto and party programme – argues for in this case, next to how the party actually voted. The AI can only answer Yes or No; a party can also abstain.
| AI | Vote | Confidence | Evidence | ||
|---|---|---|---|---|---|
| V | No | Yes 18/0/0/6 | differs | confidence: medium | not addressed |
| S | No | Yes 93/0/0/13 | differs | confidence: medium | not addressed |
| MP | No | No 0/13/0/5 | match | confidence: high | explicit |
| C | No | Abstain 0/0/20/4 | differs | confidence: medium | not addressed |
| L | No | Yes 11/0/0/5 | differsagainst own programme | confidence: high | explicit |
| KD | No | Yes 13/0/0/6 | differs | confidence: medium | not addressed |
| M | No | Yes 60/0/0/8 | differs | confidence: medium | not addressed |
| SD | No | Yes 62/0/0/10 | differsagainst own programme | confidence: high | explicit |
Committee proposal
The Riksdag rejects the motions 2023/24:2807 by Ulrika Westerlund et al. (MP) demand 2 and 2023/24:2814 by Anders W Jonsson et al. (C) demand 4.
Original (Swedish)
Riksdagen avslår motionerna 2023/24:2807 av Ulrika Westerlund m.fl. (MP) yrkande 2 och 2023/24:2814 av Anders W Jonsson m.fl. (C) yrkande 4.
Riksdag decision: The Riksdag has treated a letter from the government, which concerns the Swedish National Audit Office's report on the state's work with waiting times in health care. The Swedish National Audit Office has examined whether several of the policy instruments used by the government to reduce healthcare queues have been effective. The policy instruments are: The care guarantee (vårdgarantin), which aims to provide care within certain time limits. The Queue billion 2009–2014, which meant that the state paid out one billion kronor annually between 2009–2014. The money was distributed to regions based on how well they met requirements linked to the care guarantee's time limits in specialist care. Standardized care pathways in cancer care (SVF), which, among other things, describes what investigations and first treatments should be performed for certain cancer diagnoses. The examination also concerns whether these policy instruments have affected the goal of equitable care according to need. The government welcomes the examination and shares the Swedish National Audit Office's view that there is a need to review the effectiveness in order to strengthen the patient's position and the importance of the care guarantee as a government policy instrument. In the letter, the government reports measures taken and planned that are in line with the Swedish National Audit Office's observations and recommendations. The Riksdag filed the letter with the documents, that is, concluded the matter. The Riksdag also rejected the motion demands.
Counter-proposals
- The counter-proposal wants to give the Agency for Care and Health Services Analysis a mandate to evaluate the queue million. (MP) — Reservation 6
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 you have the right to help quickly regardless of condition and that care shall be given according to need, not according to capacity in incorrectly constructed systems.
Plan documents: 2022 manifesto
Reasoning and quotes
The plan establishes that you have the right to help quickly regardless of condition and that care shall be given according to need, not according to capacity in incorrectly constructed systems. A care guarantee that covers investigations, already-known problems and the total time until treatment is exactly a guarantee built on need rather than system boundaries. The plan's requirement for catastrophic health insurance also supports that part of the counter-proposal.
Original (Swedish)
Planen slår fast att man ska ha rätt till hjälp snabbt oavsett åkomma och att vården ska ges efter behov, inte efter kapaciteten i felaktigt konstruerade system. En vårdgaranti som omfattar utredningar, redan kända problem och den sammanlagda tiden fram till behandling är just en garanti byggd på behov i stället för systemgränser. Planens krav på högkostnadsskydd stödjer även den delen av motförslaget.
- quick care regardless of conditiondecisive»Du ska ha rätt till hjälp snabbt oavsett om du har brutit benet eller blivit utbränd.« (2022 manifesto ↗)“You have the right to help quickly regardless of whether you have broken your leg or burned out.”
- need before system capacity»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.”
- integrated care chain»Vården och omsorgen har styckats upp, mellan nivåer och aktörer, människor bollas runt i en stor administrativ apparat och det är ofta en kamp för den enskilde och dess anhöriga att få rätt tillgång till vård.« (2022 manifesto ↗)“Care and support have been split up, between levels and actors, people are bounced around in a large administrative apparatus and it is often a struggle for the individual and their relatives to get access to the right care.”
- catastrophic insurance against avoided care»Vänsterpartiet vill därför införa en tandvårdsförsäkring liknande den som finns inom övrig hälso- och sjukvård med ett högkostnadsskydd som gör att vuxna människor med behov inte ska behöva tacka nej till god tandvård.« (2022 manifesto ↗)“The Left Party therefore wants to introduce dental care insurance similar to that which exists within the rest of healthcare with catastrophic health insurance that means that adults with needs do not have to decline good dental 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.
The election manifesto's commitment is that no one should have to worry about getting care in time and that a region not meeting the care guarantee should refer onward - a guarantee intended to be strong and usable for the patient.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The election manifesto's commitment is that no one should have to worry about getting care in time and that a region not meeting the care guarantee should refer onward - a guarantee intended to be strong and usable for the patient. The counter-proposal's requirement that the guarantee covers investigations, the entire waiting time and aids strengthens precisely that patient right. The plan does not, however, specify the guarantee's demarcation, hence derived coverage.
Original (Swedish)
Valmanifestets åtagande är att ingen ska behöva känna oro över att få vård i tid och att en region som inte klarar vårdgarantin ska hänvisa vidare - en garanti som är avsedd att vara stark och användbar för patienten. Motförslagets krav på att garantin ska omfatta utredningar, hela väntetiden och hjälpmedel förstärker just den patienträtten. Planen preciserar dock inte garantins avgränsning, därav härledd täckning.
- strong care guaranteedecisive»Ingen ska behöva känna oro över att få vård i tid. Om en region inte uppfyller vårdgarantin enligt lagen ska vård erbjudas i en annan region.« (2022 manifesto ↗)“No one should have to worry about getting care in time. If a region does not meet the care guarantee according to the law, care should be offered in another region.”
- tightened supervision»Tillsynen av sjukvården ska växlas upp för att garantera kvaliteten.« (2022 manifesto ↗)“Supervision of healthcare should be stepped up to guarantee quality.”
- equivalent care»Alla invånare i hela landet ska ha likvärdig tillgång till skola, vård och omsorg.« (party programme ↗)“All residents throughout the country should have equivalent access to school, care and health services.”
- care according to need»avgöras av marknadens prismekanismer och utbudet får aldrig bestämmas av enskilda« (party programme ↗)“is determined by market price mechanisms and supply should never be determined by individuals'”
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 plan explicitly requires that aids shall be included in the high-cost protection, which is one of the points the counter-proposal wants to set down for the care guarantee's direction.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The plan explicitly requires that aids shall be included in the high-cost protection, which is one of the points the counter-proposal wants to set down for the care guarantee's direction. The plan also wants to reduce queues throughout the country and for care guarantees to be based on medical needs, which supports that the entire time from first care contact to treatment is counted. Overall, the plan supports the counter-proposal's requirement for a broader and more patient-centred guarantee.
Original (Swedish)
Planen kräver uttryckligen att hjälpmedel ska ingå i högkostnadsskyddet, vilket är en av de punkter motförslaget vill lägga fast för vårdgarantins inriktning. Planen vill också korta köerna i hela landet och att vårdgarantier ska utgå från medicinska behov, vilket stöder att hela tiden från första vårdkontakt till behandling räknas in. Sammantaget bär planen motförslagets krav på en bredare och mer patientnära garanti.
- aids in high-cost protectiondecisive»att hjälpmedel ska ingå i högkostnadsskyddet.« (2022 manifesto ↗)“that aids shall be included in the high-cost protection.”
- guarantee based on medical need»Vårdgarantier bör därför utgå från medicinska behov« (party programme ↗)“Care guarantees should therefore be based on medical needs”
- shorter care queues»korta köerna till behandling i hela landet.« (2022 manifesto ↗)“reduce queues for treatment throughout the country.”
- broad high-cost protection»att tandvården ska jämställas med övrig hälso- och sjukvård, och ingå i samma högkostnadsskydd.« (2022 manifesto ↗)“that dental care shall be placed on equal terms with other health and medical care, and be included in the same high-cost protection.”
flags: citat_migrerat
The plan's crucial healthcare promise is that queues shall be shortened and that the patient shall have the right to opt out of queues.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The plan's crucial healthcare promise is that queues shall be shortened and that the patient shall have the right to opt out of queues. A care guarantee that covers investigations and examinations and the total time from first contact to treatment is precisely what gives that promise effect for the patient. The plan does not comment on aids and high-cost protection, but the principle that care shall be given according to need and not according to ability to pay points in the same direction.
Original (Swedish)
Planens avgörande vårdlöfte är att köerna ska kortas och att patienten ska ha rätt att välja bort köerna. En vårdgaranti som omfattar utredningar och undersökningar samt den sammanlagda tiden från första kontakt till behandling är just det som ger det löftet verkan för patienten. Planen uttalar sig inte om hjälpmedel och högkostnadsskydd, men principen att vård ska ges efter behov och inte efter betalningsförmåga pekar åt samma håll.
- shortened queues and patient powerdecisive»Köerna måste kortas och man ska ha rätt att välja bort köerna genom att söka vård i andra regioner.« (2022 manifesto ↗)“Queues must be shortened and you should have the right to avoid queues by seeking care in other regions.”
- equal accessibility»Så kortar vi köerna och stärker likvärdigheten i hela landet.« (2022 manifesto ↗)“This is how we shorten queues and strengthen equality across the whole country.”
- care according to need»att snabbt få vård i den offentligt finansierade sjukvården ska ges efter behov och inte efter betalningsförmåga.« (party programme ↗)“prompt access to care in publicly financed healthcare shall be provided according to need and not according to ability to pay.”
- more care places»Vi vill skapa fler vårdplatser där det behövs med hjälp av en platsmiljard och bättre stöd till regionerna.« (2022 manifesto ↗)“We want to create more care places where needed with the help of a place billion and better support for the regions.”
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 party programme establishes that the care guarantee shall cover the entire care chain, from diagnostics and examinations to follow-up visits and rehabilitation, which is precisely the direction the counter-proposal wants to establish.
Plan documents: party programme
Reasoning and quotes
The party programme establishes that the care guarantee shall cover the entire care chain, from diagnostics and examinations to follow-up visits and rehabilitation, which is precisely the direction the counter-proposal wants to establish. The plan moreover requires that the guarantee is designed with consideration for patients with special needs and that power is shifted to patients. The requirement for assistive devices has support in the commitment to equal assistive device conditions throughout the country.
Original (Swedish)
Partiprogrammet slår fast att vårdgarantin ska omfatta hela vårdkedjan, från diagnostik och undersökningar till återbesök och rehabilitering, vilket är precis den inriktning motförslaget vill fastställa. Planen kräver dessutom att garantin utformas med hänsyn till patienter med särskilda behov och att makten förskjuts till patienterna. Kravet på hjälpmedel har stöd i åtagandet om likvärdiga hjälpmedelsvillkor i hela landet.
- care guarantee for entire care chaindecisive»Vårdgarantin ska omfatta hela vårdkedjan, från diagnostik och undersökningar till återbesök och rehabilitering.« (party programme ↗)“The care guarantee shall cover the entire care chain, from diagnostics and examinations to follow-up visits and rehabilitation.”
- consideration for special needs»Vårdgarantin ska utformas med hänsyn till patienter med särskilda behov, såsom täta kontroller.« (party programme ↗)“The care guarantee shall be designed with consideration for patients with special needs, such as frequent check-ups.”
- strengthened patient power»Det behövs en maktförskjutning inom hälso- och sjukvården till patienterna.« (party programme ↗)“There must be a shift in power within health and medical care toward patients.”
- equal assistive devices»Villkoren för hjälpmedel ska vara likvärdiga i hela landet.« (party programme ↗)“Conditions for assistive devices shall be equal throughout the country.”
The stance rests on the quoted commitment in the party's own documents; the actual vote deviated. Click the quote to verify it in the document.
The plan states that care and dignity guarantees shall exist and that the patient shall receive the right care at the right time.
Plan documents: party programme · 2022 manifesto
Reasoning and quotes
The plan states that care and dignity guarantees shall exist and that the patient shall receive the right care at the right time. The election manifesto specifically points out that 140,000 people have waited illegally long for a specialist visit or treatment, that is exactly the investigations and examinations the counter-proposal wants to incorporate into the guarantee. Setting the direction now lies thereby in line with the plan's view of the guarantee as a real promise to the patient.
Original (Swedish)
Planen slår fast att vård- och värdighetsgarantier ska finnas och att patienten ska få rätt vård i rätt tid. Valmanifestet pekar särskilt ut att 140 000 människor väntat olagligt länge på besök hos specialist eller behandling, alltså just de utredningar och undersökningar som motförslaget vill föra in i garantin. Att fastställa inriktningen nu ligger därmed i linje med planens syn på garantin som ett verkligt löfte till patienten.
- care and dignity guaranteesdecisive»Vård- och värdighetsgarantier, som grundar sig på etiska prioriteringar, ska finnas.« (party programme ↗)“Care and dignity guarantees, which are based on ethical priorities, shall exist.”
- illegally long waiting times»140 000 människor har väntat olagligt länge på besök hos specialist eller på behandling.« (2022 manifesto ↗)“140,000 people have waited illegally long for a specialist visit or for treatment.”
- the patient's position is strengthened»Att som patient få tillgång till information, kunna påverka vård« (party programme ↗)“As a patient to receive access to information, be able to influence 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.
The plan rests on the treatment guarantee not today delivering on its promise and wants to strengthen it: a strengthened treatment guarantee for cancer patients with the right to go to another care provider and compensation for extra costs, and a new statutory treatment guarantee for children.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The plan rests on the treatment guarantee not today delivering on its promise and wants to strengthen it: a strengthened treatment guarantee for cancer patients with the right to go to another care provider and compensation for extra costs, and a new statutory treatment guarantee for children. That the guarantee should cover investigations and the combined time until treatment is in the same direction. The plan does not however state itself on the guarantee's exact design.
Original (Swedish)
Planen bygger på att vårdgarantin i dag inte håller vad den lovar och vill stärka den: en förstärkt vårdgaranti för cancerpatienter med rätt att gå till annan vårdgivare och ersättning för merkostnader, samt en ny lagstadgad vårdgaranti för barn. Att garantin ska omfatta utredningar och den sammanlagda tiden fram till behandling ligger i samma riktning. Planen uttalar sig dock inte om garantins exakta utformning.
- strengthened treatment guaranteedecisive»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 treatment guarantee for cancer patients – if care cannot be provided within specified time limits patients should have the right to turn to another care provider and be compensated for the extra costs this entails”
- statutory treatment guarantee for children»Införa en ny lagstadgad vårdgaranti för barn« (2022 manifesto ↗)“Introduce a new statutory treatment guarantee for children”
- treatment guarantee falls short»Fyra av tio patienter tvingas vänta längre på vård än vad den lagstadgade vårdgarantin utlovar.« (2022 manifesto ↗)“Four out of ten patients are forced to wait longer for care than the statutory treatment guarantee promises.”
- queues are a failure»Köer till välfärdstjänster är ett misslyckande« (party programme ↗)“Queues for welfare services are a failure”
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 plan requires that waiting queues be abolished and a proper care guarantee be introduced as rights legislation for citizens.
Plan documents: 2022 manifesto
Reasoning and quotes
The plan requires that waiting queues be abolished and a proper care guarantee be introduced as rights legislation for citizens. That the guarantee should cover investigations and examinations, continuously from first care contact to treatment and aids, is precisely such a strengthening of the patient's right. The plan also wants to increase the number of care places and invest in primary care so that the guarantee can actually be fulfilled.
Original (Swedish)
Planen kräver att vårdköerna avskaffas och att en riktig vårdgaranti införs som en rättighetslagstiftning för medborgarna. Att garantin ska omfatta utredningar och undersökningar, hela tiden från första vårdkontakt till behandling samt hjälpmedel är just en sådan förstärkning av patientens rätt. Planen vill dessutom öka antalet vårdplatser och satsa på primärvården så att garantin faktiskt kan infrias.
- care guarantee as rightdecisive»En riktig vårdgaranti bör införas som en rättighetslagstiftning för medborgarna. Det ska inrättas ett vårdgarantikansli för vårdköer under Socialstyrelsens regi.« (2022 manifesto ↗)“A proper care guarantee should be introduced as rights legislation for citizens. A care guarantee office should be established for waiting queues under the management of the National Board of Health and Welfare.”
- abolished waiting queues»Avskaffa vårdköerna och införa en riktig vårdgaranti« (2022 manifesto ↗)“Abolish waiting queues and introduce a proper care guarantee”
- more care places»Öka antalet vårdplatser« (2022 manifesto ↗)“Increase the number of care places”
- strengthened primary care»Satsa på primärvården« (2022 manifesto ↗)“Invest in primary care”
The stance rests on the quoted commitment in the party's own documents; the actual vote deviated. Click the quote to verify it in the document.
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Sources and documents
- The committee report on riksdagen.se (2023/24:SoU8)
- Committee report full text (HB01SoU8)
- Per-MP voting data (API)
- Case status (API)
Documents under consideration
- Motion 2023/24:2797 — med anledning av skr. 2023/24:48 Riksrevisionens rapport om statens arbete med väntetider i vården av Fredrik Lundh Sammeli m.fl. (S)
- Motion 2023/24:2802 — med anledning av skr. 2023/24:48 Riksrevisionens rapport om statens arbete med väntetider i vården av Karin Rågsjö m.fl. (V)
- Motion 2023/24:2807 — med anledning av skr. 2023/24:48 Riksrevisionens rapport om statens arbete med väntetider i vården av Ulrika Westerlund m.fl. (MP)
- Motion 2023/24:2814 — med anledning av skr. 2023/24:48 Riksrevisionens rapport om statens arbete med väntetider i vården av Anders W Jonsson m.fl. (C)
- Regeringens skrivelse 2023/24:48 — Riksrevisionens rapport om statens arbete med väntetider i vården
Source: The Swedish Parliament