This paper is concerned with policy making in the Swedish health service. The paper begins with a description of the organisation of the Swedish health service and a brief summary of the main issues of debate within the service. This is followed by an examination of the role of the county councils, the pattern of political control in the county councils, and the role of county councils in policy making. Attention then turns to an analysis of the dynamics of the policy making process. This draws on both published sources and material gathered during interviews carried out in 1986. The final part of the paper examines the major themes or issues likely to face the county councils over the next decade.