Ensuring equitable access to healthcare in rural Sweden : analysing regional healthcare policies

Sammanfattning

Equal access to healthcare for all residents is a core principle of Sweden’s universal and publicly funded healthcare system, yet rural areas continue to face challenges that threaten equity. Long travel distances, workforce shortages, and uneven resource allocation hinder fair access to care, particularly for elderly people, migrants, and individuals with chronic conditions. This thesis investigates how regional healthcare policies and strategies address these challenges, with a focus on Region Skåne, Region Västerbotten, and Region Stockholm. Guided by the Health Equity Framework (HEF), the study applies a qualitative document review method. Regional development strategies, public health policies, and official reports were purposively sampled and thematically analyzed with the support of Computer Assisted Qualitative Data Analysis Software (CAQDAS). The analysis focused on five dimensions of health equity: equity, availability, accessibility, acceptability, and quality. Despite strong policy commitments, major barriers remain. Rural residents face long distances to care, weak public transport, digital exclusion among elderly populations, and difficulties in securing long-term healthcare staff. In addition, systemic changes in Swedish healthcare—such as the centralization of specialized units in larger cities, reliance on costly medical technologies, and rising pharmaceutical expenses—have further strained rural access. These developments risk reinforcing urban advantages while leaving rural communities more vulnerable. Regional priorities also differ: Skåne emphasizes socio-economic disparities and migrant health, Västerbotten prioritizes Sámi populations and sparsely populated inland areas, while Stockholm focuses on socio-economic and multicultural inequalities in its metropolitan context. The study concludes that while Sweden’s decentralized healthcare system enables regions to adapt policies to local contexts, the absence of stronger national coordination risks leaving rural inequities unresolved. Addressing these challenges requires targeted investment in rural healthcare infrastructure, workforce development, digital inclusion, and systematic monitoring. The findings contribute to broader debates on how universal health systems can achieve not only coverage but also equity in practice.