{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:50:27Z","timestamp":1791355827295,"version":"4.3.1"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Concerns have been raised that Swedish health care resources are increasingly directed toward administrative and managerial functions rather than clinical care. This development may be linked to the growing use of private providers within the publicly funded system. Our study investigates how administrative and managerial staffing has changed over the period between 2014 and 2024 relative to clinical staff categories in Swedish health care. We also investigate to what extent this change can be explained by the increasing use of privately provided care. A purposive database was constructed covering employed staff in governing functions, clinically active staff holding a professional licence or certificate, and regional expenditure on privately provided health care across twenty of Sweden\u2019s regional administrations for the study period (one small region with overlapping municipal responsibilities was excluded). Fixed effects panel regression, controlling for region and year, was used to estimate the association between spending on privately provided care and the number of administrative staff. All staff categories increased in number over the study period, but at markedly different rates: desk-officers grew fastest at 38 percent (27 percent adjusted for population), followed by managers at 28 percent (18), while clinical categories grew more modestly, with physicians increasing by 22 percent (13) and nurses showing the weakest growth at 10 percent (1). Growth in administrative and managerial staff varied considerably across regions but did not show a statistically significant association with regional spending on privately provided care once a common time trend was accounted for. Our findings suggest that Swedish health care has undergone a compositional shift toward administrative roles at a faster pace than clinical roles, a development not attributable to increased private provider use. Future studies should address questions about how administrative growth relates to the value it generates within the health system.<\/jats:p>","DOI":"10.3389\/fpubh.2026.1929890","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:58:50Z","timestamp":1791352730000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Governing at the expense of care: diverging growth in administrative and clinical staffing in Swedish health care over 10\u202fyears"],"prefix":"10.3389","volume":"14","author":[{"given":"Jens","family":"Wilkens","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences, Malm\u00f6, Lund University","place":["Malm\u00f6, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Frobell","sequence":"additional","affiliation":[{"name":"University College Halmstad and Campus \u00c4ngelholm","place":["Halmstad, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f6rn","family":"Ekman","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Malm\u00f6, Lund University","place":["Malm\u00f6, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"ref1","year":"2025"},{"key":"ref2","year":"2019"},{"key":"ref3","year":"2026"},{"key":"ref4","author":"Janl\u00f6v","year":"2023"},{"key":"ref5","year":"2019"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e263","DOI":"10.1002\/hpm.2458","article-title":"How and why do countries differ in their governance and financing-related administrative expenditure in health care? An analysis of OECD countries by health care system typology","volume":"33","author":"Hagenaars","year":"2018","journal-title":"Int J Health Plann Manag"},{"key":"ref7","volume-title":"Tabeller Kommunal personal 2025","year":"2025"},{"key":"ref8","year":"2026"},{"key":"ref9","year":"2025"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1136\/bmj.p947","article-title":"Fixing the health workforce crisis in Europe: retention must be the priority","volume":"381","author":"Zapata","year":"2023","journal-title":"BMJ"},{"key":"ref11","year":"2026"},{"key":"ref12","author":"Kirkpatrick","year":"2024"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1186\/s12913-020-05760-y","article-title":"Time trends in the regional distribution of physicians, nurses and midwives in Europe","volume":"20","author":"Winkelmann","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1603708","DOI":"10.3389\/fpubh.2025.1603708","article-title":"Italian healthcare professionals' role in advancing reforms within the Italian National Healthcare System, as outlined in the National Recovery and resilience plan","volume":"13","author":"Giusti","year":"2025","journal-title":"Front Public Health"},{"key":"ref15","volume-title":"Tackling Wasteful Spending on Health","year":"2017"},{"key":"ref16","first-page":"494","article-title":"The effect of implementing a care coordination program on team dynamics and the patient experience","volume":"23","author":"Di Capua","year":"2017","journal-title":"Am J Manag Care"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1186\/s12913-020-4986-0","article-title":"A quasi-experiment assessing the six-months effects of a nurse care coordination program on patient care experiences and clinician teamwork in community health centers","volume":"20","author":"Nembhard","year":"2020","journal-title":"BMC Health Serv Res"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1929890\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:58:51Z","timestamp":1791352731000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1929890\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":17,"alternative-id":["10.3389\/fpubh.2026.1929890"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1929890","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]},"article-number":"1929890"}}