County councils are in charge of how hospitals within their domain are reimbursed. Most county councils have been using a purchaser-provider model since the 1990s, in which payment is established according to volume of activities. This entails purchasing organisations working with hospital health care providers in order to draw up contracts covering finances and activities, generally based on fixed per-case payments with price or volume ceilings and quality components. However, given the high level of autonomy granted to county councils, payment mechanism details vary widely across Sweden’s administrative regions (Street et al.,