The Commercialization of Swedish Healthcare: Drivers and Effects

Background: The Swedish healthcare system is tax-funded and universal with low copayments, governed by politicians at national, regional and local levels. Since the early 1990s, the healthcare system has gradually been transformed from a mainly public system to an increasingly private for-profit driven, but still tax-financed system. This article describes the main driving forces and their effects.Methods: The marketization of healthcare is contrasted to the legal and ethical framework established by the Swedish parliament for the healthcare system. The Swedish Health and Medical Services Act states that care should be provided solely according to need and on equal terms for the whole population, prioritizing those with greater need.Results: Since the 1990s private enterprises and lobbyists have argued for market-oriented reforms where for-profit private providers can freely locate and operate outpatient services on public funding. A so-called choice reform (LOV) was implemented 2010, mandatory in primary healthcare but optional in specialist care. This led to an expansion of for-profit private providers. In 2024, 52% of primary care visits and 22% of specialist care visits were to private providers. LOV has greatly reduced the power of regions to govern healthcare. It favours patients with limited rather than those with greater and more complex needs; it increases inequities in access between rural and urban areas, and between urban high- and low-income areas. The increase in private specialists has also enabled an increase in private healthcare insurance coverage, allowing insured faster access to specialist care within the tax-financed health care system. This is inconsistent with the Health and Medical Services Act.Conclusion: Marketization has increased inequalities in access to care in Sweden. Studies are needed on how to strengthen the primary healthcare system and to address inequalities in healthcare services related to increased privatization and marketization.