This is an opinion article reflecting the views of the author.
The National Audit Office’s recent assessment of the state’s efforts to reduce unacceptable waiting times in Swedish care is unforgiving. The entire billion care and so-called “Standardized Cycles of Care in Cancer Care” (SVF) have been cut in part. Wait times have increased and the difference between regions remains. Targeted government funds had no effect. Nearly 10 billion had gone up in smoke.
Since no positive effects have been shown in the form of shorter waiting times, some patients cannot reasonably be prioritized over others
Swedish municipalities and regions, SKR, constantly claim that the regions do not want targeted grants, no indications from the state, but are happy to receive unconditional money. In practice, in this case, the regions independently converted targeted grants into freely available funds. But not all, as some have gone into increasing grant management, which may not have been the intention.
displacement
The National Audit Office also points out that targeted grants easily lead to crowding out. In health care, this argument is often made to defend that waiting times are longer for those who should not be given priority. But since no positive effects have been shown in the form of shorter waiting times, some patients cannot reasonably be prioritized over others. In this case, the reason is that managing waiting lists took staff and money and thus reduced the care capacity. For example, many nurses worked coordinating and recording rather than caring for patients.
A sub-project that the NAO does not view entirely negatively is the Special Voluntary Fund. It is said that the project initially reduced waiting times for some diagnostics, which is interpreted as the project can lead to business development. This can be questioned because the distributed funds did not have enough time to be used. Instead, this concern has caused clinics with extreme or totally unnecessary wait times to quickly narrow on their own.
That times have not improved since then is indicative precisely because no effective business development was ever achieved during the eight years that the project ran.
The National Audit Office misunderstood
Rightly so, the National Audit Office points out that the SKR’s own statistics are, for various reasons, about to become unusable, and so they have turned to the National Quality Records. The SKR report has also been criticized in terms of the number of patients rather than the number of unnecessary waiting days per patient, which is misleading. Using examples from the two biggest diagnoses — breast cancer and prostate cancer — the number of patients who waited longer than the given time limit is about the same, about 25% for all cancer patients. On the other hand, when you calculate the number of non-essential days expected per patient in each diagnosis group, breast cancer ranks among the lowest of all, while prostate cancer ranks first. It should be remembered that the project was called “Every Day Counts”.
The most reasonable conclusion would be for the state to recommend that targeted grants be terminated immediately
At some point, the National Audit Office misunderstood the Special Voluntary Fund project. People are wondering about the effects of long waiting times on care outcomes. This question is very urgent of course, but the original goal of the SVF project was to reduce the very intense psychological stress that patients experience due to the unnecessary waiting time between the suspicion of cancer and the first procedure.
Clear conclusions but cautious suggestions
The conclusions of the National Audit Office are clear, but the proposals are cautious, to put it mildly. Almost $10 billion was paid to no effect. It cannot be obvious that the state cannot influence health care through targeted “bribes”. Screwing a little bit here and there won’t be enough. The investigation also states when compared to Denmark and Norway that waiting times there are less of an issue because the country has a stronger stance.
The most plausible conclusion was to recommend that the state immediately stop direct subsidies and take care of it instead. The government-appointed investigation into healthcare leadership is urgent, but it must not delay the resolution of urgent problems. Care task formulation and assessment should be lifted immediately from the caregiver, and penalties should be imposed in case of deviations. Take the reins but be careful of the horses!
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