Tal
Göteborg 9 december 2009
Göran Hägglund, Socialminister

Tal på engelska av Göran Hägglund på European Patients Forum

OBS! Det talade ordet gäller!

Ladies and gentelmen,

Enhancing patient involvement in health care is of great importance to the overall goal of improving people´s health. To successfully achieve the goal of increased patient involvement in health care, it is critical that we pursue these matters on a national level as well as in EU policies and programmes, which this conference is aiming for.

The Swedish Government wants to create conditions for a good health and medical care system based on the needs and desires of the patients. Our vision is to create greater value for patients and make patients central to how health care is organised. Patients - not health care systems - should be the focus of health care. For this reason, the Government has taken a number of steps to pave the way for a stronger position for patients in their contact with health care services.

I would like to highlight four important measures that the Swedish Government has initiated on a national level in order to increase patient involvement. The first one is shortening health care queues and waiting times for treatment. Health care should be of good quality, based on the needs of the patients and accessible to all citizens. The waiting time for many treatments in Sweden today is much too long. This means that patients may suffer for longer than necessary.

The Swedish Government wants to shorten heath care queues and ensure easy access to health care for everyone. Therefore, we have proposed new legislation to strengthen the patient´s position in the health care system by means of a national health care guarantee. The health care guarantee entitles patients to help over the phone or a visit to a primary health care provider on the same day as contact is made. A doctors appointment is guaranteed within seven days, and if the patient is referred to a specialist the visit must take place within 90 days, with any treatment needed being provided within the next 90 days.

The Government is also investing an extra one billion Swedish kronor, approximately 90 million euros to shorten queues. With this money we have created economic incentives and competition between the county councils to encourage them to shorten the queues to different treatments. The county councils that live up to the health care guarantee and are successful in providing health care to their residents within the maximum waiting times will share the 90 million euros. Statistics show that waiting times have decreased all over the country during this period of time. This has also created very positive competition between the county councils on reaching the goals and having the shortest queues to treatments for their residents.

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The second measure one is a new Act on Free Choice Systems. An important measure to increase access to health care is to increase the number of health care providers.
The vast majority of health care services and social services are provided by the county councils´ or the municipalities´ own organisations. The new Act on Free Choice Systems provides a framework for the municipalities and county councils that want to invite private enterprises or non-profit organisations to provide health care and elderly care services and compete with the public care providers. This gives patients the right to choose between a private or a public care provider, and the funding will follow the patient´s choice. How patients choose will therefore be crucial to the care providers. They will have to offer the services required by the patients, who will decide for themselves what is good quality.

From next year all primary care in Sweden must be organised so that citizens can choose between different care providers. All care providers that fulfil the requirements laid down by the county council will be entitled to become established in primary health care and receive public funding. These free choice reforms are central to enhancing the patients´ involvement and strengthening the position of patients in health care and social services.

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The third measure is a proposal for increased patient safety and better opportunities for patients to complain. A necessity when seeking to empower patients in their contact with health care services is to make it easy to complain and suggest improvements in health care processes. Therefore, we will shortly present a proposal to the Swedish Riksdag for a system which makes it easier for patients to complain when they have been treated incorrectly or injured in connection with medical treatment. This system should also make sure that patients´ views and opinions are taken into account and used when improving health care processes.

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The fourth measure is a new Patient Data Act and increased use of eHealth. The health care system has failed to ensure that different care providers have access to the same health care information about patients. The Patient Data Act that has been in force since July 2008 contains legislation giving patients the right to access their own medical records. It also allows various care providers access to each others´ medical records so that exchange of information regarding patients´ health care details is improved. The health care system has also failed to provide patients with complete information that they should be entitled to - information about their own health situation and treatments that they have been given. Access to one´s own medical records is a key factor in increasing patient involvement and making it possible for patients to take control over their own health care and complain when necessary. Transparency is therefore a prerequisite for increased patient involvement.

I also want to highlight eHealth as one of the most important strategic measures for improving our national health care system. It is essential for patient safety and health care efficiency that the necessary information regarding a patient is accessible to the right care giver when needed. There is considerable potential for improvements to health care services when using eHealth. A report published by the Swedish Government as an official Presidency report gives examples of quantified potential from six EU Member States that we studied:

• 5 million outpatient prescription errors each year could be avoided through the use of Electronic Transfer of Prescriptions.
• 100 000 inpatient adverse drug events each year could be avoided through Computerised Physician Order Entry and Clinical Decision Support.
• This would, in turn, free up 700 000 bed days each year, and provide an opportunity to increase throughput and reduce waiting times, corresponding to a value of almost 300 million euros.
• 9 million bed days each year could be freed up through the use of Computer-Based Patient Records. This would provide an opportunity to either increase throughput or reduce waiting times, corresponding to a value of nearly 3.7 billion euros.
• Over 11 000 diabetic deaths could be avoided every year in all countries studied by educating patients and enabling them to better manage their condition through the use of EMR and Chronic Disease Management.

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eHealth is also one of the prioritised areas for the Swedish Presidency on the health agenda. eHealth is not only an important tool to increase quality of care and patient safety, it is also an important tool to facilitate international cooperation and the cross-border provision of health care services. During the Presidency we have reached a strong political mandate for closer and more concrete European cooperation on eHealth through the adoption of Council conclusions on eHealth. An example of Member State collaboration to increase the use of eHealth is the epSOS project - European Patient Smart Open Services. Twelve Member States have been working together for a year on this project, which involves trying to identify and solve practical problems that stand in the way of continuity in cross-border health care.

This sums up the essence of why we have to strengthen EU cooperation on eHealth - to provide concrete and visible benefits for European citizens when they travel, study or work abroad. The ambition for epSOS is that vital medical information on a patient's medical background will be available in a safe manner for health professionals across the EU in order to secure continuity of care and increase patient safety. epSOS also aims to make it possible to send electronic pharmaceutical prescriptions - ePrescriptions - across national boarders. For European citizens who visit another Member State and leave their medicine at home, this will make it possible to just call your own doctor and ask for the ePrescription to be sent to the nearest pharmacy in the country you are in.

These kinds of services close to the patient will be a strong catalyst for further work on solving challenges in the legal field, in semantic interoperability and technical development. From the Council conclusions on eHealth and the epSOS project we will now move forward and try to create a more permanent structure for further collaboration and governance through a joint action plan. The Swedish Government is anxious to keep eHealth on the EPSCO agenda permanently.

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Another main priority of the Swedish Presidency has been to reach an agreement on the Directive on patients´ rights in cross-border health care. The main aim of this proposal is to codify and clarify the caselaw from the European Court of Justice on the rights of patients to receive health care in other EU Member States. The main principle of the proposal is that patients should be reimbursed by their home country for health care costs incurred in other Member States if they would have been entitled to the treatment in question in their home country.

Unfortunately we have not been able to reach an agreement on the directive during this Presidency, but the Swedish Government will continue to work for an agreement on cross-border health care. As I see it, development and strengthening of health care quality and patient safety in the EU Member States will remove barriers to cross-border health care and facilitate cooperation between the Member States. I believe that increased cross-border health care provision will act as a catalyst for quality and safety development at national level. Increased patient involvement has been the focus of several reforms at national level in Sweden and it is also a strong motive for pursuing eHealth and the patients´ rights directive during the Presidency.

We will retain this focus and continue to keep patient involvement and the tools to increase patient involvement in health care on the EU agenda.

Thank you very much!