Vårdval i Glesbygd : Hur säkras jämlikheten?

User choice, which is part of NPM, has become a common steering model in social welfare services. However, since it was first introduced, it has been criticized for inhibiting social equal-ity. In 2010, Sweden introduced a compulsory system of choice in primary care. Patients are free to choose among public and private producers, all still publicly funded. The reform also allowed for free establishment of private healthcare companies, which was severely criticized by the political opposition. The critics held that free establishment could hamper geographic equality, since private producers tend to establish in densely populated areas rather than rural areas. With the introduction of user choice, the Country Councils are no longer able to control the location and resource allocation of primary healthcare centres. Still, they are compelled to meet the goal of equal healthcare for the entire population. Thus, there appears to be a tension between choice and geographic equality. The main question of the thesis is: How is the tension between user choice in primary care and the Health and Medical Act’s requirement of healthcare on equal terms for the entire population handled in a rural context? To answer the question, a case study with three rural Country Councils is conducted. A document analysis of the policy documents that regulates each Country Councils choice systems is being carried out, together with additional interviews with leading politicians and public officials in each of the three Country Councils. The results show that representatives in the Country Councils experience restraint oppor-tunity to provide healthcare in rural areas. Remarkable is that some countries fail to provide adequate health care in rural areas without breaking the law of fair competition. To prevent closures, the Country Councils admit public healthcare centres to run at a loss although this is by law prohibited. The study proposes that sufficient healthcare supply in rural areas, and thus geographic equality, calls on political planning. Market management should be complemented with political interventions like higher allowance, coordination and policy framwork adjusted to rural needs