Swedish politicians’ preferences regarding the privatisation of elderly care (original) (raw)
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Privatising The Swedish Welfare State
Economic Affairs, 2014
The introduction of private competition and choice in the Swedish welfare sector has attracted widespread attention in recent years. This paper sets out the factors that helped make this development possible, and explains why the influence of the organisational theory of New Public Management (NPM) has ensured that while market economy elements have increased in welfare services, the scope of the state and the public sector has continued to grow. The result is the emergence of welfare quasi-markets, which are increasingly subject to input-related regulation and control.
The Choice Revolution: Privatization of Swedish Welfare Services in the 1990s
Social Policy and Administration, 2004
During the s, the Swedish welfare state was declared by some to be in a "crisis", due to both financial strain and loss of political support. Others have argued that the spending cuts and reforms undertaken during this period did slow down the previous increase in social spending, but left the system basically intact. The main argument put forward in this article is that the Swedish welfare state has been and is still undergoing a transforming process whereby it risks losing one of its main characteristics, namely the belief in and institutional support for social egalitarianism. During the s, the public welfare service sector opened up to competing private actors. As a result, the share of private provision grew, both within the health-care and primary education systems as well as within social service provision. This resulted in a socially segregating dynamic, prompted by the introduction of "consumer choice". As will be shown in the article, the gradual privatization and market-orientation of the welfare services undermine previous Swedish notions of a "people's home", where uniform, high-quality services are provided by the state to all citizens, regardless of income, social background or cultural orientation.
Traits of a representative welfare state: the Swedish example
International Journal of Social Welfare, 2010
The care manager reform and the case manager reform are new reforms in the social care services in Sweden, which are evolving during the 2000s. Together they shape the social care services introducing a new way of decision-making where representatives for the organisation (care manager) and the users (case manager) negotiate. The reforms have been analysed in two studies with results presented in this article. Using the concepts of role, orientation, function and assignments, it is argued that the managers come to the negotiations on rights from different positions that are both conflicting and complementary. They further mediate the development towards a welfare mix, where the market, social networks and users interact to obtain the public welfare provision. Through this negotiated rights model, it is argued that traits of a representative welfare state emerge, with the distinction of moving the focus to the administrative practices and their differences away from political ideologies.
2008
Sažetak Despite challenges and doomsday predictions, the Nordic welfare states with high taxes and public expenditure are still with us. This paper describes strategic choices for policy makers of the welfare state and uses the case of Sweden to argue that the high tax welfare state has survived several challenges through a process of incremental change, where the welfare state is modified in order to maintain political support from voters who would otherwise favor cutbacks.
The Political Construction of Elder Care Markets: Comparing Denmark, Finland and Italy
Social Policy & Administration, 2016
In Europe over the last two decades, marketization has become an important policy option in elderly care. Comparative studies predominantly adopt an institutional perspective and analyse the politics and policies of marketization. This analysis takes a step back and examines the fundamental ideas underpinning the policies of marketization, using the 'What's the problem' approach by Carol Bacchi. The central question is how the market was discursively framed as the solution to the perceived problems of three different systems of elderly care, and how such processes are similar or different across the three countries. The analysis includes two extreme types of elderly care systems, the Nordic public systems in Denmark and Finland and the Southern European family based model in Italy. Empirically, the analysis offers interesting insights into processes of constructing and legitimating markets at the level of discourse; this occurs by defining specific problem representations, underlying assumptions and silences. In all three countries, marketization is presented as a solution which builds on rather than challenges dominant ideas of care. Conceptually, in addition to its institutions, it is crucial to understand the ideas behind the marketization of elderly care. Ideas emerge as a key leverage for making policies and practices of marketization acceptable and which decision makers and other influential political/societal actors use in policy and public debates. The importance of ideas is further underlined by the fact they do not necessarily relate to the institutions of elderly care systems in a linear way.
2013
The privatization of elderly care system occurred in response to an economical crisis as well as political decisions made in the early 1990's. Since the economic crisis was supposed to have a negative impact on quality of elderly care services, the government adopted different policies such as New Public Management strategies, the introduction of a unit price for all care services, and the law implementing-Freedom of Choice‖ to increase the quality of these elderly care services. In this study, I am going to explain how these policies have been effected on quality of both public and private home care services, as well as compare the organizational and technical differences between public and private home care companies in providing elderly care services. For this purpose, I compared the care provision of three public home care companies with six of private ones in Stockholm, to see how they are different in terms of the quality of their services. Based on my findings, the quality of home care services is higher in private home care companies than in the public ones. One of the reasons for this is the more efficient usage of New Public Management strategies in the private sector. Another factor is the lower hierarchical level in provision of care private sector-this accelerates solving the problems and provision of elderly care services in private home care companies. However the public sector doesn't have the two given advantages of private sector, still there is not a huge quality difference between public and private sector in provision of home care services.
Experiences with the privatization of home care: evidence from Denmark
Nordic Journal of Social Research, 2011
Processes of privatization in home care for the elderly in Denmark have primarily taken the form of outsourcing public-care provisions. The content and quality of services have in principle remained the same, but the providers of services have changed. The welfare state has continued to bear the major responsibility for the provision of elderly care, while outsourcing has allowed clients to choose between public and private providers of care. The major aim of outsourcing has been to empower the frail elderly by providing them with exit-opportunities through a construction of this group as consumers of welfare-state provisions. The central government in Denmark has produced the public-service reform, but the municipalities bear the administrative and financial responsibility for care for the elderly. Further, national policymakers have decided that local authorities (municipalities) must provide to individuals requiring care the opportunities to choose. With this background in mind, this article analyses how national, top-down ideas and the 'politics of choice' have created tensions locally in the form of municipal resistance and blockages. The article draws on case studies in two Danish municipalities, whereby central politicians and administrative leaders have been interviewed. We have identified four areas of tensions: 1) those between liberal and libertarian ideas and values versus local political orientations and practices; 2) new tensions and lines of demarcation among political actors, where old political conflicts no longer holds; 3) tensions between promises and actual delivery, due to insufficient control of private contractors; and 4) those between market principles and the professional ethics of care providers.