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From: Helena FW
Date: 10/22/02
Time: 5:20:02 AM
Remote Name: 212.73.29.139
Hello Tracy,
The reimbursement system in Sweden is a complicated affair, overloaded with heavy administration. The government system in Sweden and It's fundings is in three parts; the State ie the government and the parliament and different Dept, the different health districts governments (in all 20 districts) running the hospitals, and the community governments runnning schools, nursery schools, primary health care such as the local doctor, nurses, houses for severely impaired persons such as elder disabled, mental retarded living in small appartements or institutions.
All three levels are financially and administratively governed by politicians, as a consequense dependent of an administration keeping the finances within the district and professional "expertise" in different issues. But there is a reaction among the right wing liberal politicians, that will focus more on the individuals needs of treatment and less of the "system" ie what the "expertise" says.(Acceptance for certain treatment outside of the hospital by other SLP's for instance working privately, (in Sweden 10% of the SLP's)is regarded with fear from the SLP's in the clinic, as it causes withdrawl of the Dept of SLP's own budget)
Today through the internet we all citizens can find qualified facts and new knowledge about our own disease, impairment or handicap. That means that we all might have achieved certain knowledge before visiting the doctor or SLP, while we usually still are regarded as PATIENTS not CLIENTS, and personal requests might be regarded as "a difficult patient" that has to accept the professional principles ie, a certain degree or administrative routines or the current therapy format provided by the SLP's working in the hospital Clinic. ( in other words the personal pride of the professional)
Moreover there is a tendency of lack of flexibility in official treatment, with a one-therapy-at-a-time attitude, governed more by long term clinical practise than respect of individual needs of choice of therapy from the Client, PWS and adaptation of new results in Clinical research to daily clinical practise.
As a consequence, the professionals devoted to development of treatment, many times has to work privately and/or being "protected financially" by an Institution at the University. But, with an area of treatment as stuttering with no tradition of Clinical research within the Education of SLP's, there is no financial support provided for Clinical research in new areas of Stuttering.
As a consequence, the very few SLP's (2 exactly) working with PFSP or Prolonged Speech ("New" to Sweden)has to finance things as private clinicians or supported through salary from another job, and running the Clinical work "off duty", weekends, holidays and so on.
For the PWS, in other words, stuttering treatment is not a matter of choice for everyone. It is governed by your income, as not supported by the society, or by years of struggle against SLP's and health care administration to finally receive a medical referral. For most PWS, due to the fact that the stutter heavily limits their possibilities to argue against authorities, if they aren't very skilled writers it is impossible. For those who have parents fighting for their rights it is possible.
Two cases from my Clinic. An 87 year old mother from the very North (Arctic Circle) contacted me and asked for help for her 55 year old son, because of severe stuttering unimployed and hadn't made any phonecalls for over 10 years. She asks..quarrels with the health care authorities and SLP's of their district, and gets no help for referral to my Clinic. Takes her last savings and paying privately for his treatment. After 3 weeks PFSP comprehensive he is fit for fight taking the struggle with the health care. Goes to the main ENT doctor and his' waiting room with his video-tape the proof of his development of fluency, and says "If you are not willing to look at my tape, the progress I've made and reimburse my mother, I will call the police". THEN, FIRST THEN THEY WERE WILLING TO EVEN LISTEN TO HIM!But, because of pride, the reimbursement to him had to be administered through my Clinic and not to him directly. "We do not pay directly to PATIENTS". Receiving the money, he and his' mother took a trip to Canary Islands.
Another case, a young woman at treatment for the moment, from the age of 10 regarded as a "hopeless case" from the local SLP's because of her atactic dysathria in combination with heavy stuttering. Thanks to her parents struggle, she finally got a referral, when they could find the proofs that it had been the case for her.
For the moment I feel unhappy that the liberals didn't win the elections. Otherwise we could have been looking forward to a National Health Security system governing our individual rights to Choice of treatment, and almost all SLP's working privately, as in Germany. No more struggle.
All the best
Helena