Sweden consistently outperforms Canada on universal health care despite similar spending: new study

Sweden and Canada operate publicly financed universal health-care systems, but access to care in the Nordic country is “markedly better,” according to a new report from the Fraser Institute.

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In 2024, wait times leading to unmet medical needs affected two per cent of Swedes, compared with 9.1 per cent of Canadians, says the report’s author, Yanick Labrie.

The study argues that the difference between the two national systems can be found in the way they are organized. Labrie states that almost half (46.9 per cent) of primary care centres in Sweden are privately operated, while still fully funded by public dollars.

Labrie notes that private providers in Sweden perform more than 40 per cent of publicly funded hip and knee replacements and over 70 per cent of cataract procedures.

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Private providers have also expanded surgical capacity, rather than displacing it, he suggests. Between 2001 and 2019, the share of cataract patients treated within 90 days increased from 36.9 to 88.2 per cent while median waiting times fell from 6.2 to 1.8 months.

More particularly, 85 per cent of patients receive a medical assessment within three days when needed, the study states.

Labrie states that European health-care systems have attracted an increasing level attention among Canadian policymakers. For example, he states that in May 2026, Alberta Premier Danielle Smith led a delegation to Sweden to learn more about the country’s approach to organizing and delivering health care within a universal system.

Labrie notes that similar to Canada, Sweden’s health-care system is founded on the principle that access to medically necessary care should depend on need rather than ability to pay. But discussions of health-care reform in Canada often become highly polarized when it comes to expanding the role of private providers, says Labrie.

“As a result, health-care policy discussions in Canada often focus primarily on preserving existing financing arrangements rather than examining alternative models for organizing and delivering care to Canadians.”

The primary responsibility for organizing health care falls under Sweden’s 21 regions, governed by local political assemblies. Regional authorities are responsible for organizing hospitals, primary care, specialist services, and provider-reimbursement systems. Municipal governments are primarily responsible for long-term care, home care, rehabilitation support, and services for older adults and individuals with disabilities.

In contrast, says Labrie, beginning in the early 2000s several provinces (Quebec, Saskatchewan, Nova Scotia and Alberta) merged regional health authorities into larger provincial organizations, reducing the autonomy of intermediary bodies.

Meanwhile, in Sweden patients commonly pay modest co-payments for primary care visits, specialist consultations, emergency department visits and prescription drugs. Annual caps substantially limit total out-of-pocket exposure.

Sweden permits duplicate private health insurance for services already covered under the public system, whereas in most Canadian provinces, such insurance remains heavily restricted or prohibited. By the end of 2024 over 800,000 Swedes held duplicate health insurance coverage (15.8 per cent of the working-age population). Most insurance policies are financed by employers as part of workplace benefits.

“In Sweden, privately insured patients continue to contribute to the public system through income taxation. They do not opt out financially,” says Labrie.

One of the greatest health-care needs – physician access – seems to be better met in Sweden, which according to OECD data cited by Labrie, maintains a higher physician-to-population ratio than Canada, with 4.4 physicians per 1,000 population, compared with 2.8 in Canada. Sweden also has a national waiting-time guarantee aimed at improving timely access to care throughout the country.

Sweden’s Primary Care Choice Act was implemented between 2007 and 2010. The new legislation introduced patient choice among accredited primary care providers, whether publicly or privately operated. Private providers were allowed to establish new clinics and compete for patient enrolment under the country’s regional reimbursement systems.

Overall, says Labrie, the study’s findings indicate that greater private-sector participation necessarily reduces publicly financed health-care system capacity. “In several areas of Sweden, private providers expanded the overall volume of publicly funded services rather than simply displacing activity from public providers.”

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