Government spending on culture, sport and healthcare – with an analysis of administration

Executive summary

The most important finding is that the Swedish national budget has no common accounting category corresponding to administration or overhead for culture, sport and healthcare respectively. Instead, the budget distinguishes, among other things, between appropriations, transfers, agencies’ operating expenditure and investments. It is therefore impossible to read off an official percentage for administration directly from the national budget. Such a percentage must be constructed, and the result depends heavily on the definition used.

To avoid labelling all agency activity as administration, two levels are used. Narrow administration or system function refers to central costs for governance, regulation, supervision, analysis, grant administration and similar activities, where these can be isolated in separate appropriations. Direct activity is defined as the remaining funding or production of cultural, sporting, healthcare and social care services. The latter category still contains hidden administration within museums, healthcare providers, municipalities, regions, sports organisations and grant recipients. The percentages should therefore be read as system-cost proxies, not as measures of bureaucracy or inefficiency.

Over the latest five consistently verifiable years of actual outcomes, 2020–2024, total expenditure under expenditure area 9, Healthcare, medical care and social care, amounted to SEK 101.8, 138.0, 118.2, 108.8 and 116.0 billion respectively. Expenditure area 17, Culture, media, religious communities and leisure, amounted in the same years to SEK 20.4, 22.7, 19.7, 16.7 and 16.6 billion respectively. The exceptionally high levels during the pandemic period make a straightforward reading of the trend misleading.

For sport, there is a considerably cleaner government appropriation: appropriation 13:1 Support for sport. Actual expenditure was approximately SEK 3.47 billion in 2020, SEK 3.92 billion in 2021, SEK 2.79 billion in 2022, SEK 2.09 billion in 2023 and SEK 2.117 billion in 2024. The national budget does not, however, show how much of this ultimately goes towards the administration of the Swedish Sports Confederation, the national sports federations or sports clubs.

For culture, a narrow 2024 scope is constructed by adding together the cultural-policy sub-areas of expenditure area 17 – including cross-cultural activities, the performing arts, literature and language, artists, archives, cultural heritage, museums, architecture, visual art and design, and film – while excluding sport, youth policy, media, religious communities, popular education and gaming policy. This analytical total comes to SEK 9.046 billion in 2024.

Using a very narrow central administration proxy consisting of the appropriations for the Swedish Arts Council and the Swedish Agency for Cultural Policy Analysis, totalling approximately SEK 93 million, the system function corresponds to around 1.03 per cent of the constructed cultural total in 2024. The residual is approximately SEK 8.953 billion, or 98.97 per cent. This is effectively a lower bound.

For the government sub-area of health and medical care policy, actual expenditure was SEK 74.184 billion in 2024. A narrow central system-cost proxy based on the National Board of Health and Welfare, the Swedish Agency for Health Technology Assessment and Assessment of Social Services, the Dental and Pharmaceutical Benefits Agency, the Medical Products Agency, the eHealth Agency, the Health and Social Care Inspectorate and the Swedish Agency for Health and Care Services Analysis comes to approximately SEK 2.308 billion, or 3.11 per cent. The residual is approximately SEK 71.876 billion, or 96.89 per cent. Here too, the amount is not pure overhead: supervision, pharmaceutical pricing, knowledge governance, health technology assessment and healthcare analysis are independent core public functions.

Expenditure area 9 is government budget expenditure, not the cost of all healthcare and social care in Sweden. Primary care and hospitals run by the regions, along with municipal elderly care, are financed and reported largely outside the national budget.

Perhaps the most important conclusion is methodological: an exact table comparing Sweden, Norway, Denmark, Finland, the Netherlands and Germany by administrative percentage across all three sectors would create false precision if it were built directly from each country’s national budget.

Definitions, scope and methodology

What counts here as administration and overhead

There is no cross-sectoral official Swedish national-budget definition of administration or overhead that can be applied in the same way to culture, sport and healthcare. In the budget bill, the Government distinguishes, among other things, between transfers, operating expenditure and investments. Operating expenditure is not synonymous with administration: a museum employee’s exhibition work, an inspector’s supervision or an agency’s expert analysis may all be included among operating expenditure.

What counts as culture, sport and healthcare

In 2024, culture is limited to the cultural-policy components of expenditure area 17. Sport is defined as appropriation 13:1 Support for sport. Healthcare is reported at two levels: health and medical care policy, and the whole of expenditure area 9, which also covers public health, disability policy, social services, children’s rights policy and research.

Primary care and hospital care are not included at their full production cost, since the bulk of this lies in the regions’ finances. Elderly care is not included as a full municipal cost. It is therefore more precise to call the tables government budget funding rather than the full public cost of Swedish healthcare and social care.

Sweden: government expenditure and trends

The series shows why 2020–2022 must be treated with caution: both healthcare and culture were affected by major temporary government pandemic measures. A fall from 2021 to 2024 therefore does not in itself mean that normal activity declined by a corresponding amount.

Sector-specific picture for 2024

Among the larger healthcare items in 2024 were pharmaceutical benefits of approximately SEK 37.2 billion, grants for public health and healthcare of around SEK 17.7 billion, dental benefits of around SEK 7.6 billion and initiatives linked to healthcare waiting lists of around SEK 5.0 billion. Within social services, attendance allowance amounted to approximately SEK 25.3 billion and stimulus grants for the elderly-care area to around SEK 9.0 billion.

The national budget’s own economic breakdown

These percentages are useful as a check, but 8.73 and 27.44 per cent are not administrative shares. In expenditure area 17, part of the Government’s own activity consists of cultural production itself; in expenditure area 9, of supervision, preparedness and knowledge governance.

Tax expenditures are a separate scoping issue. Reduced VAT for recreation and sport is estimated at approximately SEK 6.71 billion, for cultural performances at around SEK 2.59 billion and for books at around SEK 1.92 billion. They are not appropriation expenditure and have therefore not been added to the totals.

Administration versus direct activity

Culture

This is probably an underestimate of actual overhead. The National Archives, government museums and performing-arts institutions have their own management, finance, HR, IT and premises functions that cannot be separated from substantive activity in the appropriation table. At the same time, it would overstate administrative waste to label the entire costs of the Swedish Arts Council and the Swedish Agency for Cultural Policy Analysis as overhead.

Sport

Stating that administration accounts for zero per cent and direct activity for 100 per cent would be methodologically wrong. From the Government’s perspective, the appropriation is a transfer, but it may subsequently finance both club activity and federation functions. A robust calculation requires the accounts of the Swedish Sports Confederation and the national sports federations.

Health and medical care

This figure should be interpreted even more cautiously than culture’s 1.03 per cent. The Health and Social Care Inspectorate’s supervision, the Swedish Agency for Health Technology Assessment and Assessment of Social Services’ health technology assessments, the Dental and Pharmaceutical Benefits Agency’s pricing and reimbursement work, the Medical Products Agency’s regulatory work and the National Board of Health and Welfare’s standard-setting are substantive functions within the healthcare system itself. At the same time, the regions’ local administration is entirely absent from these appropriations.

Social care and the whole of expenditure area 9

2.61 per cent should not be used as the main measure of administration in Swedish healthcare and social care. It measures certain identifiable central government system functions within a very broad expenditure area.

International comparison and harmonisation

Two problems must be kept separate in an international comparison. The first is the level of funding: a Swedish central-government expenditure item, a Norwegian municipal cultural expenditure item, a Danish regional healthcare cost and a German social-insurance expenditure item may fund the same kind of service while appearing under different institutions. The second is the definition of administration.

Eurostat’s COFOG system can harmonise public expenditure by function and is suitable for culture and sport, but it does not normally report internal overhead separately. For health, the System of Health Accounts 2011 classifies governance and system and financing administration as a separate health function, making international comparisons possible in principle.

Missing data must never be replaced with zero. Where no harmonised administration item exists, the cell should be marked as unavailable rather than filled with an estimate.

Uncertainties and data gaps

• Government expenditure is not the same as total public cost. Regions and municipalities are responsible for the actual running of large parts of healthcare and social services.
• Appropriations are not cost centres. A grant appropriation may finance administration by the recipient; an agency appropriation may finance direct substantive activity.
• Culture’s 1.03 per cent is a lower bound, not a comprehensive overhead figure.
• Healthcare’s 3.11 per cent is a system-cost proxy that includes core functions while excluding local administration by healthcare providers.
• Sport’s administrative share cannot be calculated credibly from the national budget.
• The pandemic years 2020–2022 are structural outliers and should not be used as normal years.

Recommended cost model

It is particularly important to keep system governance and regulation separate from corporate administration. Otherwise, the misleading implication arises that the Health and Social Care Inspectorate’s supervision or the Swedish Agency for Health Technology Assessment and Assessment of Social Services’ evidence work is the same type of cost as accounting and HR. Two ratios should therefore be reported in parallel: corporate overhead and total system cost.

Conclusions

The most robust way to communicate these figures is not to say that only 1 per cent of culture and 3 per cent of healthcare goes on administration. The correct formulation is that around 1 per cent of the defined cultural funding and around 3 per cent of government health and medical care funding can be identified as a narrow set of central governance, analysis, supervision and administrative functions. The actual total overhead of all providers is higher, but cannot be determined from the national budget alone.

Sources

• Government of Sweden, expenditure area 9 Healthcare, medical care and social care (prop. 2025/26:1)
• Government of Sweden, expenditure area 17 Culture, media, religious communities and leisure (prop. 2025/26:1)
• Government of Sweden, Budget Bill for 2026 (prop. 2025/26:1)
• Government of Sweden, budget bills by financial year
• Swedish Sports Confederation, about the Swedish Sports Confederation and government support
• Eurostat, Government expenditure by function (COFOG)
• WHO, A System of Health Accounts 2011
• OECD, Health spending