It’s almost eight in the morning – but hurry, or the appointments will be booked. The answering machine at the health center asks whether I need a new prescription, want to cancel an appointment, or speak with a medical professional. I press the corresponding key. “We will call back around 8:40 a.m.,” says the voice.
When the phone finally rings, it’s a little like being at a Berlin club. Whether I get in depends only partly on me. Once I had severe knee pain and couldn’t walk. The medical bouncer asked me: “Did the pain come on suddenly?” Yes. “Did you fall?” No. “Have you stressed your knee unusually hard in the last few days?” Of course, that’s how it started—I was doing excessive renovations. The verdict: evidently an overload reaction. “Raise the leg, take anti-inflammatory painkillers, wait and see. Get well soon.”
It is mainly this initial remote assessment, for which Germany’s statutory health insurance funds are currently campaigning, in combination with a unified appointment-scheduling portal. The Swedish system is regarded as a positive example. In fact, people in Sweden go to the doctor significantly less often.
For pampered Germans, the built-in lack of autonomy in the system can be frustrating. But the expectation that one always has a right to medical attention is gradually worn away. Instead, it is about trusting that the body can sort out a lot on its own—and that the people trained to do the initial assessment know what they are doing.
No Appointment Without Acute Need
Maybe you call, for example, because in the corners of your eyes you repeatedly see flashes that weren’t there before. “Does 2 p.m. work for you?”, says the bouncer. A doctor takes a look and writes an urgent referral to the ophthalmology clinic into your digital patient record. It is important to rule out serious retinal problems. You then also learn, at what change in symptoms you should rush directly to an emergency department. Three days later the ophthalmology clinic calls: “Can you be here in two hours?” Interesting, you might think, that went quite smoothly.
Thus, no appointment without acute need is the rule in Sweden’s predominantly tax-funded health system. And an appointment does not necessarily mean a medical evaluation—many complaints are simply handled by medical assistants.
What can land you on the waiting list for an appointment after several months are recurring complaints that you finally want to have examined.
Even the nationwide number 1177 is responsible for medical advice. But in Sweden’s health care system there are regional differences as well: not everywhere can you book in-person doctor appointments via 1177—by phone or in the app. When the advice says: “Call your health center and request an appointment”, the 1177 inquiry often seems like an unnecessary step.
Still, a lot in Sweden is handled by telephone. And those who do not want to use the 1177 app at all also receive findings, X-ray appointments, and similar things by post.
Parts of the Debates Resemble Each Other
The controversial German practice fee—which was ten euros per quarter and scrapped again in 2013—was, by the way, comparatively a bargain. In Sweden, depending on the region, fees range from 200 kronor to 370 kronor (currently about 18 to 34 euros) per visit, up to an annual cap of around 130 euros. If you miss an appointment without a prior cancellation, you also pay. And medications are paid by the patient up to a yearly maximum—the amount has just been raised from roughly 270 to 350 euros.
In the effort to curb medically unnecessary visits to the doctor, Sweden is evidently ahead of Germany. Yet people in Sweden also complain that everything was better in the past. There is criticism of rising fees, frequently changing points of contact, too great distances, or long waiting times, for instance for planned operations or treatment of mental illnesses. Parts of the debates resemble each other—just as the fact that healthcare, in a global comparison, still stands quite well.
