Even socialist Sweden has robust private health care and education. Why shouldn’t Canada?

To understand modern Sweden and how the country has transformed, consider Jens Eriksson’s career trajectory.

In his youth, Mr. Eriksson worked at music labels such as Stockholm Records, repping Swedish bands like the Cardigans around the world. Thirty years later, the arts aficionado runs a network of private health care clinics, a job he took after running a network of private schools – all in a high-tax, socialist country.

He admits he was an unlikely candidate for this leap. His own kids went to public school, and he had, too. But Mr. Eriksson’s evolution, like his country’s, was borne out of necessity. And it’s a path that provides Canadians with rather significant insights.

When Mr. Eriksson started working in the music industry in the nineties, profit margins were fat. A few years in, Napster was released, and that made it easy to download (and steal) music for free. The business model imploded. Reinventing himself, Mr. Eriksson moved on to film and television, only for YouTube and Netflix to upend those industries.

Come 2016, Mr. Eriksson fielded an unexpected call from a headhunter hired by AcadeMedia, a company that operates private schools across the Nordic countries. They were looking for an experienced executive to lead their Swedish network of high schools. He wasn’t quite sure what to make of it, but the more research he did, the more he realized Swedish education could use a shakeup.

Like Canada, Sweden emphasizes education and spends vast sums of taxpayer dollars on its schools. But to Mr. Eriksson’s mind, that investment wasn’t making for better classrooms. “They just kind of waste the money,” he says.

AcadeMedia had an answer for that. Starting in the nineties, Sweden opened the door to independent schools that are privately managed, but funded by taxpayers. Unlike Canadian private schools, which often cost parents $30,000 to $50,000 a year per student, there is no out-of-pocket cost to attend these schools. (Canada’s version of expensive, elite private schools is very rare in the Nordic country.)

If the owners of Sweden’s privately run schools find ways to save money, all while adhering to high educational standards, they get to keep any profits they make.

Debating the job offer, Mr. Eriksson ran the numbers and saw margins he could stomach. “Six, seven per cent profit levels while providing better services to the society? Yeah, I could live with that,” he explains.

Mr. Eriksson came to love the model, and in 2022 he took a job in Swedish health care. Just as with schools, the country permits privately operated but publicly funded clinics and hospitals. He now runs the Swedish arm of Aleris, managing a network of private clinics that specialize in orthopedic surgeries such as hip replacements.

Across Sweden, private operators are constantly scrutinized, and there is a perennial debate as to whether their profits should be reinvested back into the system. Yet the core model has endured over three decades, and it has outlasted liberal and conservative governments. Roughly 30 per cent of the country’s high-school students now go to a privately run school, and in Stockholm, one of the city’s largest hospitals, Saint Goran, has been privately run since 1999.

It is all very relevant for Canada. Persistent provincial deficits have starved many public schools of resources, particularly when it comes to special education. The country’s health care system, meanwhile, seems close to breaking and it’ll likely only get worse. Baby boomers are aging, which means health care costs will soar. They’ve already jumped to around 12 per cent of Canada’s gross domestic product, up from 6.5 per cent in 1975, according to the Organization for Economic Co-operation and Development.

The depth of the financial hole is also glaring. Ontario has run only one budget surplus since 2007, and the province has accumulated roughly $350-billion worth of debt over that period. There’s no easy way out for politicians, either. Raising personal taxes would likely be political suicide. The highest personal income tax rate is already 53.5 per cent. (Sweden also taxes personal income at a high rate, and that wasn’t enough to fix its own services.)

Yet whenever private models are mentioned in Canada, the backlash is swift. This is the country of Tommy Douglas, a land where health is a human right. Canadians also love to point at the United States and say no one in their right mind would want what they’ve got. The U.S. vastly outspends the OECD average on health care per person, but has one of the lowest life expectancies.

What these arguments often gloss over is that big chunks of the Canadian health care system are already privately run. Eye care. Dental care. Blood work. Plus, the U.S. isn’t the only point of comparison for Canada. Sweden spends roughly the same percentage of its GDP on health care as Canada, yet has a higher life expectancy. And to use Prime Minister Mark Carney’s language, Sweden is a fellow middle power, and it shares a lot of Canadian values.

Mr. Eriksson, the head of the private health care network, sounds quite Canadian himself. “We don’t want the entire system to be private,” he says during a chat in Stockholm. “We want the foundation to be publicly run and publicly owned and publicly governed.” Aleris’s goal is to improve wait times for routine surgeries, with most of its services still paid for by the government.

If Sweden, a socialist cousin, can have that, why can’t Canada?

How Sweden got here

Not so long ago, Sweden was in real trouble.

The country’s central government dramatically expanded welfare programs during the 1970s and 80s, and instead of reining them in when economic growth cooled, it kept borrowing money to keep the party going.

Eventually, the music stopped. And when it did, the government had too much debt. Ultimately, the country had a nasty real estate crash, which was followed by a multiyear banking crisis in the early nineties.

During this era, Swedes also grew exasperated by rigid state control. They were taxed heavily, yet were forced to go to certain doctors and certain schools, and the state had a heavy hand in everything, including industrial and labour policy. Swedes say it felt like living in East Germany before the Berlin Wall fell.

In 1991, a new government was elected, right as a landmark report came out, known as the Study of Power and Democracy in Sweden. The resounding takeaway was that Swedes wanted more choice, particularly when it came to their kids’ education. From there, Sweden permitted private schools, with a promise that the government would cover the cost.

For the first few years, independent schools often served niche communities or a small group of people who supported a certain pedagogic model. But by the late nineties, parent frustration had boiled over. Fed up, Peje Emilsson, a public-relations expert, decided to found a school network called Kunskapsskolan with some partners. Swedish schools, he felt, were unbelievably rigid, and they ought to cater to each student’s characteristics, needs and interests.

The Kunskapsskolan network started in 1999 with five schools and roughly 1,000 students. It has since grown to more than 100 schools across Sweden and other countries including the Netherlands, India and Saudi Arabia. The network is now run by Mr. Emilsson’s daughter, Cecilia Carnefeldt, who has a law degree from Stockholm University and an MBA from the Stockholm School of Economics.

Sitting in a small study room off a noisy hallway at Kunskapsskolan Nacka, one of the network’s primary and middle schools located in a wealthy Stockholm suburb, Ms. Carnefeldt explains that it wasn’t just parents who had grown jaded. “Lots of teachers, also the principals that came on board, came from a frustration,” she says. They often felt, “‘I know how to do this better. I know how to do this more efficient. I know how to support these different types of students in a better way.’”

As for public school operations, Ms. Carnefeldt says the regional managers were simply overloaded. “The state or the municipality, they have lots of other areas also to deal with, right?” she explains as the students roam the halls. (It is the last week of school in June and, sensing summer break, the kids are acting a bit like feral animals during the lunch hour.) “They also handle elderly care and the sports arenas and the parks and the culture and all of that.”

Independent schools, she says, can focus solely on their operations, “and they have ways of benchmarking, analyzing, and coming to decisions and getting action.”

Erik Lakomaa, the executive director of the Institute for Economic and Business History Research at the Stockholm School of Economics, has studied the two models, and found there was a lot of low-hanging fruit in the public school system that could be fixed.

At one point, he explains from his office at the university, he was hired by one of the worst-performing municipalities in Sweden to do a cost analysis of its system. When he went in, he learned the government had overpaid for Microsoft Office, and held at least a dozen times more software licences than the number of computers at a school.

Sweden also operates unusually small schools, at least by Canadian standards. To this day, the average number of students at a primary and middle school is around 225. Christian Lundahl, a researcher and professor of education at Orebro University, lays it out plainly: “Where I live, in a suburb of Stockholm, I have probably 10 schools within a walking distance of 10 minutes,” he says.

That means 10 headmasters, 10 properties, 10 gym teachers and 10 custodians. In other words, a lot of duplicative costs. In 2024, Sweden spent 8 per cent of its GDP on education, while Canada spent 6 per cent, according to the two countries’ statistical agencies. (These figures include postsecondary spending.)

A similar transformation has played out in Swedish health care. Around the same time that schools were opened up to private ownership, the country’s health care system also started flirting with the model. One of the biggest gambles was made in the late nineties, when Stockholm’s Saint Goran was slated to close because of budget and cost issues.

Out of desperation, the municipal council voted on a Hail Mary: Instead of shutting down the hospital, it awarded a Swedish company called Capio a contract to turn the hospital around. Capio, now owned by French health care company Ramsay Générale de Santé, has run Saint Goran for 27 years and its operations contract has been renewed multiple times over that period.

Expanding this model, Sweden amended legislation in 2010 and gave every patient the right to choose between public and private providers for their primary care. Just like with schools, Swedes were seeking freedom.

Before the changes, family doctors operated somewhat similarly to schools in Canada: They were managed by local councils; the doctors earned a government salary; and the health centres they worked at provided care to residents in a specific geographic area. Swedes did not like limitations on where they could seek care.

Today, roughly half of all family doctors in Sweden are employed by private providers, with their services paid for by the government.

Sweden has also permitted more private operators since the 2010 amendments, with a goal of trimming costs within the guardrails of providing good patient care.

“We’re trying to think lean,” says Mr. Eriksson, the head of Aleris Sweden. “We’re trying to make sure that we move the patient through the different steps as fast as possible.” No one should be lying around in hospital beds for a minute longer than their recovery requires.

A recent study from Sirona, a Swedish health care consultancy, found that Aleris’s knee replacement surgeries cost 40 per cent less than those performed in public hospitals, and its hip replacement surgeries cost 44 per cent less.

Because Aleris has separated planned surgeries from emergency care, it has dedicated teams who can work on predictable schedules, with fewer interruptions. In business terms, it makes for better operations management. Aleris can perform four or five hip replacements per operating room per day.

And it has helped with staffing. Mr. Eriksson says Aleris clinics tend to offer weekday daytime hours that are amenable to parents with kids. “The staff turnover is a fraction of what it is in the public system,” he said, which also helps to reduce costs.

Aleris currently generates roughly 80 per cent of its revenue from government-funded procedures, and the remaining 20 per cent from private insurance payments and self-funded care. Whereas Canadian employees may have private insurance through work that covers dental and physiotherapy, some Swedes have private health insurance provided by their employer or arranged through a trade union that covers planned surgery.

Asked whether patients can jump the queue simply by having private insurance or by paying out of their own pocket, Aleris said how a patient’s care is financed does not override the clinical assessment of how urgently they need treatment.

What it means for Canada

The fear for Canadians, of course, is the age-old slippery slope.

Private clinics may start being funded by taxpayer dollars, but will they expand their client base? Would Canadians be able to jump the queue by paying out of pocket? As they grow, would private clinics drain resources from the public system?

Dr. Jon Meddings, the retired former dean of the Cumming School of Medicine at the University of Calgary, has been vocal about that very issue this fall because of recent policy changes in Alberta. As of Sept. 1, the province allows some surgical specialists to bill the public purse while also privately charging patients for their services.

“I’m not averse to private health care, just like I don’t care about having business-class seats,” he says. “If somebody wants to pay for a better seat and a glass of wine, it doesn’t hurt me at all.”

“What bothers me is when you want to pay to take my seat,” he adds. And the problem in Alberta is that the public system is already so strapped for cash and bodies. He says the new model doesn’t necessarily add new capacity; it just makes some spots more expensive.

But Mr. Meddings also acknowledges that Canada could use a shakeup, an argument that has been made by other health care experts, including hospital CEOs.

“We have made a decision to spend money stupidly,” he says. Acute care beds cost thousands of dollars a day to run, he says, citing data from the Canadian Institute for Health Information, while beds in long-term care homes cost about $300 per day. Yet Canada does not have nearly enough long-term care spots, so elderly patients tend to get stranded in expensive hospital beds for days or even weeks on end.

He cites hip replacements as another example. They’re now a relatively standard surgery, but patients still face lengthy wait times. The longer someone waits, the worse the hip gets, which makes the recovery more complicated. That means the patient has a higher chance of having a setback and resorting to the health care system again.

It’s this very surgery that Aleris, the Swedish health care company, has prioritized. In Sweden, the average wait time once a patient has seen a specialist is 80 days. In Canada, it’s 125 days. That difference can’t be attributed to private clinics alone, but they certainly help.

Comparing health care systems

in Canada and Sweden

Wait times from specialist assessment to treatment –

hip replacement

Practising doctors per 1,000 people

Practising nurses per 1,000 people

the globe and mail, Source: OECD Health Statistics 2025

Comparing health care systems

in Canada and Sweden

Wait times from specialist assessment to treatment –

hip replacement

Practising doctors per 1,000 people

Practising nurses per 1,000 people

the globe and mail, Source: OECD Health Statistics 2025

Comparing health care systems in Canada and Sweden

Wait times from specialist assessment to treatment – hip replacement

Practising doctors per 1,000 people

Practising nurses per 1,000 people

the globe and mail, Source: OECD Health Statistics 2025

So there are benefits, but Canadians would have to ask themselves how much profit is acceptable. Aleris reports financial results publicly, and in 2025 it made $33-million in net income across Scandinavia. (Sweden is its largest market.)

Sweden’s private school operators can also make a pretty penny. The country’s largest network, Internationella Engelska Skolan, or IES, made its name by instructing in English at its schools, and its founder, Barbara Bergstrom, is a former teacher who fled the public system out of frustration. In 2012, she sold a majority stake in IES to a private equity company, and she’s gone on to become one of Sweden’s richest women.

Some critics argue any profits should be redistributed back into the system, perhaps to pay teachers or nurses more. But profit is also a motivator, and strong performance in the private system can force the public systems to improve.

What matters most, though, are patient and student outcomes.

In health care, the numbers suggest the Swedish system is working. The country spent 11.9 per cent of its gross domestic product in 2025 on health care, according to the OECD, a little less than Canada. Life expectancy, though, is 83.4 years, higher than Canada’s 81.7 years, and Sweden also has 4.5 practising doctors per 1,000 people, while Canada has 2.7.

In education, the results are mixed. Globally, Canada still outscores Sweden on the OECD’s standardized tests, known as the Programme for International Student Assessment, which grade students on math, science, literacy and problem-solving.

Within Sweden, Mr. Lundahl, the academic from Orebro University, says independent school students tend to outperform public school students on standardized tests, but that pattern does not necessarily hold once all variables are accounted for. The socioeconomic makeup of classrooms can skew results, as can factoring in students who have newly arrived from other countries.

Should Canada follow suit by adding more privately run options?

There are no simple answers. In Swedish education, neither model has proven to be an outright winner. About 80 per cent of students are still in the public system, and at the upper secondary level, some of the most prestigious schools in Stockholm, such as Ostra Real and Sodra Latin, are still public schools.

“There are lots of public schools that do a great job, and there are lots of independent schools that do a great job,” says Kunskapsskolan’s Ms. Carnehardt. “I think there’s a lot in the value of just being able to choose.”

Canada could make some simple fixes to the existing education system that would make a world of difference. One example: Hiring more special education teachers. Teachers’ unions also routinely advocate for capping class sizes.

Health care is arguably a different beast. As baby boomers age, the costs are only going to rise, and Ottawa is already heavily in debt. So are many provinces.

Private health care can sound spooky, but roughly 40 per cent of the Canadian system is already delivered through a private model. Even family doctors are technically privately run, since most are self-employed. It’s just that the government is the single payer.

Sweden offers a road map for expanding this model, but Canada doesn’t necessarily have to go as far. Perhaps only a half-step is needed, such as permitting private MRI clinics, with the tests paid for by government funding.

Or if provinces permit privately run surgery clinics, they could impose limits. In Canada, the utilities that deliver power and electricity are often private companies, and regulators enforce maximum returns that they are allowed to earn each year.

The right debate, then, might not be whether private or public is better. Instead, it could be about what guardrails – and non-negotiables – are needed.

Mr. Meddings, the former medical school dean, is still hesitant about it all. But if Canada is going to add more private care, he says, the key will be ensuring there remains a strong public system – “which is what Sweden has.”

The Decibel

The volunteers filling the gaps in Canada’s health care

Amid the news about Canada’s strained and struggling health care system, there is a bright spot. The Globe and Mail published a series recently about volunteers filling in the gaps, called Care Between the Lines – about the volunteers who take a patient-first approach in a system that can often be isolating.