Ideas, Interests and Institutions in the Swedish Health Care System

The modern Swedish health care system was constructed around the idea of a universalistic, tax-based system where public authorities take responsibility to ensure that all citizens have access to high-quality health services on equal conditions. Solidarity was built in to the system through its financing –progressive income-taxation- as well as the overriding principles of equal access and medical need as the only acceptable principle of resource allocation and prioritization. To insure these values, public ownership of health care institutions, also in primary care, became the preferred political option. The values underpinning the system, many of which were inspired by the UK Beveridge report, also aligned with the political visions of the Swedish social democratic party which governed the county during most of the period the system was constructed (1932- 1976). After 1980, the system became the target of increased criticism from the right-wing political opposition which led to a series of reforms in the 1990s and 2000s. Values associated with neoliberalism such as efficiency, private entrepreneurship, choice and consumer rights gained impact , leading to an abandonment of the previous public monopoly on care provision and a stronger attention to the patients’ satisfaction with the system. At the same time, a broad political consensus on the values of universalism and social equality has prevailed in Swedish social politics, moderating reform ambitions.