The care guarantee, which gives patients the right to surgery or treatment within 90 days, follows the '0-7-90-90' rule: immediate contact, medical assessment within 7 days, specialist appointment within 90 days, and treatment within 90 days. However, research shows that approximately 45% of patients waited beyond the 90-day target for elective procedures between 2021 and 2024. Regional disparities are stark.
In Gävleborg, patients waited 43 days for spinal surgery, while in Västerbotten and Uppsala, waits reached 180 and 182 days respectively. Some patients in Västerbotten waited three years for spinal surgery. The care guarantee is not equal for all, according to multiple reports.
Severely ill patients waited longer for surgery than otherwise healthy patients or those with mild illness. The difference is explained by otherwise healthy patients being referred to private providers with shorter waiting times, while multi-ill patients must be operated on in hospitals with intensive and aftercare, where beds are lacking due to staff shortages. A maximum waiting-time guarantee for 12 procedures was introduced in 1992 with a grant of 500 million SEK.
Waiting lists decreased substantially during 1991 and 1992 after the guarantee was introduced. By the end of 1992, only a few departments were unable to serve patients within three months. However, during 1993, the reduction in waiting lists ceased and some showed a tendency to increase.
The guarantee did not lead to a more even use of resources across the country. If a region exceeds the 90-day limit, the patient is legally entitled to care in another region or from a private provider, with the home region footing the bill including travel costs. Only a fraction of eligible patients utilized the choice clause, largely due to lack of information.
Regions may have shorter time limits than the national guarantee, but not longer. If the health center cannot meet the guarantee, the patient can switch health center up to twice a year. A digital registry for tracking wait times in Stockholm Region was introduced in 2012 but data often went unused.
According to a press release from Anna Essén, Associate Professor at House of Innovation, strategic ignorance played a significant role in healthcare professionals not engaging with the digital registry. She described navigating the complex web of individual and organizational patterns that made it unattractive to use the data. Median waits for hip replacements improved to 67 days by 2024, but knee replacement patients faced mean waits of 153 days in 2020 and 200 days in 2021.
The Swedish National Board of Health and Welfare has signaled that digital-only assessments by private app-based doctors may face stricter reimbursement caps unless integrated with the patient's physical health center. Steps are being taken towards a national healthcare agency to shorten queues. Hanna Kataoka, Chairperson of the Swedish Medical Association, said at a press conference that targeted state grants for individual diagnoses can hit right in one region but wrong in another, and that broad, long-term investments in staffing are needed.