

Härnösand, a sleepy regional capital 400km north of Stockholm, could go down as where the counter-revolution began.

This month, the regional council ordered its officials to find ways to limit the profits private companies can reap from running publicly-funded health services.

The decision marks the first concrete action taken in Sweden to reverse a 20-year-old experiment with private provision of public healthcare that has arguably gone further than in any other European country. Erik Lövgren, vice-chairman of Västernorrland regional council, who pushed the proposal, said: “We have taken the first step towards meeting the will of the voters in our county, and of the majority of the people in Sweden. This is not a question only for Västernorrland, this is a question for the whole country. But someone has to start.”

Sweden has long been a pin-up for those who believe that bringing in private-sector companies can drive efficiencies in welfare provision, its healthcare reforms lauded by the Economist, among others.



Private companies today provide about 20% of public hospital care in Sweden and about 30% of public primary care. By comparison, just 6% of total NHS spending went on commissioning private-sector providers in 2013-14.

Sweden’s drive to bring private providers into healthcare, accelerated during the eight years of centre-right rule between 2006 and 2014, has been achieved in the face of growing public opposition. In the run-up to last year’s general election, a survey by Gothenburg University’s SOM Institute found that 69% of Swedes were opposed to private companies profiting from providing public education, health, and social care, with only about 15% actively in favour.

“We have seen the result,” said Jonas Sjöstedt, leader of Sweden’s Left party, who made limiting profits in the welfare system his rallying cry in last year’s election campaign. “The whole shift in public opinion in Sweden has to do with the result of what’s actually happened: the mistreatment of the elderly in public homes. People don’t like schools that have gone bankrupt overnight. And people think it’s immoral that taxpayers’ money is taken out and sheltered in the Channel Islands.”

An investigation by local Allehanda newspaper in Härnosand found that the 10 private health centres in the region were only reinvesting about a third of profits back into their businesses, with the rest being taken out by the owners.

When the regional government’s draft plan is released next month, the private companies who run GP surgeries, specialist clinics – and even, in one case, a fully-fledged hospital – over an area the size of Wales, could be faced with a choice: they could be forced to either convert into social businesses, with strict limits on the profits they can take out, or else shut down.

Patrik Wreeby, a doctor whose company Premicare runs four of Västernorrland’s 10 private health centres, argued that the proposed reforms would only make services worse.

“They’re picking on the only part of the healthcare system which is working fine at the moment and within budget,” he complained. “They’ve taken 10 years to increase the number of private practices. How are they going to build up in one year what they’ve dismantled in 10?”

Two years ago, Sweden’s Social Democrat prime minister Stefan Löfven made much the same argument against those who want a quick end to private company involvement in healthcare and schools. But by last year’s election campaign, he too was using rhetoric about preventing “profit-seeking” in the welfare sector.

This March, as part of a deal to get parliamentary support from the Left party, Sweden’s new red-green government launched an inquiry into how new rules can be imposed on private companies providing taxpayer-funded services to ensure that their profits are reinvested in improved services.

According to Sjöstedt, the fact that a Social Democrat-led regional assembly has moved to limit profits in healthcare more than six months before the inquiry launched by its own government is due to report, shows how much appetite there is for change. “It’s proof of the big pressure you have from the voters,” he said. “This fight is already going on in the municipalities.”

Erik Lövgren hopes that his region’s move will inspire other to take matters into their own hands, just as the involvement of private providers in Swedish healthcare began in the 1990s with local experiments run by right-wing ideologues in municipal councils.

“It was municipal leaders who pioneered the system of choice in healthcare and then pushed through the change nationally,” he said. “We have the same ambition. We want to drive forward the change we want to see.”

Sjöstedt is in no doubt that powerful business groups are already working hard behind the scenes to make sure that neither the Social-Democrat led central government, nor regional governments like Västernorrland’s, succeed in bringing in new rules that will limit their profits.

“We are up for a big political fight, we are very much aware of that,” he said. “Our advantage is that we have a huge support from the public. That’s our big asset in this debate.”