Summary

Many countries in Europe facing escalating health care expenditures are introducing competition between providers, a solution presently tried in the British and the Dutch health care systems. In the post-war period Sweden has developed one of the most advanced health care systems in Europe, built on the notion of rational planning, and with a strong element of political control. This article discusses the present reconsideration of health policy issues that is taking place in Sweden. A growing number of health care politicians, adminstrators and doctors in Sweden are supporting the introduction of an internal health care market, where purchaser and producer are separated, and with more freedom of choice for patients. The transformation of health care delivery in Sweden is not carried out as a national reform, but as a series of experiments among local government providers, free to test their own model for health care provision. The background to the present ’reform movement’ in Sweden is a declining economy among local government providers, and in this article examples are given from three county councils reorganizing health care delivery. On the national scene a number of documents issued by interest organizations have appeared recently discussing options for the Swedish health care system. In the past twenty years the Federation of County Councils has played a leading role in the Swedish health policy arena, but in the last two-three years the government has challenged the interest organization of the public providers. The Swedish Medical Association, while adopting a conciliatory strategy in its relations with other actors in the health policy arena for the past twenty years, is now becoming more active, putting forward its proposals for reorganization of the health care system. What the professional association prefers is a health care system where more doctors are becoming ’free’ professionals. However, the medical profession in Sweden is inexperienced in how to behave in a competitive environment