2022-11-302022/23:SfU7 · p.1SfUMigration & social insurance
Follow-up of the National Board of Health and Welfare's work on decision support
Follow-up of the National Board of Health and Welfare's decision-support tool for sick-leave certification in digital doctor visits
What's at stake: The National Audit Office has shown that medical certificates from digitally profiled care providers more often lack information than certificates issued during in-person visits, and that there are shortcomings in the Social Insurance Agency's follow-up of the digital certificates. These shortcomings can affect legal certainty and consistency in assessing sick-leave claims for patients regardless of where in the country they live or what type of care provider they use.
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 set up a dedicated inquiry to follow up the National Board of Health and Welfare's ongoing work to develop the decision-support tool for sick-leave certification in digital doctor visits, or whether it is enough for the government to monitor the agency's already ongoing work without a separate inquiry.
Yes Yes — the committee proposal
The committee reaches the same assessment as the Social Affairs Committee and rejects the motion. It notes that the government shares the National Audit Office's assessment that consistency between regions and care providers should be improved and that national support for medical certificates based on digital doctor visits needs to be developed, and that the National Board of Health and Welfare is already working to broaden and deepen the decision-support tool. The committee expects the government to monitor the agency's work and therefore does not consider a dedicated inquiry necessary.
No No — the reservations
Reservation 1 (SD)
The reservation (SD) calls for the government to set up an inquiry to follow up the National Board of Health and Welfare's work on developing the decision-support tool into a broader, more in-depth knowledge base for sick-leave certification. The reasoning is that the National Audit Office's criticism is substantial: medical certificates from digitally profiled care providers more often lack information than certificates from in-person visits, and there are shortcomings in the Social Insurance Agency's follow-up of the digital certificates.
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 1 by SD.
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: VVänsterpartiet
Ja 234–64Ja 213–85
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 21/0/0/3 | differsagainst own programme | confidence: high | explicit |
| S | No | Yes 91/1/0/15 | differs | confidence: medium | not addressed |
| MP | No | Yes 15/0/0/3 | differs | confidence: medium | not addressed |
| C | No | Yes 19/0/0/5 | differs | confidence: medium | derived |
| L | No | Yes 14/0/0/2 | differs | confidence: medium | not addressed |
| KD | No | Yes 16/0/0/3 | differs | confidence: medium | not addressed |
| M | No | Yes 58/0/0/10 | differs | confidence: low | not addressed |
| SD | No | No 0/63/0/10 | match | confidence: high | explicit |
Broke with the party line
| SOlle Thorell (S, Västmanlands län) | No — party line: Yes |
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 motion 2022/23:19 by Clara Aranda et al. (SD).
Original (Swedish)
Riksdagen avslår motion 2022/23:19 av Clara Aranda m.fl. (SD).
Riksdag decision: Parliament has considered a letter from the government. The letter concerns the Swedish National Audit Office's examination of digital doctor's visits and hired doctors in the sickness certification process. The Swedish National Audit Office's overall conclusion shows that there are deficiencies in certain control functions during the sickness certification process. In the report, the Swedish National Audit Office recommends that the government draw up clear national guidelines for medical certificates issued on the basis of a digital doctor's visit. The government largely agrees with the Swedish National Audit Office and refers in the letter to the National Board of Health and Welfare's ongoing work on the matter. Parliament does not consider there to be a reason to take any action, but assumes that the government will follow the National Board of Health and Welfare's work. Parliament placed the letter among the records, that is, closed the matter.
Counter-proposals
- The counter-proposal wants the government to establish an investigation to follow up on the work with the insurance medicine decision support system. (SD) — 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 requires a humane insurance system and an end to being uninsured when sick, and that the person who becomes ill can trust the National Insurance Administration without having to fight tooth and nail.
Plan documents: 2022 manifesto
Reasoning and quotes
The plan requires a humane insurance system and an end to being uninsured when sick, and that the person who becomes ill can trust the National Insurance Administration without having to fight tooth and nail. It also directs explicit criticism at resources going to digital health services. An investigation that follows up and deepens the decision support, especially for digital medical certificates, aligns with this.
Original (Swedish)
Planen kräver en mänsklig sjukförsäkring och ett slut på utförsäkrandet, och att den som blir sjuk ska kunna lita på Försäkringskassan utan att behöva stånga sig blodig. Den riktar dessutom uttrycklig kritik mot att resurser går till nätläkartjänster. En utredning som följer upp och fördjupar beslutsstödet, särskilt för digitala läkarintyg, ligger i linje med detta.
- humane insurance systemdecisive»Vänsterpartiet vill se en mänsklig sjukförsäkring och ett slut på utförsäkrandet av sjuka.« (2022 manifesto ↗)“The Left Party wants to see a humane insurance system and an end to people becoming uninsured when sick.”
- criticism of digital health services»Det är inte acceptabelt att stora resurser, som behövs till människor med komplext eller långvarigt behov av vård istället går till nätläkartjänster för att behandla vanlig snuva och andra mindre åkommor hos friska människor.« (2022 manifesto ↗)“It is not acceptable that large resources, needed for people with complex or long-term care needs, instead go to digital health services for treating common colds and other minor ailments in healthy people.”
- secure benefit payments»När du blir sjuk eller föder barn ska du kunna lita på att få ersättning från Försäkringskassan utan att behöva stånga dig blodig.« (2022 manifesto ↗)“When you become sick or have a child you should be able to trust that you will receive benefits from the National Insurance Administration without having to fight tooth and nail.”
- consistent assessment across the country»Sjukvården måste vara jämlik, jämställd och tillgänglig, oavsett var i landet du bor och oavsett vem du är.« (2022 manifesto ↗)“Healthcare must be equitable, equal and accessible, regardless of where in the country you live and regardless of who you are.”
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 increase oversight of healthcare and establishes that advice shall not be given for economic reasons, which is the core of criticism against digitally profiled healthcare providers' medical certificates.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The plan wants to increase oversight of healthcare and establishes that advice shall not be given for economic reasons, which is the core of criticism against digitally profiled healthcare providers' medical certificates. The plan also stands firm that someone too sick to work can rely on insurance, which presupposes uniform and high-quality certificates. A follow-up of the decision support is thereby in line with the plan.
Original (Swedish)
Planen vill växla upp tillsynen av sjukvården och slår fast att råd inte ska ges av ekonomiska skäl, vilket är kärnan i kritiken mot digitalt profilerade vårdgivares läkarintyg. Planen står också fast vid att den som är för sjuk för att arbeta ska kunna lita på sjukförsäkringen, vilket förutsätter likformiga och kvalitativa intyg. En uppföljning av beslutsstödet ligger därmed i linje med planen.
- increased healthcare oversightdecisive»Tillsynen av sjukvården ska växlas upp för att garantera kvaliteten.« (2022 manifesto ↗)“Healthcare oversight shall be increased to guarantee quality.”
- healthcare not governed by economic reasons»För att säkra kvaliteten, hindra att råd ges av ekonomiska skäl och att förhindra att känsliga uppgifter hamnar i fel händer, vill vi att 1177 drivs i offentlig regi.« (2022 manifesto ↗)“To ensure quality, prevent that advice is given for economic reasons and to prevent that sensitive information ends up in the wrong hands, we want 1177 to be run in public administration.”
- reliable sick leave insurance»vi slår vakt om principen att den som är för sjuk för att arbeta ska kunna lita på sjukförsäkringen« (2022 manifesto ↗)“we stand firm on the principle that someone too sick to work can rely on insurance”
- equal care across the entire country»Alla invånare i hela landet ska ha likvärdig tillgång till skola, vård och omsorg.« (party programme ↗)“All inhabitants across the entire country shall have equal access to school, care and social services.”
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 wants to change the sickness insurance so that it provides better security in sick leave and that people are not passed between authorities, and the party programme requires equitable healthcare and that digital services in healthcare are well developed.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The election manifesto wants to change the sickness insurance so that it provides better security in sick leave and that people are not passed between authorities, and the party programme requires equitable healthcare and that digital services in healthcare are well developed. Deficiencies in medical certificates from digital healthcare providers undermine both of these commitments. A follow-up investigation of the decision support is therefore in line with the plan.
Original (Swedish)
Valmanifestet vill förändra sjukförsäkringen så att den ger bättre trygghet vid sjukskrivning och att människor inte bollas mellan myndigheter, och partiprogrammet kräver likvärdig vård och att digitala tjänster i vården utvecklas väl. Brister i läkarintyg från digitala vårdgivare undergräver båda dessa åtaganden. En uppföljande utredning av beslutsstödet ligger därför i planens riktning.
- security in sick leavedecisive»förändra sjukförsäkringen så den ger bättre trygghet vid sjukskrivning och se till att människor inte bollas mellan myndigheter när de behöver samhällets stöd.« (2022 manifesto ↗)“change the sickness insurance so it provides better security in sick leave and ensure that people are not passed between authorities when they need society's support.”
- equitable healthcare throughout the country»Likvärdig vård oberoende av kön och« (party programme ↗)“Equitable healthcare regardless of gender and”
- quality in digital healthcare»Digitala tjänster inom vården ska utvecklas.« (party programme ↗)“Digital services in healthcare should be developed.”
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 wants to improve rehabilitation and make sickness absence more flexible, which presumes a knowledge base that holds up.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The plan wants to improve rehabilitation and make sickness absence more flexible, which presumes a knowledge base that holds up. It also requires continuity in healthcare contact, with a fixed doctor contact who can be met both physically and digitally, and that care is based on science and proven experience. The counter-proposal's requirement for a study that follows up and deepens the support, especially in digital doctor certificates, is in line with this.
Original (Swedish)
Planen vill förbättra rehabiliteringen och göra sjukskrivningen mer flexibel, vilket förutsätter ett kunskapsstöd som håller. Den kräver också kontinuitet i vårdkontakten, med en fast läkarkontakt som kan mötas både fysiskt och digitalt, och att vården vilar på vetenskap och beprövad erfarenhet. Motförslagets krav på en utredning som följer upp och fördjupar beslutsstödet, inte minst vid digitala läkarintyg, ligger i linje med detta.
- more flexible sickness absencedecisive»Vi vill förbättra rehabiliteringen och göra sjukskrivningen mer flexibel.« (2022 manifesto ↗)“We want to improve rehabilitation and make sickness absence more flexible.”
- continuity in healthcare contact»Alla ska ha rätt till en fast läkarkontakt som man vet namnet på och som man kan möta både fysiskt och digitalt.« (2022 manifesto ↗)“Everyone shall have the right to a fixed doctor contact whom you know by name and whom you can meet both physically and digitally.”
- care on scientific basis»God vård och omsorg i hela landet, baserad på vetenskap och beprövad erfarenhet« (party programme ↗)“Good care and nursing throughout the country, based on science and proven experience”
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 care and assessments are carried out on scientific grounds and that licensed staff always work according to science and proven experience, which is precisely what a knowledge support for sick leave shall secure.
Plan documents: party programme · 2022 manifesto
Reasoning and quotes
The plan requires that care and assessments are carried out on scientific grounds and that licensed staff always work according to science and proven experience, which is precisely what a knowledge support for sick leave shall secure. The plan also wants digital care to maintain at least as good quality as physical, which argues for follow-up of shortcomings in digital medical certificates. Insurance security presumes uniform assessments.
Original (Swedish)
Planen kräver att vård och bedömningar sker på vetenskaplig grund och att legitimerad personal alltid arbetar enligt vetenskap och beprövad erfarenhet, vilket är precis vad ett kunskapsstöd vid sjukskrivning ska säkra. Planen vill dessutom att digital vård håller minst lika god kvalitet som fysisk, vilket talar för att bristerna i digitala läkarintyg följs upp. Sjukförsäkringens trygghet förutsätter likformiga bedömningar.
- care on scientific groundsdecisive»Vård, behandling och rehabilitering av fysiska och psykiska sjukdomar ska ges på vetenskaplig grund.« (party programme ↗)“Care, treatment and rehabilitation of physical and mental illnesses shall be given on scientific grounds.”
- digital care with same quality»Vi vill se en digital valfrihetsreform och vårdgaranti där alla regioner ska åläggas att erbjuda en minst lika bra digital tillgänglighet som fysisk, där du utifrån din situation alltid ska välja hur du vill möta vården.« (2022 manifesto ↗)“We want to see a digital choice reform and care guarantee where all regions shall be obliged to offer at least as good digital accessibility as physical, where you based on your situation always shall choose how you want to meet care.”
- science and proven experience»Personal i legitimationsyrken ska alltid arbeta i enlighet med vetenskap och beprövad erfarenhet.« (party programme ↗)“Staff in licensed professions shall always work in accordance with science and proven experience.”
- secure insurance»Sjukförsäkringen ska ge ekonomisk trygghet vid både kortvarig och kronisk sjukdom« (party programme ↗)“Insurance shall provide economic security in both short-term and chronic illness”
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 suggests that a review follow up work with decision support for sickness certification, including deficiencies in medical certificates from digital care providers.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The counter-proposal suggests that a review follow up work with decision support for sickness certification, including deficiencies in medical certificates from digital care providers. The election manifesto requires national standards and technical specifications for all digital healthcare information, and the party programme makes evaluation and quality control an important political task in evidence-based care. The plan therefore supports follow-up that ensures uniformity and quality in certificates.
Original (Swedish)
Motförslaget vill att en utredning följer upp arbetet med beslutsstödet vid sjukskrivning, bland annat bristerna i läkarintyg från digitala vårdgivare. Valmanifestet kräver nationella standarder och tekniska specifikationer för all digital vårdinformation, och principprogrammet gör utvärdering och kvalitetskontroll till en viktig politisk uppgift i en evidensbaserad vård. Planen stöder därför en uppföljning som säkrar likformighet och kvalitet i intygen.
- national standards for digital healthcare informationdecisive»Trygg patientsäkerheten med nationella standarder och tekniska specifikationer för all digital vårdinformation.« (2022 manifesto ↗)“Ensure patient safety with national standards and technical specifications for all digital healthcare information.”
- monitoring as political task»Utvärdering, kostnadsuppföljning och kvalitetskontroll är därför viktiga politiska« (party programme ↗)“Evaluation, cost tracking and quality control are therefore important political”
- evidence-based care»Den solidariskt finansierade hälso- och sjukvården ska vara ändamålsenlig och kostnadseffektiv, säker för patienterna och baserad på kunskap och beprövad erfarenhet« (party programme ↗)“The solidarily funded healthcare should be appropriate and cost-effective, safe for patients and based on knowledge and proven experience”
- support for return to work»Nivåerna på ersättningarna ska utformas så att den enskilde stimuleras att delta i åtgärder« (party programme ↗)“The levels of compensation shall be designed so that the individual is stimulated to participate in measures”
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 wants to develop digital decision support and structured working methods in healthcare and states that everyone has the right to equivalent care, while incorrect payments shall be combated with a special benefit fraud unit.
Plan documents: 2022 manifesto
Reasoning and quotes
The plan wants to develop digital decision support and structured working methods in healthcare and states that everyone has the right to equivalent care, while incorrect payments shall be combated with a special benefit fraud unit. Inadequate doctor's certificates from digitally profiled healthcare providers address both these commitments. A follow-up investigation of the decision support thus lies in line with the plan and is supported, but the link is inferred.
Original (Swedish)
Planen vill utveckla digitala beslutsstöd och strukturerade arbetssätt i vården och slår fast att alla har rätt till likvärdig vård, samtidigt som felaktiga utbetalningar ska bekämpas med en särskild bidragsbrottsenhet. Bristfälliga läkarintyg från digitalt profilerade vårdgivare berör båda dessa åtaganden. En uppföljande utredning av beslutsstödet ligger därmed i linje med planen och stöds, men kopplingen är härledd.
- digital decision supportdecisive»Förbättra möjligheterna att ställa tidigare diagnoser, bland annat med hjälp av digitala beslutsstöd och strukturerade arbetssätt med till exempel riskprofilering« (2022 manifesto ↗)“Improve the possibilities of making earlier diagnoses, among other things with the help of digital decision support and structured working methods with for example risk profiling”
- equivalent care»Alla har rätt till likvärdig vård – som kan ges i rätt tid och håller hög kvalitet.« (2022 manifesto ↗)“Everyone has the right to equivalent care - which can be given at the right time and holds high quality.”
- control of payments»Inrätta en bidragsbrottsenhet på Försäkringskassan« (2022 manifesto ↗)“Establish a benefit fraud unit at the Social Insurance Agency”
flags: citat_migrerat
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 wishes to investigate and follow up the work on developing decision support for sick leave, with criticism of shortcomings in medical certificates from digital care providers.
Plan documents: 2022 manifesto
Reasoning and quotes
The counter-proposal wishes to investigate and follow up the work on developing decision support for sick leave, with criticism of shortcomings in medical certificates from digital care providers. The plan explicitly states that regulations within sick insurance must be better adapted regarding knowledge and decision support, and that the quality of the investigation work underlying decisions needs to be strengthened. The requirement thus lies directly in line with the plan.
Original (Swedish)
Motförslaget vill utreda och följa upp arbetet med att utveckla beslutsstödet vid sjukskrivning, med kritik mot brister i läkarintyg från digitala vårdgivare. Planen slår uttryckligen fast att regelverket inom sjukförsäkringen bättre måste anpassas vad gäller kunskap och beslutsstöd, och att kvaliteten i det utredningsarbete som ligger till grund för beslut behöver stärkas. Kravet ligger därmed direkt i linje med planen.
- better decision support in sick insurancedecisive»Likaså måste regelverket inom sjukförsäkringen bättre anpassas både vad gäller kunskap och beslutsstöd när det kommer till psykisk ohälsa och komplexa diagnoser.« (2022 manifesto ↗)“Likewise, regulations within sick insurance must be better adapted both regarding knowledge and decision support when it comes to mental ill-health and complex diagnoses.”
- quality in investigations»Kvalitén i utredningsarbetet som ligger till grund för beslut behöver stärkas.« (2022 manifesto ↗)“The quality of the investigation work underlying decisions needs to be strengthened.”
- strengthened investigation quality»Verka för stärkt kvalitet på utredningar och förkortade handläggningstider« (2022 manifesto ↗)“Work for strengthened quality in investigations and shortened processing times”
- individualised assessments»Öka flexibiliteten och individanpassningen i beslutsfattandet« (2022 manifesto ↗)“Increase flexibility and individualisation in decision-making”
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Sources and documents
- The committee report on riksdagen.se (2022/23:SfU7)
- Committee report full text (HA01SfU7)
- Per-MP voting data (API)
- Case status (API)
Documents under consideration
- Motion 2022/23:19 — med anledning av skr. 2021/22:266 Riksrevisionens rapport om digitala läkarbesök och hyrläkare i sjukskrivningsprocessen av Clara Aranda m.fl. (SD)
- Regeringens skrivelse 2021/22:266 — Riksrevisionens rapport om digitala läkarbesök och hyrläkare i sjukskrivningsprocessen
Source: The Swedish Parliament