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HEALTH

EXPLAINED: What to do if you face a long wait for healthcare in Sweden

Sweden theoretically has a "healthcare guarantee" limiting your wait to see a GP to three days, and to see a consultant to three months. The reality is somewhat different. Here's what you can do if you face a long wait.

A doctor assesses a patient's lungs at a primary care centre in Stockholm.
Healthcare costs in Austria are rising. (Photo: Claudio Bresciani/TT)

What is Sweden’s ‘healthcare guarantee’? 

Sweden’s “National Guaranteed Access to Healthcare” or vårdgaranti, is a right to care, protected by law, that has applied in Sweden since 2005. You can see the latest version of the relevant laws here and here. Here is a summary of the guarantee on the website of the Swedish Association of Local Authorities and Regions (SKR).

Under the system, all patients are guaranteed:

  • contact with a primary care centre by phone, in-person, or by video-link on the day they seek care 
  • an appointment with a doctor, nurse, physio, or psychotherapist within three days of seeking help 
  • an appointment with a specialist doctor or consultant within 90 days of seeking help 
  • treatment or operation within 90 days, if the specialist considers this necessary 

Does the guarantee mean I have a right to treatment? 

No. If the doctor at the primary care centre, after examining you and questioning you, decides that there is no reason to refer you to a specialist doctor, they do not need to do so. 

Similarly, if the specialist doctor, after examining you, decides that no treatment is necessary, then your case is considered completed.  

Can the waiting times to see a specialist or to get treatment be longer than 90 days? 

Absolutely. In fact, they very often are. 

According to the Swedish Association of Local Authorities and Regions (SKR), in February 2022, 32 percent of patients had been waiting 90 days or more to see a specialist, and 43 percent of those who had seen a specialist had been waiting for treatment for more than 90 days.  

The situation in primary care was a little better, with 80 percent of those seeking care in contact with their primary care centre on the same day, and 83 percent having their case assessed by a doctor or nurse within three days. 

In addition, if you agree with your specialist doctor that you are willing to wait longer for an operation, then that wait doesn’t get counted in the statistics. 

So what can I do if I’ve been waiting longer than the guaranteed time? 

In reality, it’s actually less a guarantee than a target.

In primary care, there is no way for individual patients to complain that they have had to wait too long to see a doctor or nurse, or to cut their waiting times by citing the guarantee. 

“There’s no system for enforcing that guarantee,” Emma Spak, the primary care doctor who doubles as section chief for SKR’s healthcare division, told The Local in 2022. 

It would make no sense to set up a complaints line for those who have had to wait too long for phone contact with their primary care centre, she points out, when they could instead talk to patients seeking a primary care appointment in the first place. 

“It’s more of an incentive system for the regions,” she explained.

Every primary care unit and every region reports their waiting times to the national waiting time register, and then as part of the access agreement between SKR and the government, the regional health authorities receive a bonus if they meet their waiting times goal, or if they improve their waiting times. “That’s one way of sort of enforcing this guarantee,” she said. 

When it comes to specialist treatment, though, patients do have the right to demand to be examined or treated by an alternative specialist or hospital if they’ve had to wait longer than 90 days.

If your primary care centre issues you a referral to a specialist, and the specialist cannot then offer you an appointment within 90 days, the specialist, at the same time as offering you a later appointment, will often put you in contact with a unit at the regional health authority who will offer to find you an alternative specialist, either within the region or elsewhere in Sweden. 

The regional health authority will then have to reimburse any extra travel or hotel costs incurred by the patient.  

Similarly, if after examining you, a specialist cannot offer you treatment within 90 days, they will normally put you in contact with the same unit. 

Some regions have a phone line for people who have been waiting too long, or else you can contact your specialist or primary care centre and ask for information on seeking an alternative specialist. 

What happens if I don’t want to travel to see a specialist or get treatment? 

If your regional health authority offers you an alternative specialist, either within your region or in another region, so that you can get treated within the 90 day period, and you are unwilling to travel, then you lose your rights under the guarantee. 

“If you’re in Gothenburg, and they say you have to go to Stockholm to get your treatment, and you say, ‘no, I want to go here, then then you’ve sort of forfeited your right, and you have to take what’s on offer,” Spak said. 

What happens if I agree with my specialist to wait longer? 

If your specialist says that they can treat you in four months, but also offers you treatment elsewhere within the guaranteed 90 days, and you choose to be treated by your specialist, then that counts as a patient choice, which will not then be counted in the statistics. 

“The specialist might say, ‘I don’t think you will get any worse for waiting two months extra, and if you wait five months, then I can make sure that you get your surgery done here, and we can make sure that you get all the aftercare and everything here as well,” Spak said. 

But these patient decisions are also counted in the statistics, and if a region sees a sharp rise in patients choosing to wait, SKR will tend to investigate. 

“If some region all of a sudden has a lot of patients choosing a longer waiting time, then we will call them and ask what’s going on here, because patients don’t tend to want to wait extra,” Spak said.  

Can I get financial compensation if I’ve been waiting too long? 

No. 

What other ways are there of speeding up the wait for treatment? 

Don’t underplay your symptoms

When drawing up their timetable for treatment and assessment, specialists will tend to give different patients different wait times depending on the urgency of their case.

For this reason, it’s important not to underplay your symptoms when visiting a primary care doctor, as they will tend to include a few lines on the urgency of your case when they write their referral. 

Stress your flexibility 

If you are unemployed, a student, retired, or have a very flexible job, it is worth telling your primary care doctor about this, because they may write in your referral that you are able to make appointments at very short notice. The specialist may then put you on their list of people to ring if one of their patients cancels. 

“Sometimes I write in my referrals that this patient could easily come at short notice, so please put the patient on the list for people you can call if there’s a time slot available,” Spak said. 

If you haven’t told your primary care doctor this, it’s not too late. You can ring the specialist yourself and tell their receptionist that you are very flexible, and ask to be put on the back-up list. This is particularly useful if you’re waiting for something relatively unintrusive like a scan, but could also potentially work even if you’re waiting for heart surgery or a hip replacement. 

“If they’ve accepted you as a patient, and they’ve made sure that you fulfil the criteria for having that scan or whatever, then you can call them and say, ‘I have a really flexible job, I can come anytime if you have a gap,'” Spak said.

“A lot of people do that, because they can have [back-up] waiting lists. If you tell them ‘I work around the corner and I only need 15 minutes to be there’, then they might call you if someone doesn’t show up.” 

Ring up your specialist 

The queue system tends to be quite ad hoc, with no strict rules over who should be treated first, so it is often possible to reduce your wait by ringing up your specialist a few times a month, just to bring your case to their attention. Sometimes the receptionist will remember a slot that has just come free and bring forward your treatment while you are still on the telephone. 

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For members

FAMILY

What should you do when someone dies in Sweden?

They say nothing in life can be certain apart from death and taxes, but if there's a third certainty, it must be Swedish bureaucracy. Here's how to register a death, arrange a funeral and figure out who inherits what.

What should you do when someone dies in Sweden?

If your loved one dies unexpectedly at home or elsewhere, you should call Sweden’s emergency number 112. If their death was expected, due to illness or old age, you can call the person’s medical contact if they have one. A doctor will come to the house and confirm their death.

If the person dies in hospital or a care home a doctor will confirm their death.

The doctor will send the death certificate (dödsbevis) to Swedish authorities. As soon as the Tax Agency receives the certificate, they will register the death in the Swedish population register.

Who do I need to inform?

If the person is a foreign citizen, you need to notify the authorities in their home country. If you contact their country’s embassy in Sweden, they will be able to help you figure out the process.

You need to inform people as soon as you can, including friends, family and colleagues.

The first step after that may be to contact a funeral home (begravningsbyrå) who will be able to organise the funeral and the reading of a will, but also advise on what needs to be done next.

One of the first admin tasks is to order a so-called dödsfallsintyg (which also translates as death certificate, but is different from the one the doctor writes) from the Swedish Tax Agency. This will show the date of death and remaining family members, including spouse and children. If you choose to use the services of a funeral home, they will be able to order a dödsfallsintyg for you.

Swedish authorities run a site called Efterlevandeguiden for people who have lost a loved one. It contains among other things a checklist in English for what to do when someone dies (their guide is genuinely very helpful, so we advise having a look if you’re in this situation).

A funeral home can help you with as much as you need, but there’s usually a lot of decisions and tasks that you’re best placed to do, so it’s a good idea to get as much help as possible.

Many Swedes don’t like to intrude on other people’s business, so there is a risk you find that fewer people than you expect will reach out to you to offer to help or even send their condolences. In most cases, this is due to a (perhaps misplaced) respect for privacy rather than an unwillingness to help, but we’ve generally found that Swedes, when asked, are more keen to help than you think.

How do I organise the funeral?

Sweden allows a lot more time between the death and the burial than many other countries and cultures, with the laws stating that the burial must take place within one month of the death.

That said, the aim is always to respect the traditions and culture of the deceased person.

All residents in Sweden, including foreign citizens, pay a yearly funeral fee (begravningsavgift – it’s part of your tax statement, so chances are you’ve never noticed you’re paying it). This gives them the right to be buried or cremated in their Swedish home municipality for free.

Most cemeteries in Sweden are public spaces and are run by the Church of Sweden on behalf of the state, which means people from other religions may also be buried there. If you want the Church of Sweden to organise a funeral ceremony for you as well however, the deceased person will have had to be a member of the church in order to receive the ceremony for free.

If you want to spread the person’s ashes in a place other than a cemetery, you need to first get permission from the country administrative board (Länsstyrelsen).

Who pays for the funeral?

Some of it, such as a burial plot and a venue in which to hold a ceremony, has already been paid for through taxes, but there may be other expenses such as a fee for the funeral home, flowers, food for the funeral goers, a bespoke coffin, any music you wish to play, and so on.

A funeral usually ends up costing around 20,000-30,000 kronor, which is primarily paid for through the estate (dödsboet). If there’s not enough money, the estate can apply to the social services for financial support in order for the deceased person to receive a dignified burial.

If you want the deceased person to be buried in another country than Sweden, the transport of the coffin or urn will be paid for by the estate, but it could be expensive, so you should also check whether they had travel or home insurance which could cover the cost of transport. 

You need to request documents from the Swedish Tax Agency to transport the body from Sweden. The form is called passersedel för lik or, if the person is cremated in Sweden before their ashes are to be moved abroad, passersedel för stoft.

You also need to get the funeral home to confirm that the coffin or urn is safe for transport and contains what it is said to contain, and you need to get permission from the authorities in the other country.

How do I deal with all the admin?

Again, a funeral home can help you out, but the first step is the death certificate from the Tax Agency. This document will help you not only in organising the funeral, but also in dealing with administrative matters such as cancelling direct debits or contracts, or redirecting post.

Note that banks are automatically informed when someone dies, and then automatically block some of the services used by the deceased until the person’s will has been executed, including joint accounts. If you and your partner have joint bank accounts, it may for this reason make sense for you to also have individual accounts so that you don’t get blocked from all your accounts if your partner dies.

Any outstanding bills that still need to be paid should be paid for by the estate (if there’s money left after paying the funeral and probate costs, which are prioritised). Any debts will also be paid by the estate, or written off. You are not responsible for paying the deceased’s debts yourself.

Before all of this, a so-called bouppteckning will have to be arranged. This is the procedure for going through all of the deceased’s assets and debts. It can be done privately, or with the help of the funeral home, and needs to be submitted to the Tax Agency within four months.

Here’s a useful guide for administering the estate. 

What about inheritance?

In general, the inheritance laws of the country where the deceased lives apply.

In Sweden, if the deceased was not married, but had children, the children inherit. 

If the children are no longer alive, their children, i.e. the grandchildren of the deceased person, are next in line, followed by the great grandchildren (and so on, if they exist).

If there are no direct descendants left, inheritance passes to parents, followed by siblings, nieces or nephews, grandparents, and aunts or uncles. 

Cousins do not automatically have inheritance rights, and note that neither do sambos (co-habiting but non-married couples) unless they are listed in the deceased’s will. 

If there’s a will, it trumps the above order with one major exception: direct heirs (bröstarvingar), i.e. children, grandchildren et cetera, always have the right to half of their inheritance, the so-called legal share (laglott).

If the person was married, a division of joint assets (bodelning) first needs to be carried out to see how many of their assets belong to the estate and how many belong to the surviving spouse – unless they did not have children, in which case all their assets are automatically inherited by their spouse.

If the deceased and their spouse had children together, the spouse inherits everything and is allowed to spend the assets as they wish as long as he or she is alive. Their joint children are only entitled to their share of the inheritance – whatever is left – once both parents are dead.

If the deceased had children with someone else before they married their current spouse, those children (known as särkullbarn) have the right to get their share of the inheritance before their parent’s spouse dies. They are however free to waive this right in favour of the surviving spouse.

There’s no inheritance tax in Sweden.

The above guide tries to address some of the main matters, but barely scratches the surface. Do you have any specific questions about what to do when a loved one dies in Sweden? You’re always welcome to email our editorial team at [email protected]

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