Public expenditures related to welfare are expected to eventually exceed revenues. So, what might the public commitment look like with regard to health care and elderly care in the future? And how is it to be financed? What will be the significance of the corona crisis for the organization and working methods in these areas? Project timeframe 2021–2024.


Research director: Gabriella Chirico Willstedt,, 0722-43 41 08
Project manager: Simon Torell Witt,, 0766-97 69 88

Public expenditure related to health care and elderly care is rapidly increasing

An aging population will lead to a significantly increased need for health care and elderly care in the coming years. These two areas combined form a substantial part of the public commitment, while the growing need will over time represent an increasing burden on public finances. At the same time, the rapid urbanization process we are currently experiencing reinforces existing differences between urban regions and sparsely populated and rural areas. The ability to meet this growing need will thus vary considerably between different parts of Sweden. Technological developments have great potential in terms of increasing productivity in the health care and elderly care sectors. In practice, however, this often means increased costs.

Revenues for the welfare system increase at a slower rate

The welfare system is largely financed jointly by means of taxes, while also including elements of payroll taxation. As the working-age proportion of the population is expected to decrease, there is a risk that the welfare system will eventually be underfunded. The increasing demand for welfare services means that a growing share of production in the economy takes place in the public sector, where productivity growth is often slower compared to the private sector.

upcoming seminars

completed seminars

The future of Swedish elderly care 2022.09.20

What can Sweden do to combat antibiotic resistance? 2022.06.08

Post-pandemic: Lessons learned for Swedish health care 2022.04.20

High costs and limited patient benefits – on evaluating interventions in health care 2022.03.29

Dialogue meeting on a new elderly care law 2021.12.02

The Inquiry on Voluntary Private Health Insurance 2021.11.12

Health care on equal terms? 2021.09.02

The supply of general practitioners 2021.06.14

Shared Data between Health Care and Care Services 2021.02.18

Special day on the topic of health care 2020.08.18


Measuring the Value of Elderly Care 2022.10.24

High costs and limited patient benefits – on evaluating interventions in health care 2022.03.28

What explains regional differences in Swedish healthcare 2021.09.02

Ongoing studies

Trust-based governance and organization in health care: A critical discussion

The concept of “trust-based governance and management” has been widely disseminated, and there is great hope that this represents a new approach to governance and management better suited to balance the needs of citizens and the working conditions of health care workers compared to previous governance models. The report examines trust-based governance and management as a phenomenon and based on our own previous research in health care and organizations as well as the research of others, we show that the solutions now proposed may certainly solve some problems while probably also resulting in others. We want to shift our attention to the trust-based organization. By using forms of governance and management that enable managers and employees to perform well in their tasks, public organizations are able to create internal trust while also enjoying confidence from the public. Organizational trust also concerns the quality of processes and that organizations seek the ability to manage unexpected events and crises.

Authors: Thomas Andersson, professor of business administration, University of Skövde; Lisa Björk, PhD student in work science, Region Västra Götaland; Björn Brorström, professor emeritus, Local Government Institute (Kommunforskning i Västsverige); Lotta Dellve, professor of work science, University of Gothenburg; Annika Härenstam, professor emerita, University of Gothenburg, working as researcher at Stockholm University, and Stefan Tengblad, professor of human resource management, University of Gothenburg.

To be published: spring 2023.

Collaboration between municipalities and regions in care efforts involving multimorbid elderly patients

Swedish elderly care has long been characterized by a principle – that elderly people as far as possible should remain and receive care in their own homes (kvarboendeprincipen). As a result, many elderly individuals today live alone with substantial care needs, often suffering from multimorbidity. In Sweden, collaborations related to multimorbid patients are complicated since two separate actors, municipalities and regions, are responsible for providing health care and elderly care. In addition to this division, Swedish health care and elderly care services are partially carried out by external private actors, thereby representing an additional challenge for collaborations. The overall picture presented by government agencies and researchers shows a frequently insufficient coordination between various actors caring for multimorbid elderly patients.

The objective of this report is to present an overview of current challenges in Sweden when it comes to collaborations regarding elderly patients with multimorbidity who are cared for in their homes, and how these types of collaborations have been studied in international academic research. By looking at the specific experience and challenges documented in Sweden from an international research perspective, the report aims to broaden the perspective in the Swedish debate and shed new light on possible solutions.

Authors: Paula Blomqvist, associate professor of political science, Uppsala University, and Ulrika Winblad, professor of health services research, Uppsala University.

To be published: March 2023.

How was the covid-19 pandemic managed in nursing homes?

The covid-19 pandemic has had a great impact on nursing homes in terms of both residents and staff. As the individuals living in nursing homes tend to be very old and sick, they constitute a group exhibiting a high risk with regard to covid-19. Subsequently, the staff in such homes has experienced great pressure. A study is now being launched to analyze how staff members experience that the covid-19 pandemic was managed in nursing homes in order to learn from what transpired. Managers, nurses, assistant nurses and care assistants will be interviewed in four nursing homes in the Stockholm area. The report is expected to analyze the pre-existing capacities for managing the pandemic, the measures taken and the impact of various measures on staff and residents.

Authors: Sara Erlandsson and Petra Ulmanen, assistant professors of social work, Stockholm University, and Sara Wittzell, research assistant.

To be published: winter 2022–2023.

Digitalizing health care: Risks and opportunities from a Swedish systems perspective

The introduction of various novel digital technologies has been presented as a solution to some of the challenges facing health care. The report aims to analyze, on the basis of economic theory and existing empirical evidence, the ability of digital technologies to contribute to Swedish health care developing in a positive direction with regard to efficiency and equality. Which economic benefits, costs and uncertainties may arise as a result of introducing digital technologies in health care and elderly care? How are benefits and risks distributed among different actors (patient – health care provider – funding body), and, furthermore, how may this affect the conditions for and effects of digitalization? The report analyzes the empirical evidence indicating that digital care models represent cost-effective alternatives to existing models, while also discussing the relevance of this evidence in a Swedish context.

Authors: Björn Ekman, associate professor of health economics, Lund University, and Lina Maria Ellegård, researcher in economics, Lund University.

To be published: spring 2023.

Unpaid care work performed by Swedish middle-aged men and women

There is extensive research on how being a parent and caring for (young) children affect the economic outcomes of men and women in present-day Sweden. However, caring for others is not limited to raising a family but occurs later in life as well, not least for women. The report focuses on how being responsible for caring for aging parents affects the ability to work, leisure, sleep and health of men and women aged fifty and above. Questions addressed include: How are incomes and the utilization of time affected by being responsible for caring for an elderly relative? Does this affect women more than men? And what do these relationships look like in countries characterized by other models of family care and a different perspective on gender equality?

Author: Maria Stanfors, professor of economic history, Lund University

To be published: autumn 2023.

Financing future health care and elderly care – the importance of prevention

A higher proportion of elderly individuals in a growing population means that health care needs have increased both overall and on average, thus causing resource allocation problems. A partially overlooked way of alleviating this problem involves avoiding future health care needs by means of various preventative measures. The objective of this report is to compile available scientific evidence regarding the effects and cost-effectiveness of primary preventive measures and to analyze the significance of such measures in a Swedish context. The study is limited to initiatives that offer the greatest effect according to the scientific literature, both in terms of health when fully implemented and in terms of cost-effectiveness.

Author: Kristian Bolin, professor of health economics, University of Gothenburg.

To be published: spring 2024.

Funding and reference group

The reference group includes Astra Zeneca, Attendo, Getinge, Hemfrid, Insurance Sweden, Kry, Min Doktor, Pfizer, Praktikertjänst, Region Halland, Region Stockholm, Region Västra Götaland, Skandia, Skellefteå Municipality, Swedish Agency for Health and Care Services Analysis, Swedish Association of Health Professionals, Swedish Association of Local Authorities and Regions, Swedish Health and Social Care Inspectorate, Swedish Medical Association, Swedish Ministry of Finance, Swedish Municipal Workers’ Union, Swedish National Board of Health and Welfare, Täby Municipality, Vardaga and Vinnova.