KRY – Disruptive Digital Healthcare WINNING in the Swedish Welfare Economy

What is KRY?

KRY is Sweden’s first and largest digital healthcare company, founded in 2014. The company provides a platform on which users can connect with qualified healthcare professionals -nurses, doctors, and psychologists- via their smartphone or tablet. Appointments over video-chat (only) are readily available for immediate sessions via a drop-in service or for future sessions, through which health professionals diagnose patients and prescribe medication, when appropriate, and otherwise write referrals to e.g. lab tests or specialist clinics. So far, KRY has helped over half a million people in the Nordics (population of 27 million), and is continuously growing.

Below I will describe why I find KRY, as a first mover, to be a disruptive winner in the healthcare system in Sweden by providing the context in which KRY operates as well as the solution KRY offers to emerging challenges.

The deteriorating conditions in Swedish healthcare*

Sweden, a well-known welfare economy, provides universal government-funded healthcare to its citizens (for free or for a small fee). Although the system is said to have functioned frictionless in the past, it has in the past two decades struggled to provide the high-quality and equitable access to healthcare that it promises its citizens. The inadequacy of the system is becoming more prominent each year and the frustration is visibly growing among the population.

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The challenges faced by the system are complex and multifaceted, although the most critical ones can be summarized into the following inter-related points:

1. Aging population and increasing rate of health complications: Two realities demanding more attention and resources than previously provided to the healthcare system
2. Significant recent and expected future immigration: Sweden has accepted more refugees (the majority of immigrants) per capita than any other country in the world in recent years (often with health requiring attention), experiencing a 10% population increase from ~9 million to ~10 million in the last two decades, a rate expected to continue in the future although at a decreasing rate
3. Shortages of healthcare professionals: Demand of care is greater than its supply, largely as a result of (1) and (2). Already strained resources -labor, time, and capital- lead to stressful work environments and poor working conditions, in turn resulting in healthcare providers fleeing the profession, increasing shortages further. Inefficient record keeping consumes valuable time away from patients
4. Large disparities in quality between regions: The decentralized healthcare system gives independent regions similar state support, yet disparities in quality of care emerges as regions face different challenges at various costs and further have unequal access to healthcare professionals
5. LONG waiting times and unsatisfactory patient experience:
   1. Due to shortage of healthcare professionals, waiting times for appointments are one of the longest in Europe
   2. Swedish law stipulates that patients should wait less than 90 days to undergo surgery or see a specialist, yet every third patient waits longer
   3. Appointments with psychologists, particularly for children and young adults, may not be available within a year, sometimes more
   4. In rural areas appointments with doctors may not be available at all in which case they must be rented in from another municipality, which is both costly and slow
   5. Patients rarely see the same healthcare provider during separate visits and receive insufficient personal attention
6. Increasing costs to the welfare system: The costs of healthcare to the state are expected to increase from 10% to 16% of GDP between 2012 to 2050 should the current structure remain unchanged. Yet while demand increases, the healthcare profession becomes less desirable, and labor shortages increase

As we can see from the above, Sweden is experiencing a deteriorating and unsustainable healthcare provision with unsatisfactory conditions for patients and healthcare professionals at an increasingly high cost to the welfare economy.

What makes KRY a winner in the Swedish context?

KRY describes its ultimate purpose as providing well-needed equitable access to high-quality healthcare; and it does, in addition to addressing all other points in (1) through (6) above: increased efficiencies in time management and productivity, decreased costs, reduced demand of doctors, nurses, and psychologists in health clinics, and increased satisfaction and well-being of both patients and healthcare professionals. The winning elements can be described as follows:

• Equitable and convenient access: As a digital service, KRY provides an equitable access to healthcare of the same high quality to individuals in all parts of Sweden. Its convenience enables treatment of individuals that otherwise may not find the time nor health to visit a clinic
• Still free or almost free healthcare to patients: KRY receives public reimbursement for patients’ online appointments, with no difference in price compared to visits to physical clinics
• Early diagnosis and prevention: Patients can access healthcare professionals at KRY at onset of illness when they would have otherwise not bothered to travel to a health clinic, and may prevent what would have become chronic or difficult to treat conditions
• Shorter waiting times and increased patient satisfaction and trust to system: Not only do patients using KRY experience no wait time, but KRY meets with patients (in 25 languages in total) that would otherwise have gone to local health clinics. This results in less pressure on those clinics with shorter waiting times (and less chaos), improving the experience of patients in clinics and reestablish trust to the healthcare system
• Decreased demand of healthcare professionals in health clinics (helping eliminate shortage): Related to shorter waiting times, with less patients visiting the health clinics, less healthcare professionals are needed, decreasing the shortage (assuming the healthcare professionals at the clinics remain constant – which could be contested if health clinic professionals switch to become KRY professionals at a later stage)
• Better work conditions and increased satisfaction among healthcare professionals (possibly resulting in a more attractive profession to future workers): Resulting from shorter waiting times and decreased pressure on clinics
• Centralized documentation of patient medical histories: With a digitized and unified system that eventually will be accessible to physical health clinics, Sweden for the first time will be able to efficiently log and share relevant details of patient histories nationwide
• Decreased costs to the welfare economy: Due to efficiencies in time management and productivity, coordination among professionals, decreased need for expensive physical offices / clinics, efficient patient logging, decreased language translation costs, among other factors, the state’s cost per patient is 50% of the cost per patient in the traditional system. Additional money is saved as a result of early diagnosis allowing preventative (cheaper) healthcare
• Launched a digitized revolution in Swedish healthcare: Partially with KRY as a catalyzer, the Swedish government declared in 2016 that the country aims to become the “best in the world to use digitizing possibilities for the purpose of facilitating people receiving high-quality and equitable healthcare”

The inefficiencies and challenges in the Swedish healthcare system are one of the most debated topics in Swedish politics today, with proposed solutions varying across parties. Many, for legitimate reasons, point to the drastic increase in immigration as a major cause for its deterioration, although this is not the sole cause. Such argument is often portrayed by the right-wing (what some would call anti-immigration) Swedish Democrats as evidence of the unsustainable immigration politics in Sweden, and has generally contributed to increased friction between Swedish natives and incoming refugees. Without taking a political position on the matter, it is important to note that the state of healthcare in the country will affect much more than just the health of the people. The introduction of KRY’s digitized healthcare has the potential to minimize negative consequences in all spheres, physical, mental, and political.

It is worth noting that KRY currently operates in 5 European countries with continued expansion plans in neighboring states. Yet as public policies are complex and vary between governments and KRY is still establishing itself on the European continent, I chose to focus on KRY in Sweden. KRY nevertheless is a first mover in many markets and currently holds the position as the number 1 largest digital healthcare provider in Europe, although facing increasingly fierce competition across countries from companies offering similar services. Regardless of its future success, KRY will remain the digital innovator that disrupted the healthcare system in Sweden –  a disruption that has served and should serve as an inspiration for other countries wanting to create a more efficient, sustainable, and equitable healthcare system.

https://www.kry.se/

*

https://www.businesstimes.com.sg/consumer/swedes-face-problems-with-health-care-system

https://www.symbiocare.org/how-sweden-achieved-world-class-medical-and-social-care/

https://www.lakartidningen.se/Aktuellt/Nyheter/2018/01/Vantetider-och-overbelaggningar-vaxande-svenska-problem/

https://digital.di.se/artikel/kry-koper-svensk-terapi-app-som-laggs-ned

https://it-halsa.se/kry-etablerar-sig-i-malmo-och-presenterar-nasta-generations-vard/