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This thesis explores the ongoing reorientation of the Swedish health system toward Good Quality and Local Health Care (GQLHC), with a particular focus on rural northern Sweden. While the reform aspires to strengthen accessibility, continuity, and person-centredness in primary healthcare, its translation into rural contexts presents challenges.

The thesis builds on two complementary studies. The first applies a critical discourse analysis of four Government Official Reports (SOU) to investigate how the "problem" of Swedish healthcare is represented in national policy. Using Bacchi's What's the Problem Represented to Be? (WPR) approach, the analysis identifies three dominant problem framings: (i) narrow servicemissions, (ii) siloed governance structures, and (iii) fragmented care delivery, while highlighting important silences regarding health promotion, equitable access, and sustainable rural workforce planning. The findings suggest that normative policy language may reproduce limited understandings of what constitutes quality and locality in rural care delivery.

The second study presents a qualitative case study from southern Lapland, one of Sweden's most sparsely populated regions. It explores how local primary care actors experience and adapts to national reform directives in everyday practice. Drawing on interviews and observations, the study shows how rural actors adapt national policy ambitions to local realities, often through collaborative practices, trust-based management, and innovative models. However, these adaptations frequently occur despite, rather than because of, formal policy support, underscoring a misalignment between national reform agendas and rural practice environments. At the same time, limited digital infrastructure and workforce shortages constrain the realisation of reform ambitions, exposing a persistent misalignment between policy intent and policy translation.

Taken together, the studies demonstrate the persistent tension between policy vision and local practice. By applying the rural proofing policy approach, the thesis argues for a more systematic integration of rural perspectives in national health policymaking. Such an approach could help bridge the gap between policy vision and practical realities, ensuring that reforms like GQLHC genuinely deliver on their promise of equitable, high-quality, and continuous care across Sweden's diverse territories.