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User choice in Swedish eldercare: conditions for informed choice and enhanced service quality
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.ORCID iD: 0000-0001-5522-5344
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
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
Resource type
Text
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.

Place, publisher, year, edition, pages
2016. Vol. 26, no 3, 281-295 p.
Keyword [en]
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: urn:nbn:se:uu:diva-299847DOI: 10.1177/0958928716645076ISI: 000378792600006OAI: oai:DiVA.org:uu-299847DiVA: diva2:950277
Funder
Swedish Research Council
Available from: 2016-07-29 Created: 2016-07-28 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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