After World War II a rapid expansion of the Swedish health care took place. The

expansion was realised chiefly as a development of the hospitals and was both

produced and financed mainly within the public sector. The financing consisted to a

high degree of government grants from the state to the county councils.

During the period for this examination (1945-1955) the public responsibility for the

health care was expanded. This was expressed in the publicly financed system for

health insurance and the cut down in the charges that the patients had to pay for the

hospital care. These changes led to some discussions on the national level but reforms

could on the whole, with exception for the suggested reform of the open health care,

be implemented.

This case-study performed on the county council in Värmland shows that the degree

of consensus was enhanced on the regional level. The county council had by tradition

a culture of collusion assembling to the culture in the primary municipalities, and

county council was also dominated by the strong förvaltningsutskottet (the leading

executive committee). This committee functioned as a coalition government and had

earned a high legitimacy which enabled the committee to implement very

comprehensive reforms in the health care of Värmland.