Nine Swedish Regions Fined Millions for Bypassing Procurement Law on Patient Records System

• Kammarrätten i Göteborg ruled that nine regions violated procurement law by collectively agreeing to acquire the Cosmic system outside a competitive tender process
• The fines total millions of kronor — costs ultimately borne by regional taxpayers, not the officials who made the decision
• No individual accountability has been reported for the officials who approved the procurement shortcut
• The case fits a recurring pattern of Swedish regional bodies coordinating large purchases outside legal frameworks

Nine Swedish healthcare regions have been ordered to pay millions of kronor in fines after the Kammarrätten i Göteborg (Administrative Court of Appeal in Gothenburg) ruled they violated public procurement law by collectively agreeing to acquire the Cosmic electronic patient records system without a competitive tender. Aftonbladet reports that the regions struck the deal outside the legal procurement framework, bypassing the process designed to ensure taxpayers get fair value and competing suppliers get a fair chance.

Sweden's public procurement rules exist for a reason: when regional bodies spend public money on major IT systems, they are required to open the process to competition. The regions involved chose a different route — coordinating among themselves to collectively adopt Cosmic, a system developed by Cambio Healthcare Systems. The court found this coordination amounted to an unlawful direct award, circumventing the mandatory tender process that applies to contracts of this scale.

The fines land on the regions themselves, which means they land on regional taxpayers — the same people whose healthcare the system was supposed to improve. No reports have emerged of any individual officials facing personal consequences for approving the procurement shortcut. This is the standard pattern in Swedish public administration: institutions absorb penalties as budget line items, and the decision-makers who created the liability move on untouched. The regions will cover the fines from the same budgets that fund hospitals, primary care, and ambulance services.

Sweden's regions have a long and troubled history with IT procurement in healthcare. The country's fragmented system of 21 regions each managing their own patient records has produced decades of interoperability failures, cost overruns, and vendor lock-in. The Cosmic acquisition was presented as a solution — a way for multiple regions to align on a single platform and achieve the kind of coordination that the fragmented structure otherwise prevents. The appeal of skipping a lengthy procurement process is obvious when the alternative is years of tender procedures, legal challenges from losing bidders, and implementation delays.

But the shortcut has now produced exactly the kind of cost and delay it was meant to avoid, plus court-imposed fines on top. The deeper question — whether Cosmic actually delivered the promised efficiency gains in the regions that adopted it — remains largely unanswered in public debate. Swedish healthcare IT projects have a consistent record of overpromising and underdelivering, and the regions involved now face the worst of both outcomes: the system they wanted plus a legal bill for how they got it.

The fines will be paid from regional budgets. The officials who signed off on the deal will not.

Källor: Aftonbladet