Qualitative study finds Swedish employer-funded insurance holders retain willingness to fund public healthcare

People with employer-funded voluntary health insurance in Sweden reported continued willingness to pay taxes for public healthcare in a qualitative study based on 19 semi-structured interviews. Their support was driven primarily by moral commitments, especially the belief that all citizens should have equal access to healthcare, although they also expressed discomfort about the faster access their insurance can provide.

Researchers Linn Kullberg, Paula Blomqvist and Ulrika Winblad investigated how respondents accounted for continuing to support public healthcare while receiving private insurance through employment. The study examined both whether insurance holders perceived their coverage as reducing their willingness to contribute and the motivations underlying that willingness. The findings suggest that holding employer-funded insurance did not, in these accounts, erode support for the tax-funded system.

The interviews, conducted digitally between February and October 2022, lasted 26 to 83 minutes. Participants were people who had used employer-funded voluntary health insurance and had also visited publicly funded healthcare within the preceding two years. The final sample comprised 12 men and seven women aged 33 to 59, with a mean age of 45. All but one respondent had a university degree. Recruitment used personal contacts and snowball sampling, primarily in Stockholm.

The analysis used thematic analysis. The first author conducted familiarisation and initial inductive coding, after which codes were organised into five themes. The full author group discussed the developing codes and themes and considered alternative interpretations. The themes were then examined in relation to solidarity, egalitarian values and self-interest, with the broader author team conducting two additional review rounds. Ethical approval was granted by the Swedish Ethical Review Authority, and all participants provided written consent.

Respondents consistently distinguished their support for healthcare taxation from their reservations about taxation in general. Some accepted that they could not readily change their tax burden, while others questioned why insurance holders did not automatically receive a corresponding tax reduction. Even so, participants did not describe their voluntary health insurance as a reason to pay less toward public healthcare. For many, the insurance was an employment benefit rather than a replacement for collective public funding.

The most frequently developed reason for continuing to contribute was egalitarian conviction. Participants described equal access as a right that should not depend on income, employment circumstances or ability to pay. Public healthcare was viewed as a means of ensuring that medically necessary services remain available across the population, including people who cannot afford private coverage. Some respondents also expressed concern that public healthcare was under-resourced and wished it received more funding.

Respondents also described healthcare as a collective responsibility rather than something that individuals should purchase solely for themselves. Support for the system was not presented as a calculation of personal financial benefit: even those in comparatively advantaged positions said they wanted society to include everyone. Another, less prominent motive was self-interest, including the recognition that anyone may need public care despite current health or private coverage. Family members and friends without insurance also provided a reason for maintaining contributions.

At the same time, the interviews revealed tension between the principle of equality and the practical advantages associated with private insurance. Participants recognised that their coverage could provide faster access to care, while also questioning whether private insurance unfairly advantaged policyholders. Some described shame or moral discomfort when using benefits they did not consider fully legitimate. The study’s authors characterised this ambivalence as friction between egalitarian commitments and self-interested benefits rather than as an independent motive for paying tax.

The findings should not be treated as representative estimates for all Swedish insurance holders. The study included only 19 employer-funded policyholders, a group that generally bears little direct cost for its insurance, and it did not include a comparison group without insurance. The cross-sectional design cannot establish whether support changes as voluntary coverage expands, and the researchers noted that stated willingness may differ from actual tax compliance. Social desirability may also have shaped responses in a setting where support for tax-funded healthcare is broadly endorsed. Because the study was confined to one institutional context, the results may not transfer directly to healthcare systems with different financing arrangements.

Within those limits, the interviews provide evidence that employer-funded voluntary insurance did not by itself weaken the expressed willingness of these participants to finance public healthcare. Their reasons were mainly moral and institutional: healthcare was understood as a collective responsibility, and equal access was treated as a central value. The persistence of that commitment did not eliminate discomfort about privileged access, indicating that support for public healthcare among privately insured employees can coexist with ambivalence about the advantages their insurance provides.

Subject of Research: How employer-funded health insurance holders in Sweden understand and justify paying taxes for public healthcare

Article Title: Why are voluntary health insurance holders willing to pay tax towards public healthcare? A qualitative study from Sweden

Article References: Kullberg, L., Blomqvist, P., & Winblad, U. (2026). Why are voluntary health insurance holders willing to pay tax towards public healthcare? A qualitative study from Sweden. BMC Health Services Research, 26(1), Article 1322. https://doi.org/10.1186/s12913-026-15708-3

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15708-3

Keywords: voluntary health insurance, public healthcare, health taxation, Sweden, qualitative interviews, thematic analysis, equal access, employer benefits, egalitarianism, voluntary, health, insurance