Health post: Barriers to Business

Yesterday I had lunch with Martin, the CEO of JoiceCare (the company that bought the Giraff last year), to learn more about the company and why the Giraff is only in 6 homes. Martin told me a lot about the influence of Sweden’s government on budding businesses.

JoiceCare has to work with many levels of the government to develop a product. There are 21 counties in Sweden which have the main responsibility of maintaining public healthcare. Subdividing further, there are 290 municipalities in the country that oversee more lower-level government services such as schools and emergency services. JoiceCare has to work with the government on both the municipality and county level to introduce the Giraff as a healthcare product. Beyond that, there are various government agencies and laws that affect eHealth companies.

Once a Swedish citizen is 65 years of age or older, they have the ability to request any number of services available to senior citizens. They receive a menu of options, which might include three visits a week from a health professional, home delivery of certain meals, and perhaps one day, the Giraff. This is the only way to “sell” a healthcare product. Since healthcare is free for everyone in Sweden, no one would buy a 10,000kr Giraff robot outright. The government has to decide to buy it and then offer it to the people for free. (This explained my confusion about the cost of the Giraff). Thus JoiceCare has to convince the municipalities and counties that the Giraff is worth the investment and cheaper than the alternative, which is sending health professionals to visit homes in person.

Getting on the “menu,” and thus getting the Giraff in the hands of real users, requires an extensive process of submitting “procurements” to the different government groups. It is far easier to get a Giraff in the hands of a university. According to the government, that is simply a “project” that JoiceCare is doing, and projects require less oversight. These universities have the freedom to do experiments with the Giraff and assemble groups of test users, senior citizens who live with the Giraff for a certain period of time. Then the universities can follow up with these seniors and assess the value of the Giraff, gathering data and surveying the users about their experience. There are currently about 30 Giraff robots in universities in Sweden and other European countries, meaning that there are at least 30 of these test users.

This way, the Giraff is in more than 6 homes. However, JoiceCare is not allowed to know about these other users. Due to privacy laws, JoiceCare cannot know the users’ names, addresses, or particular illnesses. JoiceCare does not get the specific results of the university questionnaires, but rather generalized results and suggestions. With the company not able to perform its own testing, I can imagine that adding this extra step to product development contributes to a much slower revision process.

A few days ago, I had asked Dan what JoiceCare is doing to advertise the Giraff, and he said he wasn’t sure. I thought it was crazy that a product ready to be deployed wouldn’t be advertised. Now I realize that companies cannot simply advertise such products, especially in the healthcare sector. By building a product that will be offered by the government, JoiceCare does not have the authority to advertise or promote the Giraff to potential end users. The government will choose whether or not to make it available, and how to present it as a choice, and then the people have to decide. There are no ads in this “menu” of care.

So how easy is it to submit procurements to these government officials? Apparently it takes 6-12 months for one municipality (out of 290) to approve a submission from Giraff. Martin also explained some of the struggles of dealing with government employees in healthcare. They can be reluctant to try new things because if they get something wrong, thus potentially endangering lives, they will get fired. It is safer to keep one’s job by doing nothing at all.

There’s a lot more to this healthcare conversation and more that I learned from Martin, but that’s enough for now. It’s all far more nuanced than I expected. Tomorrow, I head off to the southern city of Malmö!

P.S. In my research about the government structure, I realized that there is a King of Sweden. This is probably obvious public knowledge, but for some reason I had been unaware. There is a whole royal family here, though as part of the constitutional monarchy they have very little executive power. (I checked, and all single princes in the royal family are under 2 years old – shame!)

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