The pace of privatisation in Swedish healthcare and social care has notably decelerated, with private giants consolidating their dominance, making it increasingly difficult for smaller players to keep up. A recent report by accounting and advisory firm Grant Thornton sheds light on this shifting landscape, highlighting how a combination of regulatory pressures, generational business changes, and growing market concentration are shaping the future of the sector.
Stagnation in Privatisation Growth
Over the past decade, privatisation in Swedish healthcare and social care has stalled, with private players only marginally increasing their market share. In 2014, private companies accounted for 22% of the market, a figure which has now fallen to approximately 21% in 2023. This stagnation is reflective of broader political trends, where municipalities and regions have begun to reverse privatisation by taking back the operation of certain services.
Stefan Wiklund, Industry Manager for Healthcare and Social Care at Grant Thornton, notes that this shift toward public control is likely to continue. “Many municipalities and regions are pulling back on privatisation, and we anticipate that this will continue. For private companies, scaling up growth may become increasingly difficult,” Wiklund asserts.
However, the situation is not uniform across all sectors. Privatisation within primary care and personal assistance has seen some incremental growth, illustrating how localised and sector-specific dynamics continue to shape the broader privatisation picture.
Market Consolidation: The Rise of Healthcare Giants
While the broader privatisation trend is slowing, one clear pattern emerging is the growing dominance of large private healthcare and social care companies. According to Grant Thornton’s report, the ten largest players now account for 40% of the private healthcare market, a noticeable increase from 2019. The dominance of these giants is particularly evident in primary and elderly care.
In primary care, the five largest companies now control 55% of the market, while in elderly care, the top five companies command a staggering 70%. This market concentration is expected to continue, with both Wiklund and Fagerlund predicting an increased role for the largest players in the years to come.
One of the key drivers behind this trend is the increasing regulatory burden placed on smaller providers. As Mats Fagerlund, Industry Leader for Healthcare at Grant Thornton, points out, “The challenges posed by increased regulations and controls are particularly demanding for smaller actors. For many, it can be costly to comply with these growing requirements.”
Regulatory Concerns and Media Attention
Regulatory scrutiny, particularly concerning welfare fraud, has dominated political discourse and continues to create anxiety within the private healthcare sector. As the 2026 elections approach, private providers are increasingly concerned that tighter regulations could limit their ability to operate, though the possibility of a blanket profit ban remains unlikely.
“The ongoing media focus on welfare fraud casts a long shadow over the entire sector. There’s a sense of concern that regulations may tighten further, restricting the operations of private companies in various ways,” says Fagerlund.
Generational Shifts and the Role of Consolidation
A key factor contributing to the dominance of large players in the healthcare sector is a generational shift within private businesses. Many of the healthcare entrepreneurs who helped establish private businesses in the early 2000s are now looking to exit, with many opting to sell their companies to larger firms.
Stefan Wiklund explains that this generational transition is not surprising. “The founders of many private healthcare companies, who started their businesses 15 years ago when the market first opened, are now aging and seeking to retire. For them, selling to the larger players is often the most viable option.”
One such example is Praktikertjänst, a cooperative in primary and dental care, which reported a turnover of SEK 10 billion in 2024. Carina Olson, the CEO of Praktikertjänst, believes that consolidation in healthcare is beneficial, particularly as technology, AI, and digitalisation become more central to the industry. “The rapid technological advancements in healthcare require significant investment. Large companies are better equipped to keep up with these changes,” Olson explains.
Profitability Challenges for Giants
Despite their market dominance, large players are facing profitability challenges. The Grant Thornton report reveals that the largest companies often perform worse in terms of profitability compared to their smaller counterparts. For instance, in primary care, the average operating margin for the sector was 4.2%, while the five largest players had a negative operating margin of -0.6%. In elderly care, the figures were 5.2% for the average company and 3.5% for the top five.
Wiklund and Fagerlund explain that these lower margins are partly due to the resources large players invest in building robust systems and processes. “Larger companies have the capacity to invest in systems, routines, and technologies that smaller companies simply cannot afford. While this can drive operational efficiency, it often leads to lower profitability in the short term,” Fagerlund notes.
The Largest Players in the Market
Here’s a breakdown of the leading players in Swedish healthcare:
Primary Care:
- Capio
- Internship
- Prima
- Doctor.se
- Kry
These companies dominate health centres, family doctor’s offices, child health centres, and vaccination services.
Elderly Care:
- Attendo
- Ambea
- United Care
- Frösunda/Norlandia
- Humane
These players are significant in-home care, special housing, and day care services.
Conclusion: A Changing Landscape
The Swedish healthcare market is evolving. While privatisation has slowed, the dominance of large private companies continues to grow. The increasing concentration of market share among the giants is a direct result of regulatory changes, generational shifts, and the pressure to adapt to new technological demands. Smaller companies are struggling to meet the growing challenges, and with political concerns surrounding welfare crime and increasing regulations, the future of private healthcare in Sweden remains uncertain. In this dynamic environment, large players seem poised to maintain their stronghold, but whether they can improve profitability amidst these pressures remains to be seen.