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Paradoxernas marknad: En studie om företagande i hemtjänsten
Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies.
2015 (Swedish)Doctoral thesis, monograph (Other academic)Alternative title
Paradoxes of the Market : A Study of Private Enterprise in the Home Care Sector (English)
Abstract [en]

The aim of this study is to understand how individuals who run a private business in the publicly financed elderly care sector experience their conditions and opportunities as owners and managers of a business in a quasi-market.  The focus is on what happens when the home care service actor’s intentions and conceptions about how home care should be provided encounter the public realm of financing and regulation.

The research was conducted as a qualitative interview study of individuals who had started and were running a small or medium-sized business in home care for the elderly. Theories of rationality as well as of actor’s embeddedness in social networks and institutions were used as tools of interpretation and analysis. I also draw on theories of trust and institutionalized distrust as mechanisms for reducing complexity in social systems.

The results demonstrate that the reasons for starting a business were multifaceted and thus cannot be understood in terms of dichotomies such as egotism or altruism. Increasing the professional scope of action and the power to make decisions was a central incentive for providers with professional training and experience of previous employment in large health and social care organizations. However, realizing the intentions proved difficult because of the restrictions typically associated with quasi-markets in the elderly care sector. The restrictions involve, for example, relations to the municipal home care service assessor and the elderly client as two different customer categories, the relation between the time allotted for care provision and the remuneration from the municipal authorities, and the tension between trust and distrust in the business relations between care providers and the representatives of the municipal organizations.  

Still, the results also show that managing a business in home care can be a positive and rewarding experience.

Abstract [sv]

Syftet med denna avhandling är att undersöka hur hemtjänstföretagare beskriver sina villkor och verksamheter som företagare på en kvasi-marknad. Bakgrunden är de senaste årens försök att skapa kundvalsmarknader som ger medborgare rätt att välja mellan offentliga och privata utförare av offentligt finansierad vård och omsorg. Ett politiskt argument för denna utveckling har varit att konkurrensutsättning och ökade inslag av företagande kan bidra till såväl förnyelse i tjänsteutbudet som ökad valfrihet och stärkt inflytande för enskilda medborgare. Ett motargument har varit risken för att privata aktörer drivs av vinstintresse på bekostnad av kvalitet.

Studien visar att hemtjänstföretagande utmärks av ett antal motstridiga och svårförenliga drag, eller paradoxer, som kan härledas till grundläggande institutionella och ekonomiska förutsättningar. Biståndsbeslut som på förhand preciserar vilka insatser som skall genomföras kringskär företagares handlingsutrymme. Otillräckliga tidsbedömningar i biståndsbeslut och låga ersättningsnivåer beskrivs som ett hinder för långsiktig kvalitet inom hemtjänsten. Ett centralt resultat i studien handlar om problematik kring tillitsbrist, framförallt i relationer mellan företagare och representanter för kommunala förvaltningar.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2015. , 336 p.
Series
Karlstad University Studies, ISSN 1403-8099 ; 2015:38
Keyword [en]
home care service, elderly care, private enterprise, quasi-markets, paradoxes
Keyword [sv]
hemtjänst, äldreomsorg, företagande, kvasi-marknader, paradoxer
National Category
Sociology
Research subject
Sociology
Identifiers
URN: urn:nbn:se:kau:diva-37234ISBN: 978-91-7063-656-1 (print)OAI: oai:DiVA.org:kau-37234DiVA: diva2:844027
Public defence
2015-09-25, Andersalen, 11D 121, Karlstads Universitet, Karlstad, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-09-01 Created: 2015-08-03 Last updated: 2015-09-01Bibliographically approved

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