2023-01-252022/23:SoU5 · p.3SoUHealth & social services
The Health and Medical Care Act's future design
The future shape of the Health and Medical Services Act: tighter requirements and clearer financing rules
What's at stake: The decision concerns how far legislation should go to stop patients with private health insurance from jumping the queue, and whether the rules on how tax-funded care may be financed should be clarified, affecting every patient in the publicly funded system.
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 should return with tighter proposals preventing private providers from hiding other principals and preventing regions from contracting with providers that also hold insurance-company contracts, along with clearer rules on how care may be financed, or whether no such task should be assigned now.
Yes Yes — the committee proposal
The committee rejects the motions calling for tighter requirements and clearer financing rules, referring to its own proposal to reject the provision on contract terms for providers with several principals, and stating that it shares the assessment that the inquiry's proposal on how care should be financed should not be implemented.
No No — the reservations
Reservation 2 (V)
The dissenter believes the proposed provision risks being insufficient since providers can hide other principals by placing each contract in a separate company, and wants the government to return with proposals ensuring both transparency about principals and that regions cannot contract with providers that also hold insurance-company agreements, along with clearer rules on how care may be financed.
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 2 by V.
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 | Yes 93/0/0/14 | departs from the plan | confidence: high | derived |
| MP | No | Abstain 0/0/16/2 | departs from 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 | derived |
| KD | Yes | Yes 17/0/0/2 | follows the plan | confidence: low | not addressed |
| M | Yes | Yes 59/0/0/9 | follows the plan | confidence: medium | derived |
| SD | Yes | Yes 64/0/0/9 | follows the plan | confidence: medium | not addressed |
Committee proposal
Parliament rejects motion 2022/23:2 by Karin Rågsjö et al. (V) motions 1, 2 and 4.
Original (Swedish)
Riksdagen avslår motion 2022/23:2 av Karin Rågsjö m.fl. (V) yrkandena 1, 2 och 4.
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 strengthen rules to prevent private care providers from concealing other clients and to prevent regions from contracting with care providers that simultaneously hold insurance company contracts. (V) — Reservation 2
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 insurance or position in society shall not determine what care you get and wants to ban profit-driven activities in welfare, so that tax funds go to activity instead of profits.
Plan documents: 2022 manifesto
Reasoning and quotes
The plan establishes that insurance or position in society shall not determine what care you get and wants to ban profit-driven activities in welfare, so that tax funds go to activity instead of profits. Requirements for openness about principals and for regions not to contract with care providers who at the same time have insurance agreements follow from this.
Original (Swedish)
Planen slår fast att försäkring eller position i samhället inte ska avgöra vilken vård man får och vill förbjuda vinstdrivande verksamhetsformer i välfärden, så att skattemedlen går till verksamhet i stället för vinster. Krav på öppenhet om uppdragsgivare och på att regioner inte får avtala med vårdgivare som samtidigt har försäkringsavtal följer av detta.
- insurance must not control caredecisive»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.”
- profit ban in welfare»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 activities within welfare.”
- tax funds go to activity»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 services that are solidaristically financed by tax funds and where money goes to activity and not to company profits is a fundamental precondition for achieving equal care throughout Sweden.”
- profit ban instead of toothless control»Välfärdsbrott bekämpas inte bäst genom ytterligare tandlös kontroll.« (2022 manifesto ↗)“Welfare crime is not best combated through additional toothless control.”
The plan demands that the principle of openness shall apply even to private care and that a person with private health insurance should not get priority in publicly financed care.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The plan demands that the principle of openness shall apply even to private care and that a person with private health insurance should not get priority in publicly financed care. The counter-proposal's demands for transparency about employers and that regions should not be able to contract with care providers that at the same time have insurance agreements follow from this. The plan also wants national rules that limit profit interests in tax-financed activities.
Original (Swedish)
Planen kräver att offentlighetsprincipen ska gälla även privat vård och att den som har privat sjukvårdsförsäkring inte får gå före i den offentligfinansierade vården. Motförslagets krav på öppenhet om uppdragsgivare och på att regioner inte ska kunna avtala med vårdgivare som samtidigt har försäkringsavtal följer av detta. Planen vill också ha nationella regelverk som begränsar vinstintresset i skattefinansierad verksamhet.
- no privileged access via insurancedecisive»Den som har en privat sjukvårdsförsäkring ska inte kunna få bättre eller snabbare hjälp i den offentligfinansierade vården.« (2022 manifesto ↗)“A person with private health insurance should not be able to get better or faster care in publicly financed healthcare.”
- transparency in private care»Offentlighetsprincipen ska gälla även privat vård och omsorg.« (2022 manifesto ↗)“The principle of openness shall apply also to private care and social services.”
- national rules»För all verksamhet som drivs på uppdrag av det offentliga och finansieras med skattemedel ska det finnas nationellt fastställda regelverk.« (party programme ↗)“For all activities run on behalf of the public and financed with tax funds there must be nationally established rules.”
- limited profit interest»Dessa ska försäkra att verksamheten drivs med hög kvalitet, att vinstintresset begränsas och inte fungerar styrande för verksamheten, samt att de anställda har samma rättigheter och samma skydd oavsett driftsform.« (party programme ↗)“These should ensure that the activity is run with high quality, that profit interests are limited and do not steer the activity, and that employees have the same rights and protection regardless of operating model.”
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 wants to remove commercially oriented actors from welfare, requires that care is distributed according to need and that freedom of information and the principle of public access apply to all publicly funded welfare.
Plan documents: party programme
Reasoning and quotes
The party programme wants to remove commercially oriented actors from welfare, requires that care is distributed according to need and that freedom of information and the principle of public access apply to all publicly funded welfare. The counter-proposal's requirements for transparency about care providers' clients, stop for agreements with care providers that also have insurance agreements and clearer financing rules express precisely these commitments. The plan therefore supports the counter-proposal.
Original (Swedish)
Partiprogrammet vill få bort de kommersiellt inriktade aktörerna ur välfärden, kräver att vården fördelas efter behov och att meddelarfrihet och offentlighetsprincipen gäller all offentligt finansierad välfärd. Motförslagets krav på öppenhet om vårdgivarnas uppdragsgivare, stopp för avtal med vårdgivare som samtidigt har försäkringsavtal och tydligare finansieringsregler uttrycker just dessa åtaganden. Planen stöder därför motförslaget.
- limit commercial care actorsdecisive»få bort de kommersiellt inriktade aktörerna« (party programme ↗)“remove the commercially oriented actors”
- care according to need»fördelas efter behov och« (party programme ↗)“distributed according to need and”
- transparency in welfare»Meddelarfrihet och offentlighetsprincipen ska gälla« (party programme ↗)“Freedom of information and the principle of public access shall apply”
- care on equal terms»Välfärdstjänster inom vård, skola och omsorg ska« (party programme ↗)“Welfare services in health care, education and social care shall”
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 wants to open up for more care providers, increase choice freedom and defend it, and establishes that diversity of providers is positive as long as people's needs and choice freedom stand in the centre.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The plan wants to open up for more care providers, increase choice freedom and defend it, and establishes that diversity of providers is positive as long as people's needs and choice freedom stand in the centre. The counter-proposal's requirement for rules preventing regions from contracting with care providers who also have insurance contracts, and for clearer financing rules, would strangle that diversity. The plan therefore speaks against the requirement, even though care according to need is a counterweight.
Original (Swedish)
Planen vill öppna upp för fler vårdgivare, öka valfriheten och försvara den, och slår fast att mångfalden av utförare är positiv så länge människors behov och valfrihet står i centrum. Motförslagets krav på regler som hindrar regioner från att avtala med vårdgivare som också har försäkringsavtal, och på tydligare finansieringsregler, skulle strypa den mångfalden. Planen talar därför emot kravet, även om vård efter behov är en motvikt.
- more care providers and choice freedomdecisive»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 freedom so that patients together with their doctor can choose care provider and time when operation or treatment fits best based on the patient's needs.”
- diversity of providers»Oavsett om den offentligt finansierade välfärden utförs av kommuner, landsting, företag, kooperativ eller föreningar måste berörda människors behov och valfrihet stå i centrum.« (party programme ↗)“Regardless of whether publicly financed welfare is provided by municipalities, county councils, companies, cooperatives or associations, the needs and choice freedom of affected people must stand in the centre.”
- choice freedom defended»Vi vill försvara valfriheten inom vård och omsorg och bedriva verksamheten nära vårdtagarna.« (2022 manifesto ↗)“We want to defend choice freedom within care and conduct activities close to care recipients.”
- care according to need»att snabbt få vård i den offentligt finansierade sjukvården ska ges efter behov och inte efter betalningsförmåga.« (party programme ↗)“to quickly receive care in the publicly financed healthcare system shall be given according to need and not according to ability to pay.”
The counter-proposal wants to prohibit regions from contracting with care providers who simultaneously have contracts with insurance companies.
Plan documents: party programme
Reasoning and quotes
The counter-proposal wants to prohibit regions from contracting with care providers who simultaneously have contracts with insurance companies. The plan's commitment is the opposite: patient choice and establishment freedom shall apply throughout the country for those who meet quality requirements, and private and public providers shall operate on equal terms because individual alternatives drive quality and diversity. The requirement for transparency about commissioners has support, however, in the plan's principle that publicly funded activities shall be subject to the same transparency rules regardless of operational form.
Original (Swedish)
Motförslaget vill förbjuda regioner att avtala med vårdgivare som samtidigt har avtal med försäkringsbolag. Planens åtagande är motsatt: vårdval och etableringsfrihet ska råda i hela landet för den som uppfyller kvalitetskraven, och privata och offentliga utförare ska verka på lika villkor eftersom enskilda alternativ driver kvalitet och mångfald. Kravet på öppenhet om uppdragsgivare har däremot stöd i planens princip att offentligt finansierad verksamhet ska omfattas av samma insynsregler oavsett driftsform.
- establishment freedom in caredecisive»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”
- individual alternatives drive quality»Enskilda alternativ i välfärdssektorn spelar en viktig roll för att driva på kvalitetsarbetet och öka mångfalden« (party programme ↗)“Individual alternatives in the welfare sector play an important role in driving quality work and increasing diversity”
- same transparency rules»Offentligt finansierad verksamhet ska omfattas av samma regler« (party programme ↗)“Publicly funded activities shall be subject to the same rules”
The counter-proposal wants to prohibit regions from contracting with healthcare providers who simultaneously have contracts with insurance companies and tighten rules for how care can be financed.
Plan documents: party programme · 2022 manifesto
Reasoning and quotes
The counter-proposal wants to prohibit regions from contracting with healthcare providers who simultaneously have contracts with insurance companies and tighten rules for how care can be financed. The plan builds care on diversity and choice: citizens shall freely be able to choose healthcare providers, private and ideally-based alternatives shall be given conditions to develop and it shall become easier to start one's own practice. A general contracting prohibition goes further than the plan allows, even though the plan simultaneously requires that care is needs-driven.
Original (Swedish)
Motförslaget vill förbjuda regioner att avtala med vårdgivare som samtidigt har avtal med försäkringsbolag och skärpa reglerna för hur vården får finansieras. Planen bygger vården på mångfald och valfrihet: medborgarna ska fritt kunna välja vårdgivare, privata och idéburna alternativ ska ges förutsättningar att utvecklas och det ska bli enklare att starta egen mottagning. Ett generellt avtalsförbud går längre än planen medger, även om planen samtidigt kräver att vården är behovsstyrd.
- free choice of healthcare providerdecisive»Medborgarna ska ges frihet att själva välja vårdgivare.« (party programme ↗)“Citizens shall be given freedom to choose their own healthcare provider.”
- diversity of healthcare providers»Flera olika vårdgivare kan stimulera till nytänkande och tillföra vården nya dimensioner.« (party programme ↗)“Several different healthcare providers can stimulate new thinking and bring new dimensions to healthcare.”
- easier to start healthcare operations»Fler vårdcentraler på landsbygden och enklare för enskilda läkare att starta egen verksamhet - så att vården finns nära till hands.« (2022 manifesto ↗)“More health centres in rural areas and easier for individual doctors to start their own practice - so that healthcare is close at hand.”
- needs-driven care»Den solidariskt finansierade hälso- och sjukvården är välfärdens kärna och ska vara behovsstyrd.« (party programme ↗)“The solidarity-financed healthcare is the core of welfare and shall be needs-driven.”
The counter-proposal wants to tighten regulation so that regions cannot contract with healthcare providers that simultaneously have insurance contracts, and introduce clearer rules for how care may be financed.
Plan documents: party programme · 2022 manifesto
Reasoning and quotes
The counter-proposal wants to tighten regulation so that regions cannot contract with healthcare providers that simultaneously have insurance contracts, and introduce clearer rules for how care may be financed. The plan is based on choice and a welfare system that combines public and private in both provision and financing, and warns against a monolithic centrally controlled welfare system. Patients should also be able to turn to another care provider when care is delayed. The demand is rejected.
Original (Swedish)
Motförslaget vill skärpa regleringen så att regioner inte kan avtala med vårdgivare som samtidigt har försäkringsavtal, och införa tydligare regler för hur vården får finansieras. Planen bygger på valfrihet och en välfärd som kombinerar offentligt och privat i både utförande och finansiering, och varnar för ett monolitiskt centralstyrt välfärdssystem. Patienten ska dessutom kunna vända sig till annan vårdgivare när vården dröjer. Kravet avvisas.
- 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.”
- no to centrally controlled welfare»centralstyrt välfärdssystem kommer stå illa rustat« (party programme ↗)“centrally controlled welfare system will be poorly equipped”
- patient's right to choose care 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 set time limits the patient shall have the right to turn to another care provider and be reimbursed for the extra costs this entails”
- choice in welfare»För Moderaterna är valfrihet en central del av den svenska« (party programme ↗)“For Moderate Party, choice is a central part of the Swedish”
The counter-proposal wants new proposals that prevent regions from contracting with healthcare providers that also have contracts with insurance companies, plus stricter financing rules.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The counter-proposal wants new proposals that prevent regions from contracting with healthcare providers that also have contracts with insurance companies, plus stricter financing rules. The plan, by contrast, is based on healthcare capacity increasing through cooperation agreements with both public and private healthcare providers and on healthcare choice within the welfare system being worth defending. Excluding healthcare providers would reduce the capacity the plan wants to mobilize to shorten waiting times.
Original (Swedish)
Motförslaget vill ha nya förslag som hindrar regioner från att avtala med vårdgivare som samtidigt har avtal med försäkringsbolag, plus hårdare finansieringsregler. Planen bygger tvärtom på att vårdkapaciteten ska öka genom samverkansavtal med både offentliga och privata vårdgivare och att valfriheten inom välfärden är värd att försvara. Att stänga ut vårdgivare skulle minska den kapacitet planen vill mobilisera för att korta köerna.
- increase capacity through agreementsdecisive»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 healthcare guarantee office should also prepare materials and establish cooperation agreements with various healthcare providers, public and private, Swedish and foreign, to be able to increase healthcare capacity in treatment, surgery and rehabilitation.”
- healthcare choice in the welfare system»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, healthcare choice within the welfare system and international trade benefit society and are important to defend”
- neutral view on operator type»Vi lägger inget egenvärde i vem som driver sjukvården« (party programme ↗)“We place no intrinsic value on who provides healthcare”
- care according to need»hälso- och sjukvården ska vara solidariskt finansierad via skattsedeln, ges efter behov« (party programme ↗)“healthcare shall be financed in solidarity via taxation, provided according to need”
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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