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The hidden welfare state:
How the rise of private health insurance is making the Nordic countries less resilient, equal and equitable

John Lapidus 

Healthcare legislation in the Nordic countries is based on the principle that care should be provided according to individual need and on equal terms. The rapid growth of private health insurance is challeng­ing these legislative provisions, with countries now moving away from their established healthcare models. The trend is towards divided systems that are no longer shared. One part – the visible welfare state – continues to be publicly funded directly through taxes. A growing part – the hidden welfare state – is based on private health insurance, which on closer inspection is not as private as this term suggests. The ongoing privatisation and fragmen­tation of Nordic healthcare is leading to reduced resilience. In other words, it is undermining the ability of healthcare systems to quickly ‘bounce back’ to a well-functioning state.

The permanent crisis in Nordic healthcare

The widespread development of society towards neoliberalism (Laruffa, 2024), a trend that has been proceeding for several decades, has had a significant influence on Nordic healthcare systems. Health­care privatisation has been high on the agenda, and the healthcare systems of the Nordic countries have undergone major changes, both in terms of provision and financing. Large parts of the public healthcare systems have been sold off to private operators, while insurance companies and private health insurance providers have entered the new healthcare markets.
The rapid growth of private health insurance means that the Nordic countries are moving away from the social democratic (Esping-Andersen, 1990) healthcare models that were established in the 1970s and 1980s towards divided (Hacker, 2002) systems that are no longer common but characterised precisely as being separated in two. One part – the visible welfare state – continues to be publicly funded directly through taxes. But there is also a growing part – the hidden welfare state (Howard, 1999) – based on private health insurance, which on closer inspection is not as private as the term suggests but rather sponsored by the state in a variety of ways (Lapidus, 2019).
The ongoing division of Nordic healthcare marks a return to the privatisation and fragmentation that characterised the healthcare sector after the Second World War. That is, before healthcare became a public undertaking that was removed from market logic and control and before the enactment of laws such as the Swedish Health and Medical Services Act (SFS 2017:30), which stipulates that care should be provided to all citizens according to individual need and on equal terms.
Private health insurance challenges the egalitarian healthcare legislation in all Nordic countries, primarily by creating favourable rules and entry points for those who take out private insurance, conflicting with the wording of these laws. It is equally obvious that the insurance system increases class inequality. Insurance companies focus on risk, which in the case of healthcare means that certain groups are excluded from the possibility of taking out insurance, while those performing manual work, for example, have to pay higher premiums than white-collar workers – the latter being at lower risk of workplace illness and injury (Lapidus, 2025). A further sign of the presence of class-based mechanisms that increase inequality is that private health insurance is taken out by high-income earners to a much greater extent than by low-income earners.
At the same time, private health insurance increases gender inequality, partly because more men than women take out insurance policies (Palme, 2017). Another gender equality factor, of which there are many, is age discrimination built into insurance policies for the purposes of profit maximisation, which, like inadequate care for the elderly (Wennberg, 2017), dispro­portio­nately harms women, for the simple reason that women live longer than men.
If we look at the bigger picture, we can see healthcare privatisation as just one part of an overall trend of gender equality coming under threat from neoliberalism, which, together with neoconservatism, ‘downplay[s] or ignore[s] structural gender inequalities in a mutually reinforcing way’ (Lin & Wang, 2023). Perhaps it is true that ‘markets do not always operate against the interests of women’ (Elson, 1992), but at the overall societal level, neoliberal policies lead, among other things, to increased pay and wealth gaps. This, in turn, has consequences for gender equality, as low-paid jobs are often dominated by women, but also because increased class differences pave the way for far-right move­ments that threaten many of the rights for which women have fought (Donà, 2021).
An important piece of the puzzle in the healthcare context is that a growing public sector was previously, during the development phase of public healthcare systems, regarded as part of the process of demo­cratisation (Premfors, 1991), but neoliberalism is reframing the public sector as a problem and burden that should be streamlined as much as possible. The fact that, for example, elderly care in the Nordic countries is characterised by this neoliberal policy of scarcity (Blyth, 2013) also has consequences for gender equality, among other things, because working women are forced to take on greater responsibility for their relati­ves when the state withdraws from this area (Meagher & Szebehely, 2013).
The privatisation and fragmentation of Nordic healthcare could lead to reduced resilience, i.e. an inability of healthcare systems to quickly ‘bounce back’ to a well-functioning state in crisis situations (Wiig et al., 2020). One such example was the COVID-19 pandemic, during which there was uncertainty over whether private healthcare personnel could be compulsorily called up (Persson, 2020). However, if we broaden the concept of resilience to include issues such as the above-mentioned violations of equality and gender equality in the healthcare legislation of the Nordic countries, there appears to be a permanent crisis that shows no signs of a resilient bounce back.
There are many reasons for the ongoing and deepening crisis in public and ‘social democratic’ healthcare systems, not least legislation that has promoted increased privatisation of healthcare provision and financing since the early 1990s. At the same time, there is a lack of understanding across all countries of what has been termed Baumol’s cost disease (Baumol, 2012), i.e. that services such as healthcare become relatively more expensive than goods over time in all countries experiencing economic growth. This means that taxes must be kept at a certain level and that the state must continue to provide additional resources, but in a country like Sweden, the opposite is true: the tax ratio has fallen dramatically (SCB, 2024) and previously indexed government grants have been de-indexed. As a result, the government has a fixed budget available – the so-called ‘space for reform’ – which is only partially assigned for healthcare and other welfare services, for which it was previously earmarked (Lapidus, 2025).

The emergence of a parallel healthcare system

In recent years, private health insurance has become widespread in all Nordic countries. The most common type of insurance is that which guarantees rapid access to care, usually at clinics where publicly funded patients wait their turn in accordance with public health­care guarantees of various and slower types. Private health insurance thus creates parallel systems alongside what was previously a common Nordic health­care system. These parallel systems require their own infra­structure, for example in the form of booking systems, where private healthcare providers and insurance companies can meet to book quick appointments for policyholders. At the same time, entirely new professional groups are needed, such as healthcare coordinators and claims adjusters, with the latter keeping track of policyholders’ medical histories to avoid the adverse selection that every insurance company fears. Adverse selection occurs when individuals with an increased risk of illness slip into the smaller groups of healthy and able-bodied individuals designated by insurance companies. Admitting people with an increased risk of illness leads to higher costs and increased premiums for all policyholders, which in turn can cause that particular insurance company to lose out to competitors.
At first glance, insurance markets appear to be entirely private and parallel systems, but in reality they are intertwined with public systems in every conceivable way. The most obvious example of this is that most privately insured individuals are attended to by healthcare providers that receive most of their income from public financiers and publicly financed patients. These private healthcare providers therefore enter into one type of agreement with public financiers and a completely different type of agreement with the many insurance companies operating in the new healthcare markets. This creates two different points of access to thousands of clinics around the Nordic countries: a fast queue for those with private health insurance and a slow queue for those relying on publicly funded healthcare.
Not only are private health insurance companies dependent on public systems in various ways, they are also directly subsidised by the public sector. To varying degrees, the Nordic countries have promoted the growth of private health insurance through generous tax deductions, and private insurance companies are therefore not as private as the term would suggest. This type of government expenditure, in the form of lost tax revenue, falls within the scope of ‘the hidden welfare state’ (Howard, 1999), which also gets its name from the commercial secrecy that often characterises semi-private schools, health­care and services of this kind. In the Nordic countries, trade associations for insurance companies keep much of the statistical data on private health insurance, information that they can choose whether or not to disclose, depending on who requests it.
The emergence of the hidden health­care system has major consequences for public and visible health­care, which, in a universal wel­fare state, is supposed to be available to all citizens. Firstly, there are a number of undermining factors rooted in the fact that, thanks to their insurance policies, policyholders no longer have a vested interest in seeing the short­comings of public healthcare addressed and are less willing to contribute through their taxes to a public healthcare system on which they are less dependent. Secondly, when private health insurance becomes widespread common healthcare systems cease to exist altogether. Two parallel systems that operate according to two completely different logics can never be the same as a universal system that is common to all citizens. Instead, what occurs is that each of the Nordic countries ends up with two different welfare states – or, in this case, two different healthcare states – one based on a visible healthcare system that relies on direct financing through taxes and the other based on a hidden healthcare system that relies on tax deductions and free-riding on public healthcare infrastructure.

Private health insurance in the Nordic countries

In all Nordic countries, rates of private health insurance have increased significantly since the beginning of the 2000s. Private insurance is most common in Denmark, where 2.9 million people, nearly half the population, have private health insurance (F&P, 2024). However, a distinction should be made between complementary and supplementary insurance: comple­mentary insurance covers provisions that are not included in the public commitment (e.g. chiropractic and dental care), whereas supplementary insurance provides faster care for policyholders than for publicly funded patients. In Denmark, there is considerable overlap between supplementary and complementary insurance, meaning that many Danes are covered by both types of insurance. This paper focuses solely on supplementary insurance, which is also the most common type in the Nordic countries. Looking exclusively at supplementary insurance, 1.7 million Danes, just under 30 per cent of the population, are covered (Tikkanen et al., 2020).
In Norway, the same dramatic increase in private, supplementary health insurance can be seen as in the other Nordic countries, from 50,000 policyholders in 2003 to over 800,000 today, nearly 15 per cent of the population (Kellner Lysne et al., 2024). Likewise in Sweden, the figure has risen to over 800,000 policy­holders (Grant Thornton, 2024), a similar number to Norway in absolute terms but fewer relative to the population. In Finland, 1.3 million people, or 23 per cent of the population, currently have private health insurance (Löytömäki, 2024). One exception to these rising figures is Iceland, where private health insurance does not yet exist on the same scale (Alexandersen et al., 2016).
As can be seen, there are significant similarities between most of the Nordic countries, but there are also distinctive features that are worth examining more closely. One of these is, as mentioned, the prevalence of supplementary insurance in Denmark, and another is the high proportion of children covered by private insurance in Finland. As many as 40 per cent of all Finnish children under the age of seven are covered by private health insurance (Lehtonen, 2017), and children under the age of three are the largest user group of private healthcare (Sointu et al., 2021). This means that almost half of all Finnish children can be seen by a specialist directly, while the other half must first see a nurse and then a general practitioner before potentially being able to access specialist care. For these privately insured children, it is therefore parents and not medical professionals who determine how, when and for which symptoms to seek a specialist consultation, which can drive up healthcare costs and be counterproductive in many other ways, known as low-value care.
One of the purposes of effective primary care is precisely to be a first line of healthcare, from where a determination is made over whether to refer the patient to specialist care. However, private health insurance creates some confusion when it comes to this so-called gatekeeping. This is particularly true of insurance policies that include so-called referral requirements, i.e. insurance that requires a referral from the publicly funded healthcare system to access specialised care provisions. In a large Norwegian study (Breivold et al., 2024), 42 per cent of all general practitioners surveyed said that they often or always feel pressured to refer patients with private health insurance to specialist care even if there are no medical grounds to do so. Furthermore, 18 per cent of doctors stated that they often or always encounter unpleasant reactions such as aggression, threats or reprisals if, for professional reasons, they refuse to comply with a referral requirement made by a patient with private insurance.
Of the 1,309 Norwegian doctors, 93 per cent stated that private health insurance increases the risk of wasting resources through over-treatment, while 90 per cent stated that such insurance contributes to inequality in healthcare (Breivold et al., 2024). Similar percentages were reported in a large Danish study (Andersen et al., 2017), and according to a survey I initiated myself there does not appear to be any significant difference in Sweden. Several of the doctors I interviewed said that it is difficult to resist demanding policyholders and that health centres seek to avoid financial loss resulting from the risk of patients leaving their register.
Policyholders’ demands risk driving up costs and increasingly turning healthcare into a consumer product, with many believing they deserve the best and most expensive care even for the most minor ailments. At the same time, healthcare is becoming a kind of prestige product, with policyholders striving to keep up with those around them: my neighbour has bought gold insurance, and I only have silver! Nordic insurance companies know how to exploit this kind of anxiety and competition. That is why they are constantly developing new products, while stratifying their insurance policies into bronze, silver and gold levels, depending on customer status and ability to pay (Euro Accident, 2025).

Driving forces behind private health insurance

It is not only insurance companies that have driven the rapid growth of private health insurance: it has also been encouraged by the governments of the Nordic countries through generous tax deductions. In both Denmark and Norway, the trend gained momentum thanks to deductions introduced by liberal-conservative governments in 2002 and 2003 (Tynkkynen et al., 2018). Likewise in Sweden, tax deductions have been an important factor behind the growth of private insurance. In Finland, private health insurance policies taken out through employers are tax-free benefits for employees (Vero.fi, 2024), contributing to the trend towards a divided healthcare system.
In Sweden, however, a Social Democratic government took the initiative to introduce a law on the taxation of private health insurance benefits, which came into force in 2019. The purpose of the law was to end public sponsorship of insurance policies, but after private meetings with the Swedish Tax Agency, the industry organisation Insurance Sweden (Svensk Försäkring) and the insurance company Skandia succeeded in getting the benefit taxation reduced to only 60 per cent (Lapidus, 2025). This tells us something about the influence that the private healthcare industry has gained over the healthcare systems of the Nordic countries, influence that also came into play when a Swedish government inquiry deviated from a government directive to propose a ban on private health insurance (Lapidus, 2025).
At a deeper level, the emergence of private health insurance in the Nordic countries would not have been possible without the preceding privatisation of provision. Only when there is a nationwide network of private healthcare providers do insurance companies have somewhere to send their customers, as publicly run healthcare providers do not give priority based on private health insurance coverage. Policyholders cannot go to Karolinska University Hospital in Stockholm or Oslo University Hospital and demand priority treatment but must instead contact a private healthcare provider.
In this way, privatisation of provision was a prerequisite for the insurance market. At the same time, private health insurance is a trigger for further privatisation of provision in various ways (Lapidus, 2025). While there is sometimes careless talk about privatisation in general terms, it is important to study different types of privatisation and their mutual interaction in the Nordic countries.

Private health insurance is not for everyone  

So who takes out private health insurance? Unsurprisingly, there are clear class and gender differences, with high-income earners greatly outnumbering low-income earners and men greatly outnumbering women. In terms of gender, Sweden is a typical example, with two-thirds of policyholders being male and one-third female (Palme, 2017). In terms of class, Finland is a good example, where 30 per cent of high-income households have private health insurance, compared to only 8 per cent of low-income households (SOU 2021:80). The large class differences in the purchase of private health insurance are not surprising, given that insurance companies prefer to attract individuals who are as young, healthy, able-bodied and high-earning as possible. Those with increased risk of illness have to pay higher premiums or, in many cases, are refused insurance. One example of this is that insurance companies often want to know the ratio between manual and white-collar workers when a company purchases insurance for its employees, as manual workers are at higher risk of both workplace illness and injury. A high proportion of manual workers means more expensive premiums for the contracting company. It is therefore on not only ideological but also purely material grounds that the trade unions within the Swedish Trade Union Confederation (LO) criticise these insurance policies, which disadvantage the working class, while white-collar unions are increasingly offering such policies to their members.
Insurance companies’ business model is based on contrasting the excellence of their own products with public healthcare to create doubt and concern among those who choose not to take out insurance. Typical examples include the Danish company Gjensidige’s slogan ‘Your shortcut to fast treatment’ (Gjensidige, 2025), Norwegian Storebrand’s comparisons between its own waiting times and those of public healthcare (Storebrand, 2025) and Danish DSS’s focus on the security that insurance provides policyholders (DSS, 2025). Emphasising the peace of mind that private health insurance provides is common practice. The other side of the coin is that public healthcare is unable to provide this peace of mind to citizens, and the consequence of persistent advertising and propaganda may be a gradual decline in trust in public healthcare.
Insurance companies justify private health insurance by saying that it creates healthy and peaceful policyholders, at the same time denying the inequality and injustice on which the entire insurance system is based. One example is the Swedish trade association Insurance Sweden, which tries to promote the notion that all social classes have the same access to insurance (Erlandsson, 2019) and persistently denies that private healthcare providers discriminate between those who have insurance and those who do not – despite the fact that the main purpose of insurance is precisely to offer priority over publicly funded patients (Svensk Försäkring, 2024).
Simultaneously justifying and denying the function of private health insurance is an effective way of establishing dominance (Van Dijk, 1993), legitimacy and general confusion over what insurance actually means. Legitimacy is central to the private healthcare industry’s ability to push through its agenda. The creation of legitimacy is partly aimed at the large majority of the population who uphold the principles of equal treatment established in healthcare legislation and therefore view the emergence of parallel healthcare systems with some scepticism. But even more importantly, it is about fostering legitimacy among individuals, companies and organisations that take out insurance policies, because even among these groups there is often a sense of unease about receiving unlawful, priority access to care over other citizens. This applies not least to white-collar unions that offer private health insurance to their members, while at the same time claiming to support universal healthcare systems. It is particularly important to address these and like-minded actors with legitimising, neoliberal arguments that they are not undermining the common good at all but rather doing public and universal healthcare a great service by leaving it to its own devices.

Private health insurance, crisis and resilience

A fragmented and privatised healthcare system risks reducing society’s resilience in times of crisis, while at the same time encouraging some citizens to act in accordance with the new doctrine of individualism and selfishness. One example is the COVID-19 pandemic, during which some managers were publicly criticised for improperly arranging vaccines for themselves and their relatives. However, it should also be noted that these managers had already disregarded the principles of the Health and Medical Services Act. For years, they had been encouraged to purchase private health insurance for themselves and their families, so why should the same approach not apply to vaccines?
A good illustration of these conflicting signals is the editorial page of the Swedish newspaper Expressen. On the one hand, the editorial page usually welcomes the growing number of Swedes who jump the healthcare queue with private health insurance (Expressen, 2020). On the other hand, the same editorial page (Marteus, 2021) claimed that business leaders who obtained vaccines on their own initiative were guilty of criminal acts.
Insurance companies also found themselves in a difficult position during the pandemic. On the one hand, completely new opportunities arose to capitalise on people’s concerns, on the other, allowing some people to jump the queue for healthcare could be perceived as more cynical than usual. Insurance companies therefore had to find more subtle ways to advertise their products, precisely at a time when they could sell more insurance policies than ever before. One such method was a so-called survey in which the Swedish insurance company Länsförsäkringar asked the opinion poll company Novus to ask a single question to private individuals aged 18–79 and those employing 1–10 people: ‘Do you think that public healthcare will be there for you when you need it?’ (Länsförsäkringar, 2020).
This so-called survey was one of several discreet ways of marketing private health insurance at a sensitive time. However, some customers were anything but discreet, demanding special treatment even when it came to COVID-19. Insurance companies were therefore forced to explain that their policies did not cover COVID-19. For other types of care, however, private insurance continued to apply as usual. Länsförsäkringar was careful to point out that the pandemic would not affect policyholders’ rights, stating on its website: ‘For other illnesses and ailments, health insurance applies as usual’ (Länsförsäkringar, 2021).
Policyholders thus continued to have priority access to specialist care, while at the same time a so-called healthcare debt was created as a result of several regions cancelling planned operations due to the COVID-19 crisis. This meant that policyholders continued to use healthcare resources, perhaps more than ever before, as even more care coordinators (often nurses) and claims adjusters (often nurses) were needed to address policyholders’ concerns and claims during the COVID-19 pandemic.
At the same time, there was uncertainty about whether private healthcare personnel could be called up during a national crisis such as the COVID-19 pandemic, which meant that neither politicians nor civil servants could provide clear answers on how the regulations should be interpreted (Persson, 2020). At the same time, increased foreign ownership of Swedish healthcare began to attract attention, prompting the Social Democratic government to commission the Swedish Defence Research Agency to conduct a study on democratic and other risks (Budryk et al., 2023). The research institute concluded that there was limited awareness of the risks and further stated that ‘The risk does not necessarily increase with foreign ownership but rather with private ownership, as this limits public transparency and control.’

Consequences of divided Nordic healthcare states

In all Nordic countries, new actors are being drawn, willingly or unwillingly, into the new healthcare and insurance markets. Among the actors with a direct financial interest in continued privatisation are insurance companies and private healthcare providers. However, there are also a number of intermediaries who benefit financially from this development, such as insurance brokers, who act as a link between insurance companies and the companies and organisations that purchase private health insurance. Among the more reluctant actors are, for example, white-collar unions, which face a difficult dilemma in that, on the one hand, they claim to defend the Nordic universal healthcare model and, on the other hand, they offer private health insurance to their members.
The emergence of parallel healthcare systems in the Nordic countries poses a significant threat to the public, and previously common, healthcare systems. Firstly, there are a number of undermining factors, such as the public sector being drained of human resources and a decline in willingness to pay tax and in public opinion and trust in public healthcare. Secondly, the common systems are, by definition, being broken down by the rapid growth of private health insurance. This is because two different healthcare systems based on two fundamentally different logics are simply not the same thing as a common, universal system in which all citizens, regardless of class and gender, collectively contribute and participate.
That there is a trend towards a divided healthcare system in the Nordic countries is a matter of fact, but perceptions and opinions about this trend are, of course, subject to personal leanings. It is perfectly possible to argue in favour of unequal and wallet-driven healthcare, because why should healthcare not be bought and sold like almost all other products in a market economy? There is a wealth of neoliberal moral philosophy to draw on here (see, for example, Friedman, 1962; Rand et al., 1986), but one problem is that representatives of the private healthcare industry rarely rely on the straightforward and intellectually honest arguments that exist for the continued privatisation of healthcare provision and financing.
In most cases, the private healthcare industry has not needed to make any arguments at all, as the development towards a divided healthcare system has been characterised by the type of gradual and almost insidious changes that have been typical of much of the neoliberal advance (Streeck & Thelen, 2005). However, once such changes have become a matter of public debate, representatives of the private healthcare industry have invented a kind of neoliberal newspeak (Lapidus, 2025), in which every step towards a divided welfare system is argued to be in the interests of public and universal healthcare, despite each such step taking us further away from universal healthcare on equal terms. It should also be added here that there are healthcare laws that stipulate the requirement for care according to individual need and on equal terms, which is why those who argue for the current wave of privatisation should at the same time argue for these laws to be repealed and rewritten.
Furthermore, representatives of the private healthcare industry often claim that the emergence of parallel healthcare systems in the Nordic countries are the result of shortcomings in public healthcare. But on closer inspection, there is no public healthcare system in the world that can compete with a parallel system that targets the healthiest and most affluent groups in society. This is especially true if that system freerides on public infrastructure and is promoted by the government through generous tax breaks and new laws and regulations that favour the private sector at the expense of the public sector.
In the Nordic countries, governments have promoted parallel healthcare systems, and these countries have thus seen rapid growth in private health insurance rates. The more private insurance systems grow, the more difficult it becomes for politicians to reverse the trend, especially as influential voter groups benefit from the new privileges. By promoting private insurance systems, politicians have given these voter groups the option to opt out of the public system. These groups therefore no longer have a vested interest in resolving the shortcomings of public healthcare. In fact, they do not even experience the shortcomings, as insurance companies’ care coordinators ensure that they receive preferential treatment over other citizens. Politicians are grateful to avoid criticism from these influential groups, who can continue to weaken the healthcare budget, which, in contrast, must be increased if quality of healthcare is to be maintained and keep pace with developments in the rest of society.
That there are hardly any actors fighting for public healthcare has not helped to check the influence of the private healthcare industry. This is evident, for example, when public healthcare inquiries are sent out for consultation, with an increasing number of consultation bodies tending to be private healthcare groups and insurance companies, all of which have a financial interest in the continued privatisation of healthcare. However, there are no corresponding campaign organisations for public funding among the bodies consulted.

Conclusions – and possible paths towards increased healthcare resilience

What we are seeing today is a gradual return to the fragmented and privatised healthcare system that characterised the Nordic countries before the public systems were established. At the same time, people’s values regarding issues such as care based on individual need and on equal terms are changing, a trend fuelled by insurance companies’ and private healthcare providers’ constant criticisms of public healthcare, used as a selling point for their own products.
It is not only the Nordic countries that have experienced a wave of healthcare privatisation in recent decades. Similar patterns can be seen in France (Cordilha, 2023), Canada (Bodner et al., 2022), Brazil (Costa, 2017), India (Hooda, 2020) and many other countries around the world. Even healthcare systems that are very similar to those in the Nordics with regard to the principle of universality, such as those in Spain and the United Kingdom, are now characterised by ongoing privatisation of provision and financing. Thus, every year, Britain and Spain set new records for the number of private health insurance policies taken out (Corbatón, 2024; Stearn, 2024).
The trend towards increased privatisation and fragmentation risks reducing the resilience of healthcare systems during crises such as the COVID-19 pandemic. In countries that once had universal, market-free (so-called decommodified) healthcare systems of a ‘social democratic’ nature (Esping-Andersen, 1990), including the Nordic countries, this development also represents a crisis in relation to the principles of universality and equal care for all citizens that are still enshrined in healthcare legislation. This is therefore a constantly deepening crisis for public healthcare systems, one that has major consequences in terms of class and gender equality. It is a crisis from which there seems no easy way of bouncing back, as is required for healthcare systems to be considered resilient (Wiig et al., 2020).
To restore resilience, in terms of ensuring equal healthcare for all citizens, increasingly drastic measures will be required as the Nordic healthcare systems become more and more divided. One example could be legislation to slow down the rapid growth of private health insurance, i.e. laws that prohibit private healthcare providers from entering into agreements with both public and private financiers. The next step could be measures to prevent privatisation of provision – sometimes referred to as profits in welfare – which enables and triggers the rapid growth of private health insurance. On a more general level, it will likely be necessary for income and wealth gaps to be reduced: under current class divides, it is difficult to generate sufficient interest to rebuild this type of resilience in healthcare systems.       
  • The rapid growth of private health insurance needs to be understood and managed from a crisis and resilience perspective, so that the resilience and equality of the systems can be strengthened.
  • The division of the Nordic healthcare systems requires political reforms and practical measures to counteract unequal access and ensure that healthcare remains a shared welfare resource.
  • Ways back to a common and market-free (decommodified) healthcare system should be developed and tested as an alternative to restore legitimacy, solidarity and equality in healthcare.

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