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How privatization hobbled Sweden’s response to coronavirus

Sweden’s longtime refusal to impose a general lockdown has seen it portrayed as an alternative “model” for coping with the pandemic. Yet death rates in its care homes have been appalling — and as a scandal that broke last month highlighted, much of the blame lies with the breakup and privatization of the country’s once-mighty public services.
 
by Anton Ösgård
 
Part 3 - Scandalous Treatment
 
Part of the answer came with a scandal that broke in mid-October, as it came to the public’s attention that in Stockholm, health care providers had been instructed not to treat the “weakest” among the elderly population.

Dagens Nyheter (DN), the country’s biggest right-wing newspaper, revealed how elderly care home facilities in the capital had, as per the instructions of the elected regional body, been barred from calling in a doctor if a patient exhibited symptoms of COVID-19.

Updated guidelines for medical prioritization instructed the care homes to treat the patients on-site — in facilities without doctors or advanced medical equipment. But even if equipment had been available, they were specifically instructed not to be used for examination of the patient if they exhibited problems with memory or drowsiness, and furthermore, if the person struggled with walking on stairs, emergency care was completely ruled out.

The for-profit health care providers responsible for care in these old-age homes had been “given the green light to ration visits” by medical professionals — resulting in more deaths than necessary. People who could have been treated and saved were instead given palliative care without any medical examination.

The DN journalist put the blame on incompetence among the politicians running the regional authority, the institution responsible for health care in Sweden, in not understanding the consequences of their own guidelines.

A finger was also pointed at the Elderly Reform Bill of 1992, which put the responsibility for care of the elderly on municipalities, while simultaneously prohibiting municipalities from employing medical professionals to work in these facilities — a monopoly granted to the regional government that would otherwise lose prestige.

In one of the first academic evaluations of the Swedish strategy, a professor researching public health understood this situation as fueled by anti-traditional stances against the elderly and overconfidence in individual responsibility. 

The former implies that Swedes are simply okay with the elderly being sacrificed for the freedom to enjoy a beer in a bar. This is an absurd conclusion, easily disproven by the fact that reports of high mortality in care homes have sparked opposition and outrage. He also argues that the coordination reveals neglect on the part of the people in charge.

The representatives of the Stockholm region have, indeed, shown their incompetence, and the law barring elderly care homes from hiring doctors is unfathomably stupid. But this argument is too shallow to capture the full scale of what is going on. 

Instead, it has become almost impossible to coordinate the contemporary Swedish health care sector, however competent its leaders. This is because a dramatic restructuring has been imposed on the previously universal health care system, making the country ill-prepared for a concerted effort to combat the virus.

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