Sweden has a reputation for getting healthcare right. And in many ways, it does. Per capita spending is among the highest in Europe, and for straightforward conditions, this is a reflection that the system works. However, not everything seems what it is, and there is a part of the picture that rarely enters the conversation.
The allocation of public healthcare funds in Sweden is heavily weighted toward acute and episodic care. You break your arm, you get treated. You have a sudden cardiac event, and the system responds, but if you are managing diabetes alongside hypertension and early-stage kidney disease, the story gets more complicated. Chronic conditions do not have a finish line, and the Swedish system was not really built for that.
The legal backbone of Swedish primary care is the Vårdgaranti, a statutory right embedded in the Patients Act. “Same-day contact with your clinic”. A medical assessment within three days. A specialist visit within ninety days. These are real commitments, and they are also what primary care clinics are measured and funded against, which means the system is optimised for access, and not for what happens after.
A patient with three chronic conditions will see their GP, cardiologist, and endocrinologist. Each will do their job. But nobody in that chain is responsible for the full picture. Nobody is paid to coordinate between them. Nobody is accountable for what happens between appointments. That is not a criticism of the doctors involved, but rather just a description of how simply the system is financed. Continuous care has no reimbursement code in Sweden, and that absence shapes everything for patients who need more than a single visit.
Politicians built careers on those numbers as a revolutionary model. Clinics get funded based on those numbers, and those numbers tell you absolutely nothing about whether anyone is actually managing your health. There is absolutely no funding for continuous care. Here is what the numbers do not measure:
- What happens on a Tuesday afternoon when something feels wrong and your next appointment is six weeks away
- Who coordinates between the four doctors who each know twenty percent of your story
- Who is accountable when the pieces do not add up
And the answer is nobody, not because doctors do not care, but because nobody in this system gets paid for coordination. The reimbursement code does not exist. So it does not happen. Only 0.17 percent of complex patients in Swedish primary care have an active coordination plan. Not seventeen percent. Zero point one seven.
That is not a gap in the system. That is the system.
To solve this, the resolution isn't political. There is no good law that is going to solve immediately this, specially with the lack of doctors and public funding going more and more over to private due to communal agreements. The resolution is practical. It starts with having someone who actually owns your case. Not a vårdcentral that sees you twice a year. Not 1177 who triages you into a queue. Someone who knows your history, follows up between appointments, catches the things that fall between the specialists, and makes sure the right hand knows what the left hand is doing.
That's what Malm is built for. That is why we as CW1, built it