January 29, 2008
Sick Swedish Kids Wait for Care, Spurring Parents to Go Private
Niklas Magnusson, The Bloomberg Press, January 24, 2008
Jorun Lindell got fed up with Swedish health care the day her son Harald waited four hours to be treated at a Stockholm emergency ward. His knees and ankles were swollen "like soccer balls.''
"We were hysterical because we didn't know what was wrong and no one would help us,'' says Lindell, 39, whose 4-year-old whimpered with pain in a waiting room at the Astrid Lindgren Children's Hospital, named after the author of the Pippi Longstocking children's books.
Lindell is among the parents backing Sweden's first private hospital for children. Opening in the second half of 2008 in Stockholm's affluent Oestermalm district, Martina Children's Hospital will handle about 20,000 emergency cases a year, a third of Astrid Lindgren's case load.
While Swedish hospitals rank among the best in the world, the slow pace of care has led many wealthy residents to opt out of the government-funded medical system. That's creating tensions in a society where cradle-to-grave welfare programs have traditionally provided equal access to care for everyone.
National health care is rooted in the welfare state created in the early 1930s by the Social Democrats, who were ousted in 2006 after ruling Sweden for most of the past seven decades.
"The new hospital for the children of the upper classes is a mockery of the most fundamental values of the Swedish system,'' said Lars Ohly, leader of the Swedish Left Party. "Care should be given based on needs, not wallets.''
Waiting times for medical care in Sweden are the longest in Europe, according to the Health Consumer Powerhouse, which analyzes health-care systems in the region. About 33,000 people had been waiting more than three months for surgery or other major treatments at the end of August, an increase of 43 percent from May, a report by the Swedish Association of Local Authorities and Regions showed.
Critics of Sweden's welfare model say there are no incentives for hospitals to improve efficiency. Oscar Hjertqvist, director of the Health Consumer Powerhouse, likens the current system to a bad restaurant getting government funding.
"In Sweden, you would get paid just to have a restaurant, but there would be no requirements that people should get any food,'' said Hjertqvist, whose group has offices in Brussels and Stockholm.
Swedish life expectancy at birth is the second-highest in the world behind San Marino, according to the World Health Organization. The country ranks first among European countries in treatment success rates and has one of the highest cancer survival rates, according to the Health Consumer Powerhouse.
"Access is the problem,'' said Eva Nilsson Baagenholm, chairman of the Swedish Medical Association. "We're in a very good position regarding all the so-called quality measures.''
The new children's hospital reflects a broader move toward privatization in Sweden that is championed by the center-right alliance, which took power in September 2006 and favors tax cuts and state asset sales.
Sweden's first private cancer clinic opened in Knivsta, near Stockholm, late last year. In July, the government scrapped a law that prevented patients with private insurance from getting preferential treatment at public hospitals.
"People are getting richer and want to spend more money on health care and education,'' said Andreas Bergh, a social sciences researcher at Lund University in southern Sweden. "Publicly funded health care can't really deliver what more and more people are demanding.''
The cost of insurance to cover care at Martina Children's Hospital would be 3,000 to 5,000 kronor ($775) per child annually, which people on lower incomes can't afford, Ohly said. Only about 3 percent of Swedes now have supplementary health insurance.
Swedes are already burdened with the highest taxes in the European Union, paying 50.1 percent of gross income in 2006, according to the Organization for Economic Cooperation and Development.
Medical resources have been strained by rising demand. More than 5 percent of Swedes are at least 80 years old, the highest proportion in Europe, government statistics show. The overall population has increased 9 percent in the past 20 years to 9 million, and the number of births has climbed 11 percent in a decade.
At Astrid Lindgren, where a statue of the author stands in front of the red brick building, doctors say parents contribute to the long waits by bringing children suffering from minor ailments to the emergency ward.
Since opening a new unit for milder cases two months ago, the hospital has cut average waiting times by about 25 percent to 65 minutes, said Anders Boman, head of the ward.
He welcomes Martina because it will help free up doctors and nurses at public hospitals.
"I notice a significant difference,'' said Cecilia Ketels, whose 5-year-old son was treated for a broken leg within an hour. "I'm pleased with the care here now.''
Jorun Lindell isn't convinced. After their ordeal, the Lindells learned that Harald suffered from a rheumatic disease that can be treated with physical therapy. In the waiting room, they feared cancer.
"The worst part was that you had to wait four to five hours to even get to talk to someone,'' Lindell said. "That's a long time for a worried parent.''
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