When an international student lacking a personnummer needs urgent help, who ought they turn to? “When a student becomes ill, there is currently uncertainty as to whether the student should turn to primary care or a student health clinic.” states SFS. In this article, we will explore the stories of international students who struggled accessing healthcare in Sweden.
Opening the student portal of the University of Gothenburg’s website, there is no direct link to healthcare-related assistance on the front page. Nor is there any information about Feelgood, the private healthcare service the university partnered with. Instead, the link is buried under two subpages. The University page states they will help all students with study-related health issues. Still, many students turn to teachers for help, such as I did.
The University of Gothenburg’s website asserted that the university’s health provider would work like a clinic and treat international students for all health-related issues. This is not true, and the website was only updated recently. How many students have fallen for these false promises? According to professor and MIJ coordinator Ulla Sätererie, international students with mental or physical issues asked her for help, and she guided them to Feelgood as the old website promised them help. The old version of the website can still be found archived. According to Sätererie, 1177 does not provide enough information for international students. The University of Gothenburg was the third most commonly applied university in Sweden in 2023. Sätereie stated: “[W]e like international students.” She acknowledged that students without personnummer are vulnerable: “[W]e have to provide them [with] a better healthcare system.”
“According to the information provided by the university, it does not specify the clinic that I can visit to consult my mental health problem (only health care service available […]) but when I need a doctor to consult, it is not available for a non-EU student.”
– Non-EU student at Lund University.
Article 25 of the UDHR states that all human beings deserve an adequate standard of living regarding health, including medical care and access to social services. When a student spends hundreds of thousands of Swedish kronor to go alone to a foreign country to study at a university, is it too much to ask to be medically treated while studying here? We may not be paying taxes (unless employed), but we pay our and our life savings to come here. Is it too much to ask for healthcare?
“[W]e know that this is an issue, […] We are trying to find ways to help all students of course, […] especially the international students with no personal number.”
– Linda Emanuelsson, student support at the University of Gothenburg.
I first sought help early in my first semester when I experienced severe stress and anxiety from my studies and the culture shock I experienced when I came to Sweden. I could not find help on the website, so I naturally turned to my professor, Sätereie. She put me in contact with Feelgood, but simply contacting them for help turned into a weeks-long back-and-forth that lasted longer than my health issue itself. They asked me for a “personnummer”; something I did not know what it was. Feelgood states they will help international students, whether they possess a personnummer or not, but everything becomes more difficult if you do not have one.
The second time I needed healthcare, I was in extreme pain in my kidney at University, laying on the floor without being able to move. I called for an ambulance. They assured me they would arrive in five minutes, but when I could not provide them with a personnummer, the operator said they could not send an ambulance to me. After begging, they sent one after half an hour. By this point, I had been in pain for a very long time. When the first responders came, they asked me for identification before helping me, but I could not talk. They gave me two Iprens and showed me the closest vårdcentral to walk to. They refused to drive me to the vårdcentral, but I could not walk. They told me to order a taxi instead. So, I cried to them to drive me instead, which they reluctantly did after much debate. Even though I finally made it to the vårdcentral, and the doctors helped me, it was ultimately useless as they never cured me. I had to visit seven other hospitals and clinics and never got treatment for my illness.
This ordeal affected my study much as I could not attend class for two months. How can Feelgood not consider this “study-related” when it impacted my study? I wondered whether I was unlucky or if other international students in Sweden had similar experiences. That is why I chose to write on this topic.
“A personnummer is a golden key to Swedish society.”
– From Difficult to Live without Personnummer by Elin Schwartz.
A “personnummer” is a ID number provided by the state through Skatteverket. It serves as an identifier in databases, and most services in Sweden are linked or limited to having a personnummer. EU students can get a personnummer, and non-EU students can also get one through a longer process. However, non-EU students can only get one if they are here for a two-year (or longer) program. Not possessing a personnummer, though, can severely limit a person’s access to services in Sweden, even healthcare.
For 2023, 15,168 people without a personnummer applied to study at a university in Sweden, as per data from UHR, the Swedish Council for Higher Education. We contacted students from four universities to hear their opinions about healthcare in Sweden.
“Not having a Swedish personnummer makes things incredibly difficult. […] Swedish doctors continuously refuse to accept or treat me and send me somewhere else”
– EU student at Uppsala University.
Although the Swedish healthcare system has received acclaim for its quality and accessibility, international students without a personnummer frequently struggle to receive help. Of all the students surveyed (which included Swedish, EU, and non-EU students), 60 percent stated dissatisfaction with the Swedish healthcare system. Considering only non-EU students, 89 percent were not satisfied. Many claimed that not having a personnummer made accessing healthcare needlessly complicated–even for many EU students. EU students will receive an EU “Blue Card”, which allows them to access healthcare in the Union. However, despite this, many EU students were still denied treatment.
One EU student who contacted us explained how the language barrier and lack of a Swedish phone number made it difficult for them to contact healthcare facilities here. They called various hospitals and vårdcentraler in an attempt to book an appointment. But, they never received a reply. They realized that the system did not register international or European phone numbers and that it was challenging to acquire a Swedish phone number without a personnummer. They had to ask a Swedish friend to make an appointment instead.
Another student recounted their experience of facing difficulties receiving help from therapists. With their Blue Card, they booked three appointments with a therapist at Feelgood after they began experiencing Schizophrenic tendencies. The Feelgood staff recommended the student go to a hospital out of fear for their condition. However, after the hospital visit, the student did not get any replies from their Feelgood therapist and was denied further help.
“Poor services when you don't have the personal ID number.”
– Anonymous non-EU student at the University of Gothenburg, talking about accessing Swedish services without a personnummer.
In Sweden, like many other institutional services, healthcare is regionalized. Finding the responsible people can be difficult in a regionalized system. Linda Emanuelsson, working at student support at the University of Gothenburg, stated that finding the people responsible for healthcare at the regional government is an arduous task, and finding someone willing to talk to her, is difficult. She told us that many systems in Sweden are not working as fully intended. Emanuelsson’s role is to convey students’ feedback to the state, but cannot do so if no one is willing to converse with her.
Feelgood, denied commenting on our questions. According to the website, they only help students with study-related issues. Emanuelsson clarified that they do offer help for physical injuries, but only if the harm arises from a school activity. For students experiencing a physical injury not related to their studies, Feelgood will not help. Three students we have been in contact with stated that Feelgood did not help them with their issues. Emanuelsson explained that the University of Gothenburg chose Feelgood after carefully considering the options and what they offer. If Feelgood is the most suitable healthcare service provider for international students, why are students not satisfied? According to our form, 80 percent of students answered with “I didn't ask for help, but I found the way by myself” to our question: “Did [the university] help you, connect you, or direct you to the right person?”
Linda Emanuelsson told us that they are actively seeking ways to improve the help offered for students lacking personnummer, but cannot do much if the regional government does not listen. Everything is tied to the law, so little can be done without legislature. Furthermore, Feelgood does not have a direct way for students to file complaints or give feedback. Students must, instead, turn to their universities, and the university then conveys the feedback to Feelgood. The students can also contact the student unions. This way of providing feedback is very convoluted. Linda Emanuelsson admitted that the appropriate university feedback channels are very indirect and hard to find, so few complaints ever reach the university or Feelgood.
Besides the university, students can also direct their feedback to the Patient Advisory Committee. The Committee “is an impartial group in all regions of Sweden that can help you present your viewpoints or complaints to the clinic or unit in question”, and they ensure that the complainants will receive answers to their complaints. We contacted and asked the Patient Advisory Committee for statistics on student complaints, but they “don’t keep statistics, whether the person is a student or not” according to their Press Secretary. Therefore, it is difficult to comprehend the number of student complaints in the country.
International students are instead covered by private insurance. At the University of Gothenburg, the insurance provided is FAS and FAS+. On their website, they state that they cover “emergency medical and dental care” and exclude “[r]egular medical check-ups [and] medications”. They do not elaborate further. On another page of their website, however, they state that they do not cover medical emergencies that did not occur “[d]uring school hours” and “in the school premises” or “on the school grounds”.
“I play at a volleyball team in Gotland and I had insurance from the team (which I paid for), but since I didn't have a personnummer they wouldn't reimburse me if I would do physiotherapy sessions so I just didn't and had to wait to come back to my home country to be cured.”
– EU student at Uppsala University.
Similar to the criticism of Feelgood, FAS does not directly take feedback from its users. Instead, students are expected to direct their complaints to the same obscure channels at their university as Feelgood. On a positive note, a spokesperson for FAS, Erland Törngren, assured us that FAS and its partnered universities have regular meetings discussing improvements to the insurance. Nonetheless, it would be much better for both FAS and the students covered by the insurance if there existed a more direct way for students to provide their feedback instead of going through the universities.
“I had an extreme toothache, and I turned to a professor. They sent me links that stated that students under 24 are exempt from the dental care fees, but we have to be registered. It was so confusing. No one could help or clarify this for me.”
– Co-author of the article, Hongyu Zhang.
Although FAS and other insurance companies reimburse the students, when a student seeks emergency healthcare treatment, they must first pay the treatment out of their own pockets before they can contact FAS for reimbursement. That can be an issue for students who do not possess such a large amount of money at hand. Nils Pasi Nävert, the Administrative Officer at the Service Center of the University of Gothenburg, acknowledged this and said it is unfortunate that this is the system, but nothing can be done if the law is not changed.
We also brought up the problem of banks with FAS. For persons lacking a Swedish bank account (which is hard to open without personnummer), they can transfer the funds to their foreign bank. Törngren was unsure whether the foreign banks would incur a transaction fee. So, the final amount the student receives might not be the exact amount they are owed. Alternatively, the student could request the reimbursement as a check, but then they must be present in Sweden.
Extra-EU international students studying one-year programs do not receive a personnummer per the law. Vjera Catovic, a spokesperson at Skatteverket, explained that a person must have a visa and physically be in Sweden for exactly one year or longer to receive a personnummer. One-year students often receive a visa slightly shorter than that from Migrationsverket, thus prohibiting them from getting a personnummer. Instead, they receive a “samordningsnummer”, which resembles a personnummer, but it cannot be used for many services in Sweden.
Possessing a personnummer is essential in living in Sweden. The dilemma is that, since many international students will stay in Sweden and apply for a one-year work visa after graduating, they will be entitled to a personnummer in the end anyway. It would be advantageous for the authorities to reconsider the laws to approve one-year students to obtain personnummer as well.
Lacking personnummer can also deny students entrance to clubs and concerts. One student told us they were refused entrance to a venue, even though they had already paid for the ticket. They were denied entrance when they failed to provide them with a personnummer.
What can be done? The spokesperson for Skatteverket told us that they do not provide one-year students personnummer “not [for] the fear that personnummer will run out” but “provisions in the law”. Despite this, many researchers and reporters have noticed a scarcity of personnummer, which has caused problems, like multiple people having the same number, a different date than their birthday, and confusion at hospitals.
By the University of Gothenburg students Khorrambanoo Askari and Hongyu Zhang.