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A literature review of the regional implementation of the central Swedish government’s health care reforms on choice and privatization

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  • Björn Ekman
  • Jens Wilkens

Abstract

The introduction in 2010 of the Freedom of Choice Act represents one of the most far-reaching reforms of the Swedish health system. While it is mandatory for the regional counties to introduce choice plans for primary care it is voluntary for ambulatory specialist services. The voluntary nature of the regulations for the latter types of care generates a potential gap between the central government’s reform attempts and the regional implementation of the plans. We review the regional implementation of this reform with respect to specialist services from a political economy perspective. Data on the scope of implementation show that counties of the same political ideology as the central government have introduced the most choice plans for specialist care. In particular, counties ruled by right-wing majorities have introduced the Choice Act to a considerably larger extent than left-wing counties. This creates a highly uneven situation across the various parts of the country, possibly at odds with the basic premises of the country’s health law of equal access to care. The introduction of choice plans forms part of a decidedly contentious set of issues that are high on the political agenda of Sweden. The nature and impacts of these reforms are also a concern to the general public and the broader industry. Considerably more rigorous analyses will be needed to assess the impact on key policy parameters such as overall system efficiency and equitable access to services as a result of these changes to the health care markets. Copyright Ekman and Wilkens. 2015

Suggested Citation

  • Björn Ekman & Jens Wilkens, 2015. "A literature review of the regional implementation of the central Swedish government’s health care reforms on choice and privatization," Health Economics Review, Springer, vol. 5(1), pages 1-5, December.
    • Handle: RePEc:spr:hecrev:v:5:y:2015:i:1:p:1-5:10.1186/s13561-015-0076-0
    DOI: 10.1186/s13561-015-0076-0
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    References listed on IDEAS

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    1. Elinder, Mikael & Jordahl, Henrik, 2013. "Political preferences and public sector outsourcing," European Journal of Political Economy, Elsevier, vol. 30(C), pages 43-57.
    2. Blomqvist, Ake G., 1992. "The Swedish health care system -- An economist's view," Health Policy, Elsevier, vol. 21(2), pages 113-127, June.
    3. Glenngård, Anna H. & Anell, Anders & Beckman, Anders, 2011. "Choice of primary care provider: Results from a population survey in three Swedish counties," Health Policy, Elsevier, vol. 103(1), pages 31-37.
    4. Anell, Anders, 2011. "Choice and privatisation in Swedish primary care," Health Economics, Policy and Law, Cambridge University Press, vol. 6(4), pages 549-569, October.
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