Sweden has a socialised healthcare system, with healthcare provided through publicly funded clinics. Patients requiring specialised care are referred by primary healthcare centres, resulting in long waiting times. Long waiting times for specialised healthcare services have become a common challenge in Sweden, leading to higher healthcare costs as interest in private healthcare increases. It has been a challenge to mitigate this delay due to multiple systemic factors.

This paper presents a dilemma-based game design methodology that integrates real-world workflow mapping, stakeholder conflict analysis, and system constraints to simulate access to specialised care in the Swedish public health system. It serves as a tool for exploring systemic inefficiencies, evaluating reform scenarios, and building shared understanding among practitioners, administrators, and policymakers.

The novelty of this work lies in its use of stakeholder-centred dilemma modelling to design serious games to elicit economic, technical, ethical, and operational tensions at the level of primary access in socialised healthcare systems. This work employs a serious games-based approach to model the socio-technical dimensions of delays experienced by individuals accessing specialised care, while maintaining the fairness and constraints of public health infrastructure. The approach enables the simulation of sensitive healthcare challenges in a neutral, safe setting, offering a replicable framework for other complex domains.