Health Law Blog Sweden

Moa Dahlin*

This summer, the Swedish Committee of Inquiry on Responsibility for Care (Vårdansvarskommittén) presented its final report to the national government. I had the privilege of serving in its Secretariat as legal adviser – an experience that gave me new insights into how law and policy meet in practice. In this blog, I will share my experience working on such a task. As a Swedish scholar, this role is quite different from the one we have as teachers and researchers at our universities.

I had previously contributed to inquiries as an expert and as part of reference groups, but working inside a secretariat was something else entirely. The daily rhythm was different: conducting background studies, attending stakeholder meetings, drafting texts, and then observing how those texts were adapted in the political process.

The Inquiry’s Task

The Committee’s mandate was ambitious: to assess whether Sweden should shift from regional to State responsibility (huvudmannaskap) for healthcare.

Sweden’s health system is known for high standards, but it also faces persistent challenges, including unequal access, waiting times, and regional disparities. Would shifting responsibility from the 21 regions to the State solve these problems or create new ones?

After extensive analysis, the Committee concluded that there was insufficient evidence to justify a full State takeover. Partial State responsibility was also rejected as a risk for further fragmentation. Instead, the Committee recommended stronger State governance within the existing structure, particularly in areas where regional variation is unjustified, such as pharmaceuticals, vaccinations, screening, workforce planning, forensic psychiatry, and air ambulance services.

Two Lawyers, Two Roles

One of the most rewarding aspects of the Secretariat work was sharing the legal responsibility with another lawyer, a full-time judge.

At first, I was struck by her capacity: the sheer speed with which she could absorb new material, the detail with which she mastered unfamiliar legal areas, and her ability to keep track of the fine print while drafting large sections of the report. Working alongside her made me reflect on my own role – and helped me see my strengths more clearly.

Unlike her, I was employed only part-time. My other duties at the university – teaching, research, and academic service – meant that I could not (and was not expected to) produce the same volume of detailed investigations. Instead, my contribution was to serve as legal adviser in a broader sense: identifying the key principles, helping the Secretariat see patterns across the material, and finding ways to present the legal terrain so that colleagues from other disciplines and the Committee’s politicians could navigate it.

Her strength lay in precision and speed of analysis. Mine was thematic framing and communication. Together, those roles complemented each other. The combination gave the Secretariat both depth and breadth – detail on the one hand, and a principled narrative on the other.

In hindsight, I realize that this duality was essential. It not only made the legal work stronger, but it also reminded me that lawyers bring different kinds of expertise depending on background, employment terms, and professional culture. Recognizing and valuing those differences was one of the most important lessons I took with me from the inquiry.

Law Meets Other Disciplines

Another learning experience was the way lawyers and non-lawyers approached the task differently.

We lawyers tended to map responsibilities carefully: Who is accountable – the State, the regions, the providers, the individual professionals? Which supervisory authorities exist, and what sanctions can they impose? What are the constitutional dimensions of the State–region relationship?

Our colleagues approached the same problems in a much more open manner. They held countless meetings with regional politicians and directors, asking how they understood mandatorship and how the Swedish regions govern healthcare in practice. They studied reforms in the Nordic countries and overall, they thought more freely about what “governance” could mean.

This combination – their open, reality-based, forward-looking perspective and our law-based approach – produced rich discussions. Out of these exchanges, we developed four concepts of responsibility in health care: system responsibility, financing responsibility, provision responsibility, and operational responsibility. These categories helped us, and the Committee, to elaborate on the current system and different reforms in a wider way than would have been possible if we had just used the narrow legal definition of huvudmannaskap.

I am convinced that we would not have arrived at this analytical framework without our mutual respect for each other’s methods and our willingness to listen across professional cultures.

What Legal Scholars Bring

From this experience, I take with me a renewed conviction that legal scholars have much to contribute inside government inquiries – not only from the outside as commentators.

• We bring structure. We notice unclear concepts, gaps in logic, inconsistencies.

• We think in principles. We can step back and ask: What values are at stake? How does this align with constitutional design and patient rights?

• We work with text. We know that how a problem is described shapes how solutions are imagined.

This does not mean that lawyers decide politics, far from it. Political members of the Committee made the final judgments. But our analysis and clarifications informed those decisions.

That is, I think, the proper way to describe the role: lawyers do not dictate outcomes, but we help ensure that when political decisions are made, they are grounded in clear concepts, principled reasoning, and coherent legal frameworks.

Lessons for the Future

My strongest takeaway is that more legal scholars should consider working inside inquiry committees. Many of the challenges in healthcare – equity, efficiency, legitimacy – are not only political but legal. They touch on constitutional design, administrative responsibility, and the protection of patient rights.

Lawyers should not shy away from these debates. By engaging directly, we can help make reforms more principled, more precise, and ultimately more legitimate.

Bridging law and policy is not always easy – the process can be messy and sometimes frustrating – but it is also inspiring. And I believe it is necessary if we want health care reforms to meet both political and legal standards.

This post is part of my ongoing reflections on law, health policy, and the role of legal scholars in public decision-making. Comments and discussion are warmly welcome.

* Moa Dahlin is an Associate Professor in Public Law at Uppsala University.

September 4, 2025

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