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Mångfaldens marknad och arbetets villkor: Om följder av kundval (LOV) i hemtjänsten
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Economic History.
2013 (Swedish)Book (Other academic)
Abstract [en]

Over the past few decades, the welfare sector in Sweden has been increasingly exposed to competition. Even though this transformation has caused intense debate, the effects of this change in working life have been less discussed. The aim of this study is to investigate how the system of customer choice (“LOV”) in home-based elderly care affects the workers’ employment and working conditions. The study draws mainly upon experiences from three municipalities in Central Sweden: Uppsala, Linköping and Örebro. The source material is primarily in-depth interviews with employees, trade union representatives, employers and local government officials. The study has an intersectional approach, and the analysis also relates to the scholarly debate on quasi markets, rationality, flexibility and precarious employment. 

The results show, among other things, that the customer choice model, including the reimbursement system in use to pay the providers, implies structural risks for temporary employment, reduced manning and stress. Since the system does not include price competition, the providers tend to compete by reducing labour costs. The system also presupposes rigorous planning and increased (often digitalised) control of the individual worker. Moreover, the providers tend to maximise the time the workers are in direct contact with the customers, since this is the only time they can invoice. This means that the workers have less time for transports between the house calls, as well as less time for work meetings, occupational health and safety training and so on. The customer-focused rhetoric in this system helps to legitimize this practice.  

Another finding is that many small companies operating within this quasi-market lack collective agreements. The workers can sometimes be subjected to severe abuse, for example through cash-in-hand payment and work in the grey area between regular employment and self-employment. In many cases, the employers use workers who are participating in public labour market programs as cheap labour. Since many companies use foreign languages, ethnicity and culture for competitive advantage, workers with an immigrant background are most at risk of being abused. Even though the municipalities have the main responsibility for the elderly care, they strictly maintain that issues on employment relations and working conditions should be handled by the social partners alone. A conclusion is that trade unions, employers and the local governments need to establish a tripartite cooperation in order to combat unfair competition, labour abuse and the undercutting of wages and labour standards.

Place, publisher, year, edition, pages
Lund: Work, Technology and Social Change (WTS), Lunds Universitet , 2013. , 98 p.
, Arbetsliv i Omvandling, ISSN 1404-8426 ; 2
Keyword [en]
Welfare sector, Sweden, New Public Management, home based elderly care, customer choice, quasi markets, precarious employment
National Category
Social Sciences Health Care Service and Management, Health Policy and Services and Health Economy
URN: urn:nbn:se:uu:diva-208253ISBN: 9789187521010OAI: diva2:651556
Available from: 2013-09-26 Created: 2013-09-26 Last updated: 2016-01-21Bibliographically approved

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