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User choice and the changing notion of social citizenship in Swedish eldercare
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.ORCID iD: 0000-0001-5522-5344
(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 [en]
Social citizenship, User choice, Eldercare, Sweden, Social rights
National Category
Political Science Public Administration Studies
Identifiers
URN: urn:nbn:se:uu:diva-319248OAI: oai:DiVA.org:uu-319248DiVA: diva2:1086377
Available from: 2017-04-02 Created: 2017-04-02 Last updated: 2017-04-05
In thesis
1. Marketization in Swedish Eldercare: Implications for Users, Professionals, and the State
Open this publication in new window or tab >>Marketization in Swedish Eldercare: Implications for Users, Professionals, and the State
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
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:nbn:se:uu:diva-319504 (URN)978-91-554-9886-3 (ISBN)
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

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Citation style
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