2025-03-192024/25:SoU21 · p.3SoUHealth & social services
Review of the law on choice systems in elderly care
Review of the law on free-choice systems in elderly care
What's at stake: The ability to choose a provider for home care or specialised housing is limited in many places today, even though a large share of older people say they want to be able to choose between private and public alternatives. The issue concerns older people's influence over their own care and how the legislation on free-choice systems should be developed to enable it.
Case texts and AI reasoning are AI-translated from the Swedish originals; the Swedish text is authoritative.
What the vote decides
The motions called for the government to task a suitable authority with investigating how older people's freedom to choose a home-care or housing provider could be strengthened through a review of the law on free-choice systems, while the committee held that the matter is already being addressed as part of the government's broader work on elderly care and that no separate assignment was needed.
Yes Yes — the committee proposal
The committee points out that the government is already taking several measures to strengthen the quality of elderly care and is working from a holistic view of the individual's needs, including a new proposed Social Services Act intended to make care more preventive, knowledge-based, and accessible, and on that basis does not consider that parliament needs to issue a separate mandate for a review of the law on free-choice systems.
No No — the reservations
Reservation 5 (C)
The reserving party (C) holds that patients' and users' right to influence is a cornerstone of Swedish elderly care, but that older people's ability to choose a home-care provider or choose their housing is limited today, even though a survey shows that more than 90 percent of older people want to be able to choose between private and public providers. The party wants the government to task a suitable authority with investigating how older people's freedom of choice regarding housing and home care can be improved through legislative changes and other measures.
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 5 by C.
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: KDKristdemokraterna, LLiberalerna
Ja 265–20Ja 233–52
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 | Yes | Abstain 0/0/21/3 | differs | confidence: high | explicit |
| S | Yes | Yes 93/0/0/13 | match | confidence: medium | derived |
| MP | No | Yes 16/0/0/2 | differs | confidence: low | not addressed |
| C | No | No 0/20/0/4 | match | confidence: high | explicit |
| L | No | Yes 15/0/0/1 | differsagainst own programme | confidence: high | explicit |
| KD | No | Yes 17/0/0/2 | differsagainst own programme | confidence: high | explicit |
| M | No | Yes 60/0/0/8 | differs | confidence: high | not addressed |
| SD | No | Yes 62/0/0/10 | differs | confidence: medium | not addressed |
Committee proposal
Parliament rejects the motions 2024/25:285 by Dan Hovskär and Hans Eklind (both KD), 2024/25:1851 by Jessica Rodén and Petter Löberg (both S) request 1 and 2024/25:3166 by Christofer Bergenblock and others (C) request 13.
Original (Swedish)
Riksdagen avslår motionerna 2024/25:285 av Dan Hovskär och Hans Eklind (båda KD), 2024/25:1851 av Jessica Rodén och Petter Löberg (båda S) yrkande 1 och 2024/25:3166 av Christofer Bergenblock m.fl. (C) yrkande 13.
Riksdag decision: Parliament rejected approximately 60 proposals on elderly care in motions from the regular motion period 2024. The proposals concern, among other things, the organization and function of elderly care, health and medical care within elderly care and personnel in elderly care. Parliament refers, among other things, to ongoing work in the field.
Counter-proposals
- The counter-proposal wants medical resources in elderly care to be strengthened by introducing a medically responsible doctor linked to elderly care. (C) — Reservation 5
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 demands a total ban on profit-driven business forms in welfare and that no actors that are there to make profit exist in care and support.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The plan demands a total ban on profit-driven business forms in welfare and that no actors that are there to make profit exist in care and support. The counter-proposal instead wants to investigate how elderly people's opportunity to choose between private and public providers can be widened, that is, to expand the freedom-of-choice system. The plan believes that market solutions have hollowed out welfare and therefore speaks against the demand.
Original (Swedish)
Planen kräver ett totalförbud mot vinstdrivande verksamhetsformer i välfärden och att inga aktörer som är där för att göra vinst finns i vård och omsorg. Motförslaget vill tvärtom utreda hur äldres möjlighet att välja mellan privata och offentliga utförare kan utvidgas, det vill säga bygga ut valfrihetssystemet. Planen anser att marknadslösningar urholkat välfärden och talar därför emot kravet.
- total ban on profits in welfaredecisive»Vänsterpartiet vill införa ett totalförbud mot alla vinstdrivande verksamhetsformer inom välfärden.« (2022 manifesto ↗)“The Left Party wants to introduce a total ban on all profit-driven business forms within welfare.”
- no profit actors in care»se några aktörer som är där för att göra vinster i välfärden.« (party programme ↗)“see any actors that are there to make profits in welfare.”
- end to market-based care»Vi vill sätta punkt för marknadsvården.« (party programme ↗)“We want to put an end to market-based care.”
- market hollows out welfare»De senaste decennierna har politiken förlitat sig på att marknaden ska lösa våra behov av trygghet, men marknadslösningar har urholkat vår gemensamma välfärd« (2022 manifesto ↗)“In recent decades, policy has relied on the market to solve our needs for security, but market solutions have hollowed out our shared welfare”
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 election manifesto's line is to take back democratic control over welfare and stop privatisation, and that equivalent elderly care must be secured through a new elderly care act – not through expanded choice systems with more private providers.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The election manifesto's line is to take back democratic control over welfare and stop privatisation, and that equivalent elderly care must be secured through a new elderly care act – not through expanded choice systems with more private providers. A mandate to investigate how choice in housing and home care can be expanded through constitutional amendments pulls in the opposite direction. The party programme at the same time recognises the need to be able to choose care alternatives, which makes the assessment derived rather than self-evident.
Original (Swedish)
Valmanifestets linje är att ta tillbaka den demokratiska kontrollen över välfärden och stoppa sönderprivatiseringen, och att likvärdig äldreomsorg ska säkras genom en ny äldreomsorgslag - inte genom utbyggda valfrihetssystem med fler privata utförare. Ett uppdrag att utreda hur valfriheten i boende och hemtjänst kan utvidgas genom författningsändringar drar i motsatt riktning. Partiprogrammet erkänner samtidigt behovet av att kunna välja omsorgsalternativ, vilket gör bedömningen härledd snarare än självklar.
- stop privatisationdecisive»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 privatisation.”
- elderly care act for equivalence»Vi vill ha en ny äldreomsorgslag som säkerställer att alla får en lika bra omsorg i hela landet och tillgång till sjuksköterskor dygnet runt.« (2022 manifesto ↗)“We want a new elderly care act that ensures everyone receives equally good care throughout the country and access to nurses around the clock.”
- welfare outside the market»avgöras av marknadens prismekanismer och utbudet får aldrig bestämmas av enskilda« (party programme ↗)“determined by the market's price mechanisms and provision must never be determined by individuals”
- choice within common sector»att välja mellan olika pedagogiska utformningar, olika vårdformer och olika« (party programme ↗)“to choose between different pedagogical approaches, different forms of care and different”
The party programme wants to strengthen people's ability to genuinely choose a welfare system that fits them and strengthen self-determination over welfare, and that the elderly should be offered the housing they wish.
Plan documents: party programme
Reasoning and quotes
The party programme wants to strengthen people's ability to genuinely choose a welfare system that fits them and strengthen self-determination over welfare, and that the elderly should be offered the housing they wish. This speaks for an investigation of elderly people's choice in housing and home care. Simultaneously, the plan wants to remove commercially oriented actors, which makes the support conditional and uncertain.
Original (Swedish)
Partiprogrammet vill stärka människors möjlighet att på riktigt välja en välfärd som passar dem och stärka egenmakten över välfärden, och att den äldre ska kunna erbjudas det boende hen önskar. Det talar för en utredning av äldres valfrihet i boende och hemtjänst. Samtidigt vill planen få bort de kommersiellt inriktade aktörerna, vilket gör stödet villkorat och osäkert.
- genuine choice in welfaredecisive»Vi vill stärka människors möjlighet att på riktigt välja en välfärd som passar dem« (party programme ↗)“We want to strengthen people's ability to genuinely choose a welfare system that fits them”
- elderly's choice of housing»Kommunerna behöver bli bättre på att planera så att den äldre när hen så önskar och behöver ska kunna erbjudas äldreboende, serviceboende eller annat lämpligt alternativ.« (party programme ↗)“Municipalities need to become better at planning so that the elderly when they wish and need to can be offered retirement housing, service housing or other appropriate alternative.”
- strengthened self-determination»Vi vill stärka egenmakten och inflytandet över välfärden.« (party programme ↗)“We want to strengthen self-determination and influence over welfare.”
- remove commercial actors»Vi vill därför få bort de kommersiellt inriktade aktörerna och i stället främja idéburna verksamheter inom välfärdssektorn.« (party programme ↗)“We therefore want to remove commercially oriented actors and instead promote idea-based activities within the welfare sector.”
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 commits to defending choice within care and welfare and to opening up for more healthcare providers.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The election manifesto commits to defending choice within care and welfare and to opening up for more healthcare providers. The party programme makes the right to choice into what should ensure that publicly funded welfare is adapted to the individual's needs. An investigation of how the elderly's ability to choose housing and home services can be improved is thus directly in line with the plan.
Original (Swedish)
Valmanifestet åtar sig att försvara valfriheten inom vård och omsorg och att öppna upp för fler vårdgivare. Partiprogrammet gör rätten till valfrihet till det som ska trygga att den offentligt finansierade välfärden anpassas till individens behov. En utredning av hur äldres möjlighet att välja boende och hemtjänst kan förbättras ligger därmed direkt i linje med planen.
- defend choice in caredecisive»Vi vill försvara valfriheten inom vård och omsorg och bedriva verksamheten nära vårdtagarna.« (2022 manifesto ↗)“We want to defend choice within care and welfare and conduct activities close to care recipients.”
- more providers and increased choice»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 healthcare providers and increase choice so that patients together with their doctor can choose healthcare provider and time when surgery or treatment is best suited according to the patient's needs.”
- choice adapts welfare»Människors rätt till valfrihet är det som ska trygga att den offentligt finansierade välfärden anpassas till individens behov.« (party programme ↗)“People's right to choice is what should ensure that publicly funded welfare is adapted to the individual's needs.”
- joint funding, more actors»Centerpartiet vill se en välfärd som är gemensamt finansierad men som ger valfrihet och där fler aktörer bidrar till ökad innovation, effektivitet och kvalitet.« (party programme ↗)“The Centre Party wants to see welfare that is jointly funded but provides choice and where more actors contribute to increased innovation, efficiency and quality.”
The plan explicitly states that it should be self-evident to choose your own home care company and care home and that elderly care should be characterised by choice and diversity in supply.
Plan documents: party programme
Reasoning and quotes
The plan explicitly states that it should be self-evident to choose your own home care company and care home and that elderly care should be characterised by choice and diversity in supply. The counter-proposal's demand for an investigation into how elderly people's choice in housing and home care can be improved through constitutional amendments follows directly from that commitment. The plan also wants care choice and establishment freedom to prevail throughout the country.
Original (Swedish)
Planen slår uttryckligen fast att det ska vara självklart att själv få välja hemtjänstföretag och äldreboende och att äldreomsorgen ska präglas av valfrihet och mångfald i utbudet. Motförslagets krav på en utredning av hur äldres valfrihet i boende och hemtjänst kan förbättras genom författningsändringar följer direkt av det åtagandet. Planen vill dessutom att vårdval och etableringsfrihet ska råda i hela landet.
- free choice of home care and housingdecisive»att själv få välja hemtjänstföretag och äldreboende.« (party programme ↗)“to choose your own home care company and care home.”
- choice in elderly care»Äldreomsorgen ska präglas av valfrihet för den enskilde och mångfald i utbudet.« (party programme ↗)“Elderly care should be characterised by freedom of choice for the individual and diversity in supply.”
- care choice throughout the country»Vårdval och etableringsfrihet ska råda i hela landet för den som lever upp till kvalitetskraven.« (party programme ↗)“Care choice and establishment freedom shall prevail throughout the country for those who meet the quality requirements.”
- choice in all areas»välfärdstjänsterna stärker individens makt och ska tillämpas på alla områden där så är möjligt.« (party programme ↗)“welfare services strengthen the individual's power and shall be applied in all areas where this is possible.”
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 stipulates that the design of support to the elderly shall be characterized by choice, that elderly care shall be conducted in both private and public sectors and that the individual themselves should be able to choose provider within the framework of granted assistance.
Plan documents: party programme
Reasoning and quotes
The plan stipulates that the design of support to the elderly shall be characterized by choice, that elderly care shall be conducted in both private and public sectors and that the individual themselves should be able to choose provider within the framework of granted assistance. The counter-proposal's demand to investigate how elderly people's choice of residence and home care can be improved is thus precisely what the plan commits to.
Original (Swedish)
Planen slår fast att utformningen av stödet till äldre ska präglas av valfrihet, att äldreomsorg ska bedrivas i både privat och offentlig regi och att den enskilde själv bör kunna välja utförare inom ramen för beviljat bistånd. Motförslagets krav på att utreda hur äldres valfrihet i boende och hemtjänst kan förbättras är därmed precis det planen åtar sig.
- choice in caredecisive»av det stöd som ges präglas av valfrihet« (party programme ↗)“of the support that is given shall be characterized by choice”
- right to choose provider»Den enskilde bör själv kunna välja utförare« (party programme ↗)“The individual themselves should be able to choose provider”
- care in different operation forms»Äldreomsorgsverksamheten ska därför bedrivas« (party programme ↗)“Elderly care activities shall therefore be conducted”
- free choice of healthcare provider»Medborgarna ska ges frihet att själva välja vårdgivare.« (party programme ↗)“Citizens shall be given freedom to choose their own healthcare provider.”
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 makes choice a central part of the welfare model and establishes that important decisions should be able to be made by the individual themselves and that elderly people have the right to an old age that is based on their own preconditions and wishes.
Plan documents: party programme · 2022 manifesto
Reasoning and quotes
The plan makes choice a central part of the welfare model and establishes that important decisions should be able to be made by the individual themselves and that elderly people have the right to an old age that is based on their own preconditions and wishes. An inquiry into how elderly people's choice of housing and home care can be improved follows directly from this. The plan does not, however, mention the legal regulation of the choice system, which is why the position is derived.
Original (Swedish)
Planen gör valfriheten till en central del av välfärdsmodellen och slår fast att viktiga beslut ska kunna fattas av den enskilde själv samt att äldre har rätt till en ålderdom som utgår från egna förutsättningar och önskemål. En utredning om hur äldres val av boende och hemtjänst kan förbättras följer direkt av detta. Planen nämner däremot inte valfrihetssystemets lagreglering, varför ställningstagandet härleds.
- choice in welfaredecisive»För Moderaterna är valfrihet en central del av den svenska« (party programme ↗)“For Moderates, choice is a central part of the Swedish”
- elderly people's own wishes»Äldre har en självklar rätt till en trygg och värdig ålderdom« (party programme ↗)“Elderly people have a natural right to a safe and dignified old age”
- diversity of providers»En mångfald av aktörer är också en förutsättning« (party programme ↗)“A diversity of actors is also a prerequisite”
- secure elderly care»Den som behöver omsorg på ålderns höst ska känna sig trygg med det.« (2022 manifesto ↗)“Those who need care in old age shall feel secure with it.”
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 defends choice within welfare and establishes that the elderly's individual wishes shall be respected and that they shall be able to remain in their familiar environment.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The plan explicitly defends choice within welfare and establishes that the elderly's individual wishes shall be respected and that they shall be able to remain in their familiar environment. An investigation of how elderly choice regarding housing and home care can be improved follows from these commitments, as does the initiative for more housing forms such as means-tested secure housing. The law on choice systems is not, however, explicitly addressed.
Original (Swedish)
Planen försvarar uttryckligen valfriheten inom välfärden och slår fast att de äldres individuella önskemål ska respekteras och att de ska kunna bo kvar i sin invanda miljö. En utredning av hur äldres valfrihet i fråga om boende och hemtjänst kan förbättras följer av dessa åtaganden, liksom av satsningen på fler boendeformer som biståndsbedömt trygghetsboende. Just lagen om valfrihetssystem berörs dock inte uttryckligen.
- choice within welfaredecisive»Sverigedemokraterna ser att marknadsekonomi, valfrihet inom välfärden och internationell handel gynnar samhället och är viktigt att försvara« (2022 manifesto ↗)“Sweden Democrats see that market economy, choice within welfare and international trade benefit society and are important to defend”
- elderly wishes are respected»liksom att de äldres individuella önskemål och preferenser respekteras« (party programme ↗)“as well as the elderly's individual wishes and preferences are respected”
- right to remain»kvar i sin invanda miljö, även om vård- och omsorgsbehov ökar« (party programme ↗)“remain in their familiar environment, even as care needs increase”
- more housing forms for elderly»Satsa på biståndsbedömt trygghetsboende« (2022 manifesto ↗)“Invest in means-tested secure housing”
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
- The committee report on riksdagen.se (2024/25:SoU21)
- Committee report full text (HC01SoU21)
- Per-MP voting data (API)
- Case status (API)
Documents under consideration
- Motion 2024/25:1029 — Kvalitet i äldrevården av Kerstin Lundgren (C)
- Motion 2024/25:1364 — Folkhälsan i fokus av Carina Ståhl Herrstedt m.fl. (SD)
- Motion 2024/25:1365 — God vård och omsorg för äldre av Carina Ståhl Herrstedt m.fl. (SD)
- Motion 2024/25:1412 — Jämställdhet och diskriminering av Michael Rubbestad m.fl. (SD)
- Motion 2024/25:1527 — Skydds- och tvångsåtgärder inom vården och omsorgen för äldre personer av Peder Björk och Malin Larsson (båda S)
- Motion 2024/25:1635 — Språkkrav i välfärden av Lawen Redar (S)
- Motion 2024/25:183 — Förbättrade måltider för äldre i det offentliga av Catarina Deremar (C)
- Motion 2024/25:1851 — Lagen om valfrihetssystem (LOV) inom välfärdsområdet av Jessica Rodén och Petter Löberg (båda S)
- Motion 2024/25:2224 — Språkkrav inom vård och äldreomsorg av Johanna Rantsi (M)
- Motion 2024/25:2234 — Utdrag ur belastningsregister för personer som arbetar med äldre av Johanna Rantsi (M)
- Motion 2024/25:2358 — Svenska språket inom äldreomsorgen av Peter Hultqvist (S)
- Motion 2024/25:2392 — Kognitiva sjukdomar som leder till demens av Mats Sander (M)
- Motion 2024/25:2395 — Heltäckande registerutdrag för personal inom offentlig verksamhet av Caroline Högström (M)
- Motion 2024/25:2493 — Bemanning i verksamheter nära medborgarna av Gunilla Svantorp m.fl. (S)
- Motion 2024/25:2515 — Lagen om valfrihetssystem av Markus Kallifatides m.fl. (S)
- Motion 2024/25:2553 — Språktest för arbete i omsorg och äldreomsorg av Ann-Sofie Lifvenhage (M)
- Motion 2024/25:2675 — Möjlighet att anställa kommunala läkare av Ann-Sofie Lifvenhage (M)
- Motion 2024/25:2701 — Pilotprojekt - seniorhälsa av Ann-Sofie Lifvenhage (M)
- Motion 2024/25:2772 — Språkkrav för vissa jobb inom omsorgen av Sten Bergheden (M)
- Motion 2024/25:2774 — Äldres möjligheter att få bo kvar i sin hemkommun av Sten Bergheden (M)
Source: The Swedish Parliament