Your doctor can now write you a prescription to visit Sweden. Will any healthcare cover it?

Not all prescriptions go through the pharmacy. Around the world, it’s become somewhat commonplace for doctors to prescribe time in nature or outdoor activity for the benefit of their patients. 

In Japan and South Korea, for example, doctors prescribe forest bathing, and in Canada, doctors can give patients a free annual Parks Canada pass when they prescribe time outside. 

But what if your doctor could write you a prescription to spend a week in Sweden? And what if your health insurance paid for it?

Well, it might not be so far-fetched. Recently, Sweden’s tourism board announced that the nation had become the “first country in the world to be offered on prescription.”

I’m personally a bit Sweden-obsessed, so I can get on board with this. I spent nearly a month there last summer and loved it so much that I ended up giving up my ticket for Taylor Swift’s Eras Tour to stay longer. I road tripped through the forests around my great-grandfather’s birthplace, backpacked above the Arctic Circle in Lapland, and island-hopped along the brand-new Stockholm Archipelago Trail. 

You don’t have to convince me that Sweden is a place for improving one’s physical health and mental wellbeing. 

But what about your insurance company? How far will a prescription get you with them? I wanted to find out, so I did a little digging.

If we think about what we would like our patients to embody or to do, it’s kind of what Sweden lives every day.

- Dr. Stacy Beller Streyer

What are doctors saying?

The announcement was accompanied by a printable document you can take to your doctor to explore the benefits of, say, cycling around Swedish cities, foraging for berries in its vast forests, hiking long-distance trails, or enjoying regular saunas.

This “appendix” of Swedish health benefits, akin to a fine-print list of side effects, references dozens of scientific studies supporting the physical and mental health benefits of nearly every aspect of travel in Sweden. 

Better air quality than most of Europe? Check. Antioxidant-rich lingonberry foraging? Check. Attending a live metal concert? Yup, they’ve got research to support the benefits of that, too (apparently, ‘extreme’ music can “enhance positive emotions and regulate anger”).

They’ve even got international doctors on record saying they would happily prescribe a trip to Sweden. One supporter is Dr. Stacy Beller Streyer, a pediatrician near Washington, D.C., and associate medical director for ParkRx America, which advocates for nature prescriptions in the US.

“If we think about what we would like our patients to embody or to do, it’s kind of what Sweden lives every day,” Dr. Beller Streyer tells me. 

How a nature prescription works

If you’re unfamiliar with nature prescriptions, here’s how Dr. Beller Streyer explained it to me: Say you have anxiety, and your doctor thinks you would benefit from spending some time in the great outdoors. Instead of just saying, “Hey, I think you should get outside more,” your doctor would work with you to figure out exactly where you should go, when and how often you should go, what you should do there, and for how long. Your doctor would document this plan as your prescription, and you’d ‘fill’ it by following the instructions.

“Some individuals may, at first, think that they don’t have any green space near them,” Dr. Beller Streyer says. The ParkRx website has a database of thousands of public green spaces all over the US so you, or your doctor, can find something accessible that would fit well within your everyday life. “When you talk to them [patients], that’s part of the counseling you go through with them.”

A prescription trip to Sweden would work much the same way. You and your doctor could discuss specific places and activities, and then you’d book it yourself and be on your way to chase that Scandinavian health. 

There’s just one problem: The costs associated with nature prescriptions, such as travel to a National Park or entrance fees to get in, are not covered or reimbursed by US health insurance providers. And flights to Sweden? They’re not cheap, at least not from the US.

Does health insurance cover nature therapy?

Here’s where I’m curious about whether an official, doctor-ordered trip to Sweden might actually have some medical merit. By coincidence, Dr. Beller Streyer says she’s had several conversations recently about the potential for US health insurance to cover nature prescriptions in the future. It’s likely to be a “long road,” she says, but I see a bit of hope there—it’s not impossible.

I’ve found official tax guidance from the IRS to be ambiguous regarding health-related travel expenses. Without going into all the complexities, Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) offer some tax benefits for health-related spending. I read through some fine print in search of a legal way to use those funds to cover part or all of a doctor-ordered trip to Sweden, and to see whether such expenses might be qualified as tax-deductible on your income tax return.

Is it a PR gimmick? Partly, yes, but it’s also based on what’s real and what’s authentic in Sweden.

- Dr. Stacy Beller Streyer

“You can’t include in medical expenses a trip or vacation taken merely for a change in environment, improvement of morale, or general improvement of health, even if the trip is made on the advice of a doctor,” the IRS says in its definitions of medical expenses you can claim. Your time away from home should also not include a “significant element of personal pleasure, recreation, or vacation.”

At the same time, you can “include in medical expenses amounts you pay for transportation to another city if the trip is primarily for, and essential to, receiving medical services.”

If you have a specific plan to treat a specific ailment, noted on an official prescription document, is that legally different from advice for a change of scenery? 

Unfortunately, I can’t answer that. However, recent court cases indicate that there may be some room to redefine what’s considered a ‘recreational’ experience as opposed to medically necessary treatment.

In the last decade, a number of families have sued their insurance companies for rejecting claims for wilderness therapy programs, and one current case sounds optimistic for the cause. On October 14, a federal judge in the state of Rhode Island denied an insurance company’s request to dismiss a lawsuit over coverage of one such program.

In short, a family sued Blue Cross & Blue Shield of Rhode Island for denying their claim to cover their child’s three-month residential wilderness therapy program, which cost nearly USD$50,000. Blue Cross argued that they’re exempt from paying because the family’s plan excludes “recreational wilderness therapy programs,” while the family argues that the program was necessary healthcare, not a “recreational” adventure.

The judge did not make a ruling on whether the specific treatment in question should be classified as ‘recreational.’ However, she ruled against dismissing the lawsuit on the grounds that the insurance company’s fine print was ambiguous, according to court filings.

“It would strain credulity to interpret the Plan to mean that the mere fact that therapy takes place in a wilderness setting automatically qualifies it as ‘recreational’ and therefore excluded,” the judge wrote.

The lawsuit will be allowed to proceed, which could set a precedent for how such programs are defined for insurance purposes in the future.

Why Sweden wants to be the first country available by prescription

What was Sweden’s goal in offering itself up for prescription trips? Was it more than just a clever media stunt?

“Yes and no,” says Nils Persson, chief marketing officer for Visit Sweden. “Of course this is a marketing campaign for Sweden as a destination,” to show off its wellness benefits, but that’s not all.

“We also saw benefits of raising awareness of nature and culture prescriptions and activities in general with this campaign,” he wrote via email, “as a way to increase mental and physical health no matter if it takes place in Sweden, New York, London, Berlin, Paris or elsewhere.”

Calling your city, state, and federal representatives to share your support for nature prescriptions is far from useless … Cities and towns can create their own nature access programs by expanding public transit routes to make trails and parks more accessible.

Many of the people who would benefit most from a prescription trip are vulnerable or low-income individuals who would not be able to afford such a trip, Dr. Beller Streyer explains. Unless it were covered by insurance, of course. Until then, practically speaking, she says she’d be happy to prescribe Sweden if someone came to her to ask for it specifically.

Since the pandemic, Dr. Beller Streyer says she’s seen a “huge” increase in people looking to nature to improve their health and general wellbeing. She thinks there’s a good chance other countries might follow in Sweden’s footsteps and also offer themselves up as prescriptions.

“I do think it’s a great idea,” Dr. Beller Streyer says, adding that she’s seen people seek more creative solutions for their health challenges. “Is it a PR gimmick? Partly, yes, but it’s also based on what’s real and what’s authentic in Sweden.”

What you can do: Call your representatives

If you live near a green space you love or you have the means to travel, you might not need a prescription to nudge you to get outdoors. Making nature an official ‘healthcare’ offering could, however, make traveling to such places easier and more equitable for everyone else.

Here’s the bad news—or at least the realist take: It’s unlikely that US federal officials will make travel prescriptions, even for nature, a priority in the near future.

The good news? Calling your city, state, and federal representatives to share your support for nature prescriptions is far from useless. At the local level, cities and towns can create their own nature access programs by expanding public transit routes to make trails and parks more accessible.

In today’s hyper-online world, it doesn’t take much to inspire a whole movement. All you need is a very clickable idea. Like, say… prescription vacations to Sweden, endorsed by your doctor.

Find your local reps here.

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