Abstract Health care in Sweden is a public sector responsibility and equity in access to care is quite important. The Swedish system is organized into several levels, with the Federation of County Councils at the top, and with regional, county, and local levels. In theory, the four hospital tiers developed by these different levels provide a clear hierarchy for acquisition of sophisticated new technologies. In practice, certain problems have emerged, especially rigidity of the system. Reforms are underway. Sweden was one of the first countries to become involved in the assessment of health care technology. From the beginning, technologies were assessed to determine if they were ‘consistent with proven scientific knowledge and good experience’. Sweden has a national program in health care technology assessment (TA), and TA is increasingly visible to policy makers and physicians. Health care TA has been effectively institutionalized in Sweden and has a bright future. The greatest problem in the Swedish context is the large number of unassessed technologies. Because of this, international cooperation is essential.