National and local reforms in Sweden have focused on reducing waiting times, increasing efficiency, containing costs, choice, and competition, and introducing more private providers. Quality and safety is comparable to many western countries, possibly slightly higher for clinical quality, and lower for aspects of patient-centered care. Evidence of the effects of reforms locally and nationally is limited, and especially of their effects on quality and safety. The future is likely to see more emphasis on patient empowerment, performance measurement, and national and international comparisons, performance-related financial incentives, new payment systems, and care coordination for older people.