Even hospitals are now being outsourced to the private sector in Sweden. We talk to Yonna Olsson, chief executive of Proxima, the Capman-backed healthcare provider about her contract wins and Proxima's growth.

HCE: I hadn't realised that even small hospitals in Sweden were being outsourced. How come and what do the contracts look like?

YO: We have been running a hospital in Stockholm for almost 10 years. Last week we took over another hospital in the middle part of Sweden. The contract is for 5 years (possible extension for + 2 + 2). Essentially, it was surplus to requirements but the politicians didnt want to close it. You could say that the private sector was the less of two evils.

HCE: So what are you doing in them?

YO: Elective surgery - orthopaedic and gynae plus general surgery. The county councils have given us a certain minimum level of patients which gives us 50% of the business and the rest we have to find by referrals. Obviously we are going to try to make them as effective as possible.

HCE: I guess it adds up to a lot of business.

YO: Yes, the latest hospital will add almost SEK 200m a year to our sales which should rise from around SEK 300m in 2009 with 450 staff to SEK 530m in 2010. That is from a mix of oputsourced primary care, two diagnostics centres and the two hospitals.

HCE: And I hear that St Goran, Capio's flagship emergency hospital in Stockholm, the largest private hospital in the country, is about to come up for renewal with Lundby hospital following next year. How big do you see the outsourced hospital sector becoming?

YO: Well there are a lot of smaller and mid sized hospitals which the counties plan to outsource, but I would guess that in practice it will only be 1 or 2 a year.

HCE: What gets me is that Stockholm has gone through this huge process of outsourcing nearly half its primary care to the private sector and yet nothing seems to be being measured. How will they know whether it has worked?

YO: Yes you are right, The primary measurement really is accessibility or waiting lists. Can you make telphone contact with a doctor in 24 hours and can you get an appointment within 7 days? That is what we are geared up to.

Underneath that there is a system of capitation and flexible payments for treatment. Essentially, we only get paid if patients visit their doctor 1.9 times or less per year. If the rate goes above that we don't get paid for the visit. The secret then is to add lots of new patients and to ensure that you see them maybe 1.8 times a year on average. It is about increasing the number of patients that a family doctor sees from 8-9 a day, to 15 where you can make a small profit. You need to see 12 patients a day to break-even. In some cases, doctor are seeing 25 patients a day. But, to do that, you have to shorten the consulting period to 15-20 minutes and Swedes aren't used to that - they are used to saving up their problems and then visiting the doctor with 4-5 issues! We have to show them that they can come more regularly and have shorter visits.

HCE: Man! Twenty minutes - in the UK when I see a GP I am lucky to getten! Is there any going back from this privatisation process?

YOP: No, the train has left the station, All political parties are in favour of patient choice. The rate of change will vary depending on who wins the 2010 election, but the train is in motion.