In international comparisons, the Swedish health care system has been seen to perform well. In recent years, market-oriented, demand-driven health care reforms aimed at free choice of provider by patients and free establishment of doctors are increasingly promoted in Sweden. The stated objective is to improve access and efficiency in health services and to provide more and/or better services for the money. Swedish health policy aims to provide equal access to care, based on equal need. However, the social and economic gradient in disease and ill health does not translate into the same social and economic gradient in demand for health services. A market-oriented, demand-driven health care system runs the risk of defeating the health policy aims and of further increasing gaps between social groups in access and utilization of health care services, to the detriment of those with greater needs, unless it is coupled with need-based allocation of resources and empowerment of these groups.