In recent decades, the Swedish welfare system has come to involve more privateactors. Swedish law, however, is still clear that health and social care should be characterizedby good quality regardless of its mode of operation. A central concern hasbeen how to politically ensure quality as welfare providers become more numerousand of different types. To what extent are politicians still able to monitor qualitywithin private health- and social care? The article reviews several quality assurancemechanisms that are built into the privatization reforms: how contracts are specifiedand monitored and how patients use their choices to send signals about carequality. A review of the literature illustrates the difficulty for politicians to formulategood contracts and follow them up. Also, patients’ choices are not a reliablesource of information about care quality since they rarely make informed choices.Not being able to monitor quality in a proper way risks creating a legitimacy gapfor the entire welfare system.