Research seminar with Bo Rothstein, who holds the August Röhss Chair in Political Science at University of Gothenburg, a position established by a donation to the university in 1901. His research concentrates on the issue quality of government. This relates to corruption, clientelism, social justice, welfare policies and human well-being. The Care Responsibility Committee (Sv: Vårdansvarskommittén) was appointed by the Swedish government in June 2023 to produce a basis for decisions that will enable a full or partial transfer of the responsibility for health and medical care from the current twenty-one regions to the state. According to the terms of reference, the grounds for the commission of inquiry are a number of problems that have emerged with the current system of regional responsibility for the main part of health and medical care in Sweden. A summary of the problems identified in the government's terms of reference is: 1. The existence of significant differences between the regions in terms of both access to care and the outcome of healthcare interventions. This problem should be seen in the light of the Health and Medical Services Act's stipulation of "care on equal terms for the entire population". 2. There is great variation between the regions in terms of how the so-called care guarantee is met. Swedish healthcare is legally regulated by an obligation legislation, i.e. the principals have an obligation to provide citizens with health and medical care, however, this is not a right that patients can legally claim. 3. Long waiting times for care in comparison with comparable countries. 4. Comparatively low performance of the Swedish healthcare system in terms of how patients assess involvement, information and coordination between different healthcare providers. 5. A low level of available hospital beds compared to similar countries, resulting in overcrowding. This has led to shortcomings in patient safety. 6. The inability of the regions to meet the statutory requirements for access to care. 7. Significant work environment problems for healthcare staff. 8. Difficulties for the state, which has overall responsibility for health and medical care, to drive development in the desired direction. 9. Ambiguity regarding the legal status of the regional cooperation organisation (SALAR) in terms of accountability and transparency, while the role of the state authority in the area (the National Board of Health and Welfare) has been reduced. 10. The Corona Commission identified obstacles to the government's ability to lead the country in a national crisis and pointed to shortcomings in the behaviour of the regions during the crisis. The inquiry should analyse the pros and cons of a change in mandatorship, which should be interpreted as a question of whether a transfer of the mandatorship to the state would solve or at least reduce these ten sets of problems in the Swedish health and medical care. This report to the commission concerns the consequences of such a change for citizens' influence and democratic accountability and for the legitimacy of the health and medical care system in Sweden. The conclusions are that it is not likely that changing the responsibility for this policy to the state would increase democracy, accountability or legitimacy. Instead, it is argued that a combination of the regional level of democracy in combination with increasing citizens’ rights in the implementation process could improve legitimacy and accountability of the Swedish public health care system.
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