Free choice of assistive equipment
A stronger right to choose assistive equipment was introduced in 2014 in the Health Care Act
(1982:763) and in the Patient Act
(2014:821). The motivation was to give the individual larger opportunities for influence (Prop. 2013/14:67). A part of the increased opportunity to introduce assistive equipment was the introduction of the so-called Free choice, a model in addition to the traditional prescription of assistive equipment (Prop. 2013/14:67
). Some county councils had since 2007 pursued a trial with the support of governmental stimulus funding. Free choice means that the user of the assistive equipment can buy equipment outside the operator’s procured offering of assistive equipment based on a given order figure. The user of the assistive equipment can use their own means to pay the difference in excess of the amount of the order to get more expensive equipment. This makes the user of the assistive equipment the owner of the equipment and in charge of its service. However, a service account is often used with a certain sum of money for equipment needing more extensive service.
The free choice of assistive equipment requires that there is a diversity of suppliers of assistive equipment on the consumer market which is not the case. The model requires also that the user of the equipment has access to independent consumer guidance which to a large degree is lacking at the moment. This makes it more difficult for the user to make an informed choice. (National Board of Health and Welfare (2016), p. 7)
It is noted that the number of users receiving assistive equipment through freedom of choice is small, with the exception of hearing aids. The reason for the low use of freedom of choice in other areas of assistive equipment is thought to be that those prescribing assistive equipment do not to a large degree inform of the possibility and that the demand is low among the users. The hearing area being dominating is explained by economic incentives for audiometric offices to promote their own products. The audiometric technicians have a double role, partly as caregivers and partly as hearing aid sellers.
The model has received criticism, among other things, from The Swedish National Council on Medical Ethics in the report Co-payment and out-of-pocket payment in public health care – ethical aspects
, where the council states that co-payment contradicts the intentions of the Health Care Act – that good care is to be given on equal terms. Also organisations within the disability movement have expressed criticism, and for example the National Association for Hearing Impaired People has stated that hearing care has become a ruthless business
, more expensive and of poorer quality for individual hearing impaired people.
The Equality Commission states that the model has equality problems, that private caregivers have economic interests to choose a certain alternative. The Commission proposes instead a solution where only an employee of the region may give out the assistive equipment and give neutral information. If private caregivers are used, they must not have a connection to a certain producer of equipment (SOU 2020:46
Personal representatives were introduced in 1995 when ten municipalities in the country received the possibility to carry out trials with personal representatives for three years. Personal representatives were one of the propositions in the psychiatry reform (Prop 1993/94:218
), which was supposed to lead to an improvement of the living conditions for persons with intellectual disabilities.
The representatives act as support in contacts with the authorities, caregivers and other actors the individual needs to be in contact with. Using personal representatives is aimed at persons with intellectual disabilities and considerable and essential difficulties in performing activities in different areas of life. To be entitled to a personal representative a person must be 18 years old or older, and have extensive care, support and services, rehabilitation and employment needs. In addition, the person must have a need for long-term contacts with social services, primary health care and specialised psychiatry and other authorities. Such persons are for example those who in addition to an intellectual disability have an addiction problem.
Personal representatives are managed by the municipalities and are partly funded by the government, the National Board of Health and Welfare and the provincial government. A decree on government grants to municipalities managing personal representatives entered into force on 1 August 2013. The decree regulates the operations, purpose and tasks. The decree also regulates the conditions for receiving government grants.
Coordinated support for parents to children with disabilities
Parents to children with disabilities are often obliged to take on a big responsibility in coordinating and administering the support the child needs. The number of contacts and the related work can be extensive and strenuous. To ease the situation for the parents initiatives have been taken to improve the cooperation for the child’s support. The Swedish NAO proposed in 2011 trial operations with certain cooperators to help families and ease the cooperation with the actors involved
. The National Board of Health and Welfare presented in 2017 a cooperation model in the form of knowledge support.
The model is expected to increase children’s access to functioning support and reduce the parents’ workload. The knowledge support presents organisational and practical success factors in the efforts to develop the coordination.