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“Sweden’s public health care system developed in the 19th century and expanded during industrialization. Regions (formerly called county councils) became legally responsible for providing inpatient hospital care to their residents in 1928 due to the implementation of the Hospitals Act (Sjukhuslagen 1928:303). In the 1950s, subsidies for outpatient (or ambulatory) services and medicines increased through the introduction of national social protection systems. The expansion of the welfare state and the health sector accelerated during the 1960s, but the primary focus concerned hospitals. Access to outpatient services improved during the 1970s as part of a reform introducing uniform and low patient fees (the so called “seven-crown reform”). In parallel, regions became responsible for providing outpatient hospital services to patients, and the responsibility for primary care and mental health care services, previously a national responsibility, was transferred to the regions. At the same time, the national parliament decided to socialize the private pharmacies and the National Corporation of Swedish Pharmacies (Apoteksbolaget) was established in 1971. Both of these reforms reflected the dominant belief at the time that services could be improved under public ownership.”

Source: Janlöv N, Blume S, Glenngård AH, Hanspers K, Anell A, Merkur S. Sweden: Health system review. Health Systems in Transition, 2023; 25(3): i–198.

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“In the late 1980s, the lack of choice for inhabitants was debated and, not least, the regions were criticized for a lack of cost control and poor efficiency (Roos, 1985). This criticism paved the way for a number of New Public Management reforms in several regions in the early 1990s, including a purchaser–provider split, new contracts for providers and increased choice for inhabitants. However, many regions returned to a traditional mode of planning and control following the financial crisis in 1990–1994.

“During the early 1990s, the trend was also to transfer responsibility from regions to municipalities. In 1992, the ÄDEL reform was implemented whereby responsibility for long-term inpatient health care and care for elderly individuals was transferred from the regions to the municipalities. A few years later, the municipalities took over the responsibility of care for people with functional impairments (the physical impairment reform, Handikappreformen) by the Act Concerning Support and Service for People with Certain Functional Impairments (Lag om stöd och service till visa funktionshindrade 1993:387) (see Section 2.7.2 Regulation and governance of provision), and for people with mental impairment or long-term mental illness (the psychiatric reform, Psykiatrireformen). The objective of these reforms was to improve services through integration between health care and social services of the municipalities. About one fifth of total regional health care expenditure was transferred to the municipalities that were financially compensated for these new responsibilities.”

Source: Janlöv N, Blume S, Glenngård AH, Hanspers K, Anell A, Merkur S. Sweden: Health system review. Health Systems in Transition, 2023; 25(3): i–198.

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“In the last two decades, society has become increasingly digitalized, which has developed health care services through the introduction of various e-services and digital consultations. Sweden aspires to be a leading country in relation to eHealth (see Section 4.1.3 Information technology and eHealth). Another shift relates to patients’ involvement in the health care services provided, where reforms for a more person-centred care system with primary care as its foundation are being implemented. Recent reform trends also concern increased concentration of highly specialized care together with implementation of standardized clinical pathways in different diagnoses, where cancer care was the starting point.”

Source: Janlöv N, Blume S, Glenngård AH, Hanspers K, Anell A, Merkur S. Sweden: Health system review. Health Systems in Transition, 2023; 25(3): i–198.

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World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems and policies in the US and sixteen other OECD member nations.

Page last updated March 31, 2025 by Doug McVay, Editor.