Competition and Reform in the Swedish Health System

Sweden has had success containing its overall rate of health expenditures without compromising its citizens' well-being. Nevertheless, the country's health system has recently faced organizational problems, including queues for elective surgery; inadequate continuity of care; shortages of personnel; and pressures from patients for greater influence over care. County councils have begun experiments in "comparative competition" among public and/or private providers, to expand patient choices, and to link the choices to providers' salaries and institutional budgets. If these experiments in planned market approaches prove effective, Sweden may again serve as a model for publicly operated health systems.

Author(s): Richard B. Saltman

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Volume 68, Issue 4 (pages 597–618)
Published in 1990