I Think This Woman Misses The Point

‘Unlike Sweden, when you call an ambulance in the US, it comes’

Recently, I have read a chain of stories about a health care crisis that, until I moved to Sweden, was barely on my radar. And coming from the US, a country mired in health care woes, I thought I had heard it all.

In recent months, newspapers around Sweden have reported a slow trickle of deaths connected to the slow or lack of response from ambulances.

The author seems to think that this is the exception, not the rule in Sweden’s highly socialized health care system. Which I think might be more of a wellness system than a healthcare system. I don’t know that for sure, and maybe someone with more experience or knowledge will comment.

What it seems like, to me at least, is you are in good hands as long as the goal is to keep you from getting ill. As the saying goes, “An ounce of prevention is worth a pound of cure.” It seems that in all socialized systems, the problems start when one becomes ill and/or needs emergency care.

While an emergency operator undoubtedly has a tough job, one piece of it sounds fairly straightforward: if someone asks for an ambulance, in most cases, they probably need it.

Obviously, she never read this blog, Ambulance Drivers, or many other EMS and Emergency Medicine blogs. The problem in our country the opposite of what she describes here. We send ambulances, often with lights and sirens, to trivial problems. The difficulty is in knowing what is going on. Nor is there much evidence that EMTs and paramedics are all that good in deciding if someone really needs to be in the hospital. That doesn’t count the blatant system abusers, of which there are many. The problem is that if we miss ONE patient and that patient dies, the entire system comes under scrutiny. So, we are incredibly risk averse. While that might be good, it’s incredibly expensive. Plus a lot of people get free health care, including EMS, and have no incentive NOT to abuse the system. I’ve talked about that before, so I won’t now.

Don’t get me wrong; I’m not making any broader suggestions that Sweden’s health care system should look more like the US’s. My point is just the opposite: if a country with such a fractured health care system can make ambulance services work, shouldn’t Sweden be able to as well?

Sorry MS Ahlfeldt, this is not a bug, it’s a feature of the Swedish health care system. All socialized health care systems feature rationing, especially of emergency care. That’s the most expensive part of the system because it can’t be scheduled and cost contained.

The intentions behind the Swedish process are good: a more careful screening of emergency victims is intended to cut down on wait times and guarantee care… and possibly save money. But in a twist of irony, instead of feeling as though the care I need is guaranteed, the current model has undermined my confidence that I will get that care at all.

I’m not so sanguine as MS Ahlfeldt about the rationale behind the Swedish system. Again, socialized health care is fine, until you need get really ill.

As an immigrant with imperfect Swedish, I felt especially vulnerable. After Erik broke his arm, my conversation left me with the feeling that our emergency care rests on a decision made by one bureaucrat behind a desk, not a group of people concerned with my son’s safety. In a new country that I’m still figuring out, I don’t want to be concerned that an ambulance might not come, despite my protests.

Wait! No translator? No Language Line to speak to you in your native English to make it easier for you to communicate? That’s something the “fractured” (her word) US system does, both at 9-1-1 and in the hospital. How can Sweden not do that? It’s not because they have a homogenous population. There are a lot of Middle Eastern immigrants in Sweden who don’t speak Swedish. Surely there must be Arabic, Farsi, and other language translators available to them.

The bureaucrat she mentions is what is called a “gatekeeper” in the US. About 15 years ago, this was the system envisioned for medical care and EMS in general. You wouldn’t call 9-1-1 or if you did, you’d get a nurse or some other trained person who would determine if you needed an ambulance or emergency department and how soon. Phone triage is tough, and regimented phone triage systems make it harder, not easier because they try to take human judgement out of the equation.
The Swedish system seems to be the embodiment of a system based on algorithms with no room for judgement.

Interestingly, we never find out if she did get an ambulance or how long it took to respond.

Here is another case where the caller/patient died because the call taker didn’t think she needed an ambulance.

Report slams denied ambulance call death

“The operator considered her to still be communicating verbally and decided that she didn’t need an ambulance,” Annika told The Local at the time she filed her complaint.

In a meeting with SOS Alarm, Jill’s mother asked them to explain how it was possible to deny someone an ambulance simply because that person was talking.

“How could you even call for an ambulance in the first place?” she recalled asking them asked.

“No one could answer that one.”

So, you have to be unable to speak to qualify for an ambulance? But, if you aren’t able to speak, how do you call an ambulance?

Even Joseph Heller wouldn’t be able to figure that one out.

My point is not to slam the Swedish system or to claim that our system is perfect. The major problem with US healthcare is neither availability or quality, it’s financing. Which no on seems to want to talk about. Sweden seems to have realized that and is trying to deal with it. Sadly it seems like the old equation is rearing it’s ugly head.

Which equation?

“You can have it fast, good, or cheap, pick two.”