In common with many other countries, Sweden is reviewing options for reforming its health services. The report of an expert group set up by the government to examine alternative ways of financing and delivering health services was published last year.1 In line with the brief provided by the minister of health, the report analysed three models for the future. These models seek to build on the strengths of the existing system while at the same time tackling its weaknesses. A period of debate is now under way, and decisions are unlikely to be taken until after the election in September.

Sweden exemplifies the integrated approach to the provision of health services.2 This entails a combination of public finance and public provision. At a local level county councils raise most of the resources for health care through income taxes, and they also manage the provision of hospital and primary care services. Swedish people enjoy ready access to a full range of services, and there is a strong commitment to equity in the delivery of services. Within this system democratic control of health services and accountability to the local public are particularly emphasised. Administrative costs are low, and this enables most of the available resources to be spent on direct patient care.

Against these strengths, several weaknesses have become increasingly apparent in recent years. These include the existence of waiting lists for some hospital procedures, a perceived lack …