Monday, February 02, 2009

The Swedish Healthcare System in Action

I went to Apoteket the other day. Had to pick up a dildo, it’s not everywhere you can get one of those at the pharmacy. I kid, I kid. Come on now. I had to pick up a prescription.

The interesting thing about this is that I had found myself in two different conversation about the Swedish healthcare system prior to my trip to Apoteket. One group of three other Americans, and one group of four Swedes. Both conversations had a whole lot of negative things to say about the healthcare system. The Americans tended to complain about the waiting times. The Swedes however, really railed against the system. Going so far as to say that one should never go to a Swedish doctor. That the system was marred by shoddy care, incompetence, and long lines. To steal a line from Bill Simmons, ladies and gentlemen, your 2008 tax kronor at work. Obviously this all made me feel wonderful about heading off to Apoteket to pick up a prescription.

But it was an exciting experience. I had never been to Apoteket in Sweden to actually get any sort of medicine. To use that social health care system that is raved about the world over, but that had just been taken down a notch by two separate conversations here in Sweden.

I was met by a sea of people. The place was packed. Luckily, no one was waiting in line. Because everyone had grabbed a number and quietly sat themselves on the provided benches. It was all so very Swedish. And I reveled in it.

So I grabbed a number as well. I sat down and waited patiently. I was the patient after all. The lovely pharmacist called my name. I handed over my prescription and she said she’d take care of it. Well actually, she looked at the clock and then corrected herself. A colleague would take care of it. Apparently her shift was coming to an end.

So I went and sat down. Patiently waiting. Apparently my boyish charm and good lucks convinced the pharmacist to work overtime. I know this has worked on my local pharmacist back home. She called me back and asked for my ID. Shit. All I had with me was my American driver’s license. I hastily explained what the deal was, recited my personnummer, which was also listed on my prescription, pointed out my date of birth on my driver’s license. She was convinced. I’m telling you – boyish charm.

Anyway, at this point it had been established that I was much more American than Swedish. And for the first time in Sweden I really felt like I was being treated differently for being American. And strangely enough, I was quite pleased about it. Despite the pharmacist suddenly speaking in that special tone of voice reserved for people we just aren’t sure understand. You know the one, a little bit slower, a little bit louder, just a little bit demeaning. And still I appreciated it.

The pharmacist began explaining, in great detail, very simply, with lots of pointing to labels and papers, about how I was to administer the medicine. It was good. I appreciated the thoroughness of it all. Medicine isn’t one of those things that should be handled lightly. So after being well versed in how to cure myself with the help of big pharma, I went on my merry way.

A better man for having experienced the Swedish healthcare system. But a poorer man. Because healthcare in Sweden isn’t really free. I paid, with the exchange rate at the time, about 80 American dollars for my prescription. I checked with my friendly local pharmacist from back home, (there he is again, he does good work) and was told that the same prescription in the US would have cost me $146.99 for the name brand or $51.99 for the generic brand.

Welcome to Sweden. And the Swedish healthcare system.

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  1. Lucky you and your charm! To me, had I forgotten my ID's, she would have shouted aloud: NEEEEXT!

  2. With one or two more prescriptions of the same cost will bump you up to free medicin for the rest of the year.

  3. Dude, nice work with the charms there! In Sweden they're usually very strict on these sort of things. She obviously has a thing for accents ;)

    Allow me to step in here and say that i agree with a lot ofthe people you've talked about the Swedish health care system with said. The waiting lines are just crazy! I waited at the emergency for 5 hours without getting any help. Then I decided to go home... THEN I got a bill sent home. A medical bill for 300 kr! Screw you!

    There are definitely positive things to say about the Swedish health care system, as well, though. One being the fact that you don't need to have an expensive health insurance to get good health care, meaning that people from all social classes are entitled to the same health care.

    If I was more opposed to the Swedish health care than I already am and had a proneness to being sarcastic I would probably describe the Swedish health care with the following sentence: "The waiting lines may be long but at least we're all standing in the same line!"

    Sadly enough, though, I guess that's what you get when you have equal health care for everybody.

  4. It's not totally free, but a lot of important medication is subsidised.
    Up until the age of 23 I think you pay 60 kronor (around $8) per year for birth control pills. I have heard how much they are in America and it makes me shiver...

    Like someone mentioned above there is a maximum a year you have to pay for medication, and then it is totally free. That sum is only 1800 kronor, which, if you have some kind of chronical disease you will reach pretty quick, and then you are done paying.

    Same goes for going to clinic, the maximum per year you have to pay is 900 kronor.

    So the most you are every going to pay a year is 2700 kronor, and for this you need no health care insurance, nothing.

    To me, that is pretty cheap :)

  5. I'm surprised that the pharmacist didn't offer you to buy the cheaper brand (if they had it that is). They have done for me in the past and you can save a lot of money that way. Maybe ask if there is a cheaper substitute next time?

  6. Ewa, what Hairy got most probably WAS the cheaper kind. Actually, you have to specifically state that you don't want the cheapest (generic) alternative or that's what you get - if you really don't want the generic one, you'll have to pay the difference yourself with no subsidy. Because actually, even below 900 SEK, the price cost to you is often subsidized for expensive medications. The price for the same drugs still wary greatly between different countries though. From my experience here in Sweden, generic and non-generic tends to be pretty close in terms of price - it's market economy really. From time to time, non-generic is actually the cheapest alternative.


    I've never gotten this craze over ID's. Maybe I've been blessed with more boyish good looks and charm than I thought. And a trust-worthy face of course. I've often forgotten my ID and it's never been a big problem. I even forgot to bring an ID for my "mönstring", the checkup for the compulsory military training. I guess it's different for you shifty foreigners though. Or maybe it's a regional thing.

  7. But mysmasken you forget the taxes you have to pay! The only difference between the health insurance and the taxes is that the ones who don't pay taxes also are entitled to health care. Which is nice. But for the tax payers it's still a lot of money, exactly as it is to the people who pay for their health insurance.

    In other words, the Swedish health care system is good for the poor and unemployed (well, kind of, since they still have to pay the fees you mentioned) but from an ordinary tax payer's view it's just as good as a health insurance. in other words, the difference between the Swedish health care system and, for example, the American one is not that big. For most people, anyway.

  8. Robban: Yes and know. We DO pay more taxes in Sweden, but the low- and middle class also makes more than in the US, not to talk about the minimum wage.

    Sweden does not have a law for minimum wage, but in the only study I could find, that is 3 years old*, the minumum wage in Sweden was between 12.790 and 15.340 kronor.

    So lets play with the number 12 790, to be fare.
    If you made 12.790 SEK in year 2006 you would be taxed 25.7%** and keep 9.501 SEK after taxes.

    Lets then pick the federal minimum wage in the state with the highest minimum wage - Washington state - from the same year which was $7.63 *** (note that the federal min wage was $5.15**** at the time!).
    They pay no personal state income tax, only federal which would be 10%*****.

    That leaves them with $1.322 before tax, and $1.190 after tax every month.
    The dollar was at quite a peak around this time, January 2006, 1 USD was 7.70 SEK. That would leave this person with 9.165 SEK a month.

    Still less than the average Swedish person, despite the high taxes in Sweden.

    Now, I'm no expert att this, just playing around with numbers for fun. And no, I'm not a Socialdemokrat.

    I acutally think the system in Canada is a good, healthy balance between the US and Sweden :)





  9. hey, sorry about the rash but thanks for sharing the story. should be gone in no time. :)

  10. Hej! I do enjoy reading your blog. From the earlier comments, it's obviously not an easy thing to compare healthcare prices (cheaper out-of-pocket costs usually means higher taxes), but I'd say at a minimum you have to add in the cost of seeing a doctor if you want to get a prescription. I was surprised the prescription cost in Sweden is so high - in Australia, which has a similar universal healtcare coverage, the maximum out-of-pocket cost for most prescriptions is A$32.90, or US$21.37 - less for generics. And if you're lucky you won't get charged for the doctor visit.

  11. @smek – I was kind of surprised it was easy as it was actually. Usually those ids are like gold.

    @anonymous – that’s what Ive heard. Unfortunately, or maybe fortunately, I think I average maybe one prescription every three years.

    @robban – ooh, I like the accent thing. Im going to start playing that up a bit more. Ill have middle aged pharmacist ladies melting in my hands.

    You bring up some good points about the health care system. Both the positives and the negatives. I guess my question to you would be whether you think it is worth it standing in that same line with everyone?

    @mysmasken – yeah birth control with no insurance is expensive. Of course there are plenty of low cost options. And plenty of places hand out free condoms. But that is pretty cheap here.

    Youre right that is pretty cheap. But I haven’t gotten anywhere near that and Ive been her for nearly two years. I guess that’s one of the things I often come back to. The healthy people pay with their taxes for the unhealthy people. Of course, theres something to be said for that sense of altruism. I just don’t really know if I completely buy into it Im afraid.

    @ewa – yeah I was given no choice at all. But Ill keep that in mind next time for sure!

    @jacob m – well there we go. I had no idea.

    And good work using that boyish charm. Its important to rely on that in order to get through life. As a semi-foreigner I find it quite useful.

    @robban – those taxes are what kind of get you. They are sneaky like that. Because youre absolutely right. It might be free but you’ve basically given the government an interest free loan.

    @mysmasken – so many numbers. Im going to leave that one for robban to respond to.

    @rednk – its important to share. Golden rule. Kind of.

    @richard – its true, straight across comparisons are quite difficult. They leave out so many other variables. Although they do make for some fun anecdotal evidence.

    I had no idea Australia was so cheap in terms of prescriptions. That’s impressive.

  12. Yupp, you're right. I don't believe in altruism. It's not natural, and maybe only something religion/church can beat into people, so for Sweden being in the top 3 of people believing in evolution over genesis it doesn't make sense that Swedes would be so altruistic, hehe.

  13. Thanks for redirecting the response-duty to me, Hairy... My response, though, is the same as yours: "So many numbers..."

    OK fine, I'll try to give a more elaborate response than that...

    Mysmasken, I don't know why you chose to compare the minimum wages of the US and Sweden. I was talking about the AVERAGE Swede, not the Swedes working for minimum wages.

    Obviously, I don't know all the numbers. I was just trying to highlight the fact that for most Swedes a health insurance would have been as good (or very close to "as good") an option as paying taxes and getting "free" universal health care. I still believe that and you didn't prove me wrong about that since you chose only to compare the people working for minimum wages, who, correct me if I'm wrong, do not constitute a majority of the population of Sweden.

    Now, the good news is, as I mentioned in my earlier posts, that the Swedish health care system doesn't leave poor people stranded.

  14. @mys and robban - just trying to facilitate conversation. or something like that.

  15. Soo...I've got an update on the ID issue.

    I went to the pharmacy last week and I did show my ID. I wasn't asked, I just handed it over. That got me thinking that maybe I actually show my ID more often than I thought. Without even realizing it. But then, my present prescriptions are all in the computer. I send my doctor an Email and he logs into the pharmacy system's both nifty and convenient I find. With Paper Prescriptions I still hold that I usually haven't showed an ID. And as a confirmation to that (not really); I went to the University Hospital (another town) for treatment yesterday. When I arrived to the clinic I said "Hi". The woman in the reception responded in kind. And then she added - You must be Jacob. (yup. Hov in da vorld did she know?). Then in an apologetic matter said "could you just give me your Personal Number for verification purposes. It's protocol I'm afraid. And I can't help but wonder...maybe this whole ID craze IS a Swedish thing. If you are one, you don't really need it. I'm sure positive that I've never ever used an ID when seeking care. When I was younger I always handed over my "patientbricka", but that's hardly an ID (no photo). When I've gotten library cards I used the same Patientbricka. It's...why would I lie? I'm Swedish...I'm ENTITLED to "free/almost free" care. Foreigners...they're a shifty bunch...and maybe they're health tourists or illegals!

    It's the "honest blue eyes". Except that mine are hazel.

  16. I love the investigative journalism going on here.

    I must say, I have stalked to a lot of people who dont have a swedish id who ave struggled horribly to get things done in this county in terms of banking or health care. lucky for me, I have a swedish id. good times in just being a halfway shifty foreigner.

  17. Yea, I stalked a girl when I was younger to. Well, not really stalked...but I just happened to run into her a lot if you know what I mean. But that was in HS and not really the subject at hand. ( A lot of people, eh?)

    I read about a girl (I think) that had to bring her Swedish spouse to the post office to verify that she was who she said she was when she picked up her new Swedish DL. Apparently he had to show his ID (DL?) and look at the DL and verify that the woman on the picture was really the woman with him. Seemed a tad ridiculous to me. Maybe things have changed drastically in the last few years, but I know that when I picked up my DL a few years back, all the clerk did was look at the picture on the new DL and then look at me to confirm that - yep, same guy.

    I didn't even have an ID when I got my DL. Well, I did have a passport - which could work as an ID but is not something that you bring with you on a regular bases.

  18. stalked, talked, its pretty much the same thing right. oops. definitely talked.

    I dont think Ive ever heard of a swede having to take another swede to prove who they were but Ive heard of americans and canadians that have had to do that.

  19. the Swedish Systems defense though...The Swedish System - Let's call it Big Brother - has been keeping close tabs on it's little brothers and sisters from the moment they were born. E.g. you do know that Big Brother's got a blood sample from you taken at the time of your birth, right? It's stored in a bio-bank Karolinska Sjukhuset. If need be you could very well be verified that you are who you say you are using this. Big Brother is watching; but it's eyes doesn't stretch beyond the Swedish border. Big Brother knows us and pretty much everything that we've ever done. Big Brother doesn't know Canadians or Americans.

  20. Also - I realize that my English in above comment was a tad blow par; I changed my mind quite a bit regarding what to time as I was typing an unfortunately, shoddy English was the result. Mea Culpa.
    I speak better English than that. Though even when I speak, my mind tends to drift, making my train of thought hard to follow sometimes.

  21. @jacob - youre right about big brother. but at the same time, the fra law has really brought that up in terms of the governments right to monitor cross border communications. like email to canada or the us for example.

  22. One thing people need to remember when talking about the Swedish health care system is that you are always guaranteed care.
    Sure the lines can be a little long and you have to wait, but they never refuses to take care of you.
    The Swedish isn't "free", it's paid with tax money.
    Therefore some people says "why not use health insurance instead?".

    Well it's not a good idea if you really think about it.

    By law everybody are obligated to pay tax. Therefore nobody can say "I never get sick, I don't need a health insurance".
    Or "it's too expensive for me".

    If a person doesn't have health insurance and he/she get sick,
    who is going to pay his/her medical bill? The goverment doesn't have to, since they don't get any money for it. And the public will say it's an outrage and that something should be done.
    But since the public doesn't want to spend their own money on others, nothing will be done.
    So we would have to let them die, at home in silence.

    And by leaving the health care system in the hands of insurance companies not everybody would get the care they are supposed to get.
    Since the companies strives for profit, it's in their interest to do everything they can to avoid paying people when they get sick.
    And this is what's going on in the USA.

    Even the Swedes themselfs doesn't seem to understand the fact that their health care is among the best in the world, and that they are guaranteed care(which is not the case in America). And most Swedes don't know how expensive health care really is, but this only shows that they have a good system that takes care of them.

    And the Swedish health care isn't extremely expensive just beacuse it's financed with tax money.

    Here are some facts about the American health care and the "fantastic" insurance system they have.

    "Of 30 industrialized nations the United States is the only one that does not—as a right of citizenship—guarantee access to health care. Germany alone has a multi-payer universal health care system, while the remaining 28 industrialized nations have single-payer health care systems."

    "Universal health care would be too costly?
    *In comparison to any other industrialized nation with universal health care, the Unites States spends at least 40% more per capita on health care.
    *Despite covering all the uninsured and increasing already active health care benefits, federal studies by the Congressional Budget Office and the General Accounting Office show that converting to single payer universal health care would save 100 to 200 billion dollars per year.
    *Again, despite covering all the uninsured and increasing already active health care benefits, state studies conducted by Massachusetts and Connecticut have shown that single payer universal health care would save 100 to 200 billion dollars.
    *Since Canada changed to a single payer, universal health care system in 1971, the costs of health care in Canada as % of GNP—that were identical to the United States at the time of the switch—have increased at a much lower rate than have the costs of health care in the United States.
    Due to lower administrative costs, single payer universal health care costs would be lower than the current United States system. As of now, the United States spends 50to 100% more on administration than single payer systems."

    //The Foreigner

  23. "Universal health care would leave the people without certain, necessary services?
    *Studies show that people in universal health care systems have more doctor visits and more hospital days than do people currently residing in the United States.
    *Due to payment problems or access to care, around 30% of Americans experience issues with admittance to health care servers, a number far higher than that of any other industrialized nation. Approximately 17% of United States citizens do not have health insurance, and 75% of these uninsured people have trouble paying for/accessing health care.
    *In comparing Canada and the United States, it appears that Americans experience greater difficulties in accessing health care than do Canadians.
    *Health care access is directly related to income and race in the United States, and has resulted in the less wealthy and minorities having poorer health than the well-off and whites.
    *Because the United States has a 30% oversupply of medical equipment and surgeons, there would be no waiting lines under a universal health care system, as demand would increase only 15%.
    A universal health care system would allow all United States citizens access to health care; not only those with the ability to pay. Because of the economic status of the country—in the oversupply of the providers and infrastructure, along with the ability and willingness of the United States to spend more on health care than other industrialized nations—waiting in lines for proper care would not become an issue."

    "A universal health care system would result in government control, negatively affecting health care and infringing on the people’s right of choice?
    *Under a single payer universal health care system there would be a choice of healthcare providers, dissimilar to the current managed system where people must only see providers listed on the insurer’s panel to access medical benefits.
    *Fees would be set under a universal health care system like they are now in 90% of cases. A major difference would be that providers would have a way to negotiate fees for the patients benefit, unlikewith the current managed system in which fees are generally set with potential profits in mind.
    *Taxes, fees and benefits would be determined by the insurer, who would be under the control of a diverse board of people consisting of consumer, provider, business and government representatives. The system would not be at the hand of the government, although the government would have to approve the taxes. A public trust, not the government, would run the system.
    Changing to single payer universal health care, administered by a state health system would actually be much less intrusive than the current system of the United States. The voices of both consumers and providers would be heard and their messages applied in determining benefits, rates, and taxes. Confidentiality would not be breeched if people sought to receive services of different health care providers, as they would not need to apply for the change."

    // The Foreigner

  24. "Universal health care is a form of socialized medicine and would be unacceptable to the people of the United States?
    *Socialized medicine is in part, by definition “a government regulated system…”(4). But single payer universal health care is not socialized medicine as it is a health care payment system not a healthcare delivery system. In such a delivery system health care providers would be in fee for service practice. The providers would not be government employees, as they would be with socialized medicine. It is true that the public would fund universal health care but the government would not administer it.
    *National and state polls have repeatedly shown that between 60 and 75% of Americans would prefer a universal health care system.
    Single payer universal health care would actually be preferred by many United States citizens and is not a form of socialized medicine."

    "The problems with the United States health care system are being/are best solved by the current system of corporate managed care medicine, which is most efficient?
    *The public sector is the most efficient part of the current United States health care system; Medicare spends only 3% of premiums on administration. Conversely, private for profit organizations—that spend 20-30% of premiums on administration and profits—are the least efficient delivery method of health care.
    *From the years 1990 to 1996, the cost of health care in the United States grew more under managed care than any industrialized nation with single payer universal health care.
    *It has been reported that the quality of health care, under the managed system has deteriorated and access problems have increased. The number of uninsured Americans has climbed from 10 million in 1989 to 43.4 million in 1996.
    *Research shows that satisfactory with the United States health care system is the lowest of any industrialized nation.
    *Specifically 80% of citizens and 71% of doctors believe that health care quality has been compromised under the managed care system."

    So before Sweden stop using tax financed health care, they should think about these studies.

    // The Foreigner

  25. These facts are from before Obama's health care reform was passed.

    We can only hope that Obama will continue to improve the health care for all Americans, after all these years without a decent care, they truly deserve it.

    // The Foreigner

  26. I'm an American in Sweden, and I can say that I never received such crappy care in the U.S. In my experience, most Swedish doctors are arrogant and could give a rat's ass less about their patients. Swedish healthcare is a nightmare, and I agree with the Swedes who advise to NEVER go to a Swedish doctor. Even if you get one who cares, they have limited power with all the other idiots. Maybe you can skim by with colds and scratches, but God help you if you have a serious illness. Then you can kiss your ass goodbye unless you've got money to get the hell out of here. The patient advocacy groups are a load of crap as well and do nothing to help. If you are not terrified to live here, you should be. Probably the only reason most people are around is just bc of the sheer power of the human body to repair itself. And this reputation about Sweden being so good to women is a lie as well. If you have a disease that is more common for women, good luck with all the stupid male doctors. Most of them are absolute ignorant jerks. Do not, do not trust the doctors here. I am serious. It could cost you your life. Get the hell out and find a real doctor. You have to cover your own ass here. The doctors will ignore you and leave you to endlessly suffer and rot. Read the paper - it's everywhere. It happens all the time. It's hell, and it's so sad and devestating for so many people who's lives are destroyed in this medical dictatorship... Be careful! And good luck!

  27. Just noticed the comment above that says that in Sweden you have to wait a long time, but no one refuses to take care you. That is an outrageous lie!! Maybe the paperwork says that you will be taken care of, but the paperwork lies. They have time and time again refused to do anything for me. It has been a living hellish nightmare to get care in this system. Read the paper!!! They refuse to help people all the time. They are understaffed and they don't give a shit about you. Sounds too horrible to be true? That's what I tell myself each day living this hellish nightmare, but guess what? People are disposable. Sick people don't have the resources to fight for themselves. And the really sick ones die. The doctors have the final word. Lots and lots of people do NOT get care here. Wake up people!! It's all a bunch of freakin lies!!

  28. I must say that, personally, I've always had pretty good experiences with the Swedish health care system.