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Marketization in Swedish Eldercare: Implications for Users, Professionals, and the State
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.ORCID iD: 0000-0001-5522-5344
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

During the last decades, Swedish policy makers have implemented various marketization reforms into the public welfare sector in order to make it more cost-efficient and to improve its quality. The aim of this dissertation is to investigate what implications this marketization trend has had for the organization of Swedish eldercare. In particular, the research question addressed is how marketization reforms such as privatized provision, increased competition, and user choice have transformed the relationship between the service users, the professionals, and the state. To answer the research question, four articles are presented in the dissertation, each corresponding to a separate empirical investigation. Together, the articles demonstrate that the increased reliance on marketization in Swedish eldercare has made it more difficult for the local authorities to directly control the quality of the services, since it reduces their ability to allocate public resources and expects them to govern the provision of eldercare through the entering of contracts. This development has also implied that service users themselves become increasingly responsible for ensuring that the quality of their care is high. Moreover, the articles show that the increased reliance on audit by the national government and its agencies has tended to undermine the professionalization of eldercare staff, thereby limiting their autonomy and ability to ensure service quality. As a whole, the dissertation contributes with a more comprehensive understanding of how marketization has altered the organization of Swedish eldercare and under what conditions it might undermine the goals of social equality and ensuring that all citizens have equal access to good quality care.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. , 48 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 142
Keyword [en]
Marketization, Eldercare, Universalism, Social care, Privatized provision, User choice, Competition, Swedish welfare state
National Category
Political Science Public Administration Studies
Research subject
Political Science
Identifiers
URN: urn:nbn:se:uu:diva-319504ISBN: 978-91-554-9886-3 (print)OAI: oai:DiVA.org:uu-319504DiVA: diva2:1087105
Public defence
2017-06-02, Brusewitzsalen, Statsvetenskapliga institutionen, Gamla Torget 6, Uppsala, 10:15 (Swedish)
Opponent
Supervisors
Available from: 2017-05-10 Created: 2017-04-05 Last updated: 2017-05-29
List of papers
1. User choice in Swedish eldercare: conditions for informed choice and enhanced service quality
Open this publication in new window or tab >>User choice in Swedish eldercare: conditions for informed choice and enhanced service quality
2016 (English)In: Journal of European Social Policy, ISSN 0958-9287, E-ISSN 1461-7269, Vol. 26, no 3, 281-295 p.Article in journal (Refereed) Epub ahead of print
Abstract [en]

Proponents of user choice argue that this type of policy arrangement improves the quality of public social services since users are expected to select the most highly performing providers. In order for users to make informed choices, however, they need quality information about the services offered by different providers. In this article, we carry out a case study, investigating whether information about service quality was presented to users of home-based elderly care in Sweden. The analysis is based on unique data regarding the information of 223 providers in 10 municipalities. The results suggest that the information was poor and lacking in important quality dimensions. This indicates a lack of real user power since it is virtually impossible for users to make informed choices without relevant information. It also makes it less likely that the general quality level of home-based services will increase as a result of the user choice.

Keyword
Elderly care, informed choice, quality information, service quality, user choice
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Political Science
Identifiers
urn:nbn:se:uu:diva-299847 (URN)10.1177/0958928716645076 (DOI)000378792600006 ()
Funder
Swedish Research Council
Available from: 2016-07-29 Created: 2016-07-28 Last updated: 2017-04-05
2. Marketisation of Nordic Eldercare – Is the Model Still Universal?
Open this publication in new window or tab >>Marketisation of Nordic Eldercare – Is the Model Still Universal?
2017 (English)In: Journal of Social Policy, ISSN 0047-2794, E-ISSN 1469-7823, Vol. 46, no 3, 603-621 p.Article in journal (Refereed) Published
Abstract [en]

The objective of this article is to analyse whether the increased reliance on marketisation in the provision of social care challenges the universality of eldercare in Sweden, Denmark, Finland and Norway. The study focuses on national reforms for contracting out and user choice of provider, analysing their consequences for four universalistic dimensions: (i) equal inclusion, (ii) public funding, (iii) public provision and (iv) comprehensive usage. The findings suggest that, although need-based inclusion and public funding remain key principles in all four countries, there is an increased reliance on private provision in Sweden, Denmark and Finland. In addition, the introduction of topping-up services challenges the dimension of comprehensive usage by enabling users with economic resources to turn to the private market to increase the comprehensiveness and quality of their care.

Keyword
Universalism, Marketization, Welfare state, Nordic countries, Social Policy, Eldercare
National Category
Political Science
Research subject
Political Science
Identifiers
urn:nbn:se:uu:diva-317314 (URN)10.1017/S0047279416000830 (DOI)000402805800010 ()
Funder
Swedish Research Council
Available from: 2017-03-14 Created: 2017-03-14 Last updated: 2017-08-18Bibliographically approved
3. Professionalized through audit?: Care workers and the new audit regime in Sweden
Open this publication in new window or tab >>Professionalized through audit?: Care workers and the new audit regime in Sweden
(English)In: Social Policy & Administration, ISSN 0144-5596, E-ISSN 1467-9515Article in journal (Other academic) Submitted
Abstract [en]

The objective of this article is to analyze whether the audit processes adopted in Swedish eldercare and childcare support or undermine the professionalization of the occupations working there, that is, nurses, nursing assistants, pre-school teachers and child minders. In particular we investigate whether the three main forms of audit; standard-setting, inspections and quality measurements, support or undermine the occupations’ ability to achieve professional closure and enhance their external and internal autonomy. The paper finds that the audit process adapted in eldercare is non-supportive of the professionalization of both nurses and nursing assistants. In childcare, however, it appears to support professional development, particularly for pre-school teachers. These findings suggest that audit processes do not have to be detrimental to professionalization. Instead, it appears that the state can design them in such a way that they make visible and close the work tasks of specific staff groups and thereby support, rather than undermine, their professional development

Keyword
Professionalization, Audit, Social care, Eldercare, Child care
National Category
Social Sciences Public Administration Studies
Identifiers
urn:nbn:se:uu:diva-319246 (URN)
Available from: 2017-04-02 Created: 2017-04-02 Last updated: 2017-04-05
4. User choice and the changing notion of social citizenship in Swedish eldercare
Open this publication in new window or tab >>User choice and the changing notion of social citizenship in Swedish eldercare
(English)Manuscript (preprint) (Other academic)
Abstract [en]

This article aims to analyze how the policy makers who crafted the Swedish choice reform in eldercare reasoned with regard to the tension between user choice and citizens’ right to quality care. To answer this question, three dimensions are addressed in the paper: (i) what role did the choice reform assign to the users and how did the policy makers view their ability to make informed choices? (ii) How did the policy makers view the role of the public authorities and what tools were they given to ensure citizens’ equal access to good quality eldercare? (iii) Did the policies entail a new form of social citizenship for the elderly? The findings suggest that while Swedish policy makers introduced a system where eldercare users were encouraged to make free choices between providers, thereby allocating resources among these, the users also became more responsible to ensure service quality through their choices. In addition, the choice reform altered the regulatory role of local authorities who no longer had full control over the resource distribution and also become more restricted in their regulatory abilities. Furthermore, the paper argues that the Swedish choice reform entails a more libertarian notion of social citizenship, implying that users are to take on greater responsibility for their own well-being and protection against social risks.

Keyword
Social citizenship, User choice, Eldercare, Sweden, Social rights
National Category
Political Science Public Administration Studies
Identifiers
urn:nbn:se:uu:diva-319248 (URN)
Available from: 2017-04-02 Created: 2017-04-02 Last updated: 2017-04-05

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