‘The customer in focus!’ The municipal home-care provider's presentation of activities in marketized eldercare

Authors

DOI:

https://doi.org/10.7577/nat.4779

Keywords:

Valfrihetssystem, Marknadisering, Hemtjänst, Äldreomsorg, Offentlig utförare, Kommuner, New Public Management

Abstract

Just over half of Sweden’s municipalities have introduced freedom of choice for users of home-care services, based on the Swedish Act on System of Choice in the Public Sector (LOV). The system of choice results in a ‘welfare mix’ in the municipalities, where public and private providers compete. This article investigates how the public provider of home-care services presents its activities in the context of LOV and marketization. Are approaches to ‘convergence’ or ‘divergence’ applied in relation to the idea of the private company? Convergence means that the public provider attempts to imitate the private company in the presentation of its activities, whereas ‘divergence’ refers to the public provider’s efforts to highlight the differences. The empirical study comprises directed content analysis and includes the 106 municipalities with LOV that have presented the public home-care provider on the municipality’s website. The study concludes that the dominant approach represents divergence, supplemented with several elements of convergence. The public provider’s presentations emphasize, for example, municipal ownership and the municipality’s long-term experience providing home-care services. At the same time, there are company-inspired elements, such as the use of the term ‘customer’. The results of the study are situated in a discussion of how public providers develop in the context of marketization. The situation that public providers uncritically ‘import’ courses of action from private companies may challenge central values in public administration, such as transparency, objectivity, universalism, and adherence to the democratic chain of delegation.

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Author Biographies

David Feltenius, Umeå universitet

David Feltenius är docent och universitetslektor vid Statsvetenskapliga institutionen, Umeå universitet, SE-901 87 Umeå.

Jessika Wide, Umeå universitet

Jessika Wide är filosofie doktor och universitetslektor vid Statsvetenskapliga institutionen, Umeå universitet, SE-901 87 Umeå.

References

Alford, J. & O’Flynn, J. L. (2009). Making Sense of Public Value: Concepts, Critiques and Emergent Meanings. International Journal of Public Administration, 32, 171-191. https://doi.org/10.1080/01900690902732731 https://doi.org/10.1080/01900690902732731

Andersson, C., Qvist, M. & Sundström, G. (2021). En särskild typ av megaprojekt. Grafström, M., Qvist, M. & Sundström, G. (red.). Megaprojektet Nya Karolinska Solna: beslutsprocesserna bakom en sjukvårdsreform. Göteborg: Makadam förlag. https://www.statsvet.su.se/polopoly_fs/1.543348.1614350359!/menu/standard/file/Megaprojektet_NKS.pdf

Anttonen, A. & Häikiö, L. (2011). Care ‘going market’: Finnish elderly-care policies in transition. Nordic Journal of Social Research, 2. https://doi.org/10.7577/njsr.2050 https://doi.org/10.15845/njsr.v2i0.111

Anttonen, A. & Karsio, O. (2017). How marketisation is changing the Nordic model of care for older people. Martinelli, F., Anttonen, A. & Matzke, M. (red). Social services disrupted. Changes, challenges and policy implications for Europe in times of austerity. Cheltenham: Edward Elgar, 219-238. https://doi.org/10.4337/9781786432117.00020 https://doi.org/10.4337/9781786432117.00020

Ascoli, U. & Ranci, C. (2002). Dilemmas of the welfare mix. The new structure of welfare in an era of privatization. New York: Kluwer Academic. https://doi.org/10.1007/978-1-4757-4992-2 https://doi.org/10.1007/978-1-4757-4992-2

Blix, M. & Jordahl, H. (2021). Privatizing Welfare Services: Lessons from the Swedish Experiment. Oxford: Oxford University Press. https://doi.org/10.1093/oso/9780198867210.001.0001 https://doi.org/10.1093/oso/9780198867210.001.0001

Blomqvist, P. & Winblad, U. (2019). Why No Nonprofits? State, Market, and the Strive for Universalism in Swedish Elder Care. Nonprofit and Voluntary Sector Quarterly, 48(3), 513-531. https://doi.org/10.1177/0899764018819870 https://doi.org/10.1177/0899764018819870

Blomqvist, P. (2016). NPM i välfärdsstaten: hotas universalismen? Statsvetenskaplig tidskrift, 118(1), 39-67. https://journals.lub.lu.se/st/article/view/15955/14447

Bode, I. (2006). Disorganized welfare mixes: voluntary agencies and new governance regimes in Western Europe. Journal of European Social Policy, 16(4), 346-359. https://doi.org/10.1177/0958928706068273 https://doi.org/10.1177/0958928706068273

Brandt, M. (2021). Styrning av social- och hälsovårdstjänster under marknadsliknande förhållanden. Myndigheters syn på valfrihetens inverkan i Finland och Sverige. Nordisk Administrativt Tidsskrift, 98(2). https://doi.org/10.7577/nat.4588 https://doi.org/10.7577/nat.4588

Brunsson, N. (2011). Politisering och företagisering – institutionell förankring och förvirring i organisationernas värld. Lind, R. & Ivarsson Westerberg, A. (red.). Ledning av företag och förvaltningar – former, förutsättningar, förändring. Stockholm: SNS förlag, 231-255.

Dahl, R. A. & Lindblom, C. E. (1953). Politics economics and welfare. Planning and politico-economic systems resolved into basic social processes. New York: Harper & Brothers.

Dunér, A. (2020). Biståndshandläggning inom äldreomsorgen – villkor och dilemman. Studentlitteratur: Lund.

Dunér, A., Bjälkebring, P. & Johansson, B. (2019). Autonomy, Choice and Control for Older Users of Home Care Services: Current Developments in Swedish Eldercare. Journal of Social Service Research, 45(1), 129-141. https://doi.org/10.1080/01488376.2018.1479677 https://doi.org/10.1080/01488376.2018.1479677

Ehn, P. & Sundström, G. (2020). Förvaltningspolitik i förändring. Ehn, P. & Sundström, G. (red.). Statlig förvaltningspolitik för 2020-talet: en forskningsantologi. Stockholm: Statskontoret. https://www.statskontoret.se/siteassets/rapporter-pdf/2020/oos38.pdf

Erlandsson, S., Brodin, H., Graff, L. & Karsio, O. (2022). Choice models in nordic long-term care: care managers’ experiences of privilege and disadvantage among older adults. European Journal of Ageing. Published: 06 May 2022. https://doi.org/10.1007/s10433-022-00697-z https://doi.org/10.1007/s10433-022-00697-z

Feltenius, D. (2017). Towards a more diversified supply of welfare services? Marketisation and the local governing of nursing homes in the Scandinavian countries. Sivesind, K. H. & Saglie, J. Promoting Active Citizenship Markets and Choice in Scandinavian Welfare. London: Springer, 117-156. http://dx.doi.org/10.1007/978-3-319-55381-8 https://doi.org/10.1007/978-3-319-55381-8_4

Feltenius, D. & Wide, J. (2019). Business as usual? Civil society organizations in a marketized Swedish welfare state. Journal of Civil Society, 15(3), 230-248. https://doi.org/10.1080/17448689.2019.1623452 https://doi.org/10.1080/17448689.2019.1623452

Feltenius, D. & Wide, J. (2021). Conservation or disappearance? The public provider of home care services in a system of choice. Public Management Review. Published online: 08 Jun 2021. https://doi.org/10.1080/14719037.2021.1937685 https://doi.org/10.1080/14719037.2021.1937685

Fersch, B. & Jensen, P. H. (2011). Experiences with the privatization of home care. Evidence from Denmark. Nordic Journal of Social Research, 2. https://doi.org/10.7577/njsr.2051 https://doi.org/10.15845/njsr.v2i0.108

Foged, S. K. & Houlberg, K. (2022). The economic costs of voucher markets for public service provision. Local Government Studies. Published online: 08 Feb 2022. https://doi.org/10.1080/03003930.2022.2033229 https://doi.org/10.1080/03003930.2022.2033229

Forsell, A. (1994). Företagisering av kommuner. Jacobsson, B. (red.). Organisationsexperiment i kommuner och landsting. Stockholm: Nerenius & Santérus.

Furusten, S. (2020). Fler som kan mindre och färre som kan mer – en konsekvens av ökad konsultanvändning i förvaltningen. Ehn, P. & Sundström, G. (red.). Statlig förvaltningspolitik för 2020-talet: en forskningsantologi. Stockholm: Statskontoret. https://www.statskontoret.se/siteassets/rapporter-pdf/2020/oos38.pdf

Graneheim, U. H. & Lundman, B. (2004). Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24, 105-112. https://doi.org/10.1016/j.nedt.2003.10.001 https://doi.org/10.1016/j.nedt.2003.10.001

Gruening, G. (2001). Origin and Theoretical Basis of the New Public Management. International Public Management Journal, 4(1), 1-25. https://doi.org/10.1016/S1096-7494(01)00041-1 https://doi.org/10.1016/S1096-7494(01)00041-1

Hall, P. (2012). Managementbyråkrati: organisationspolitisk makt i svensk offentlig förvaltning. 1. uppl. Malmö: Liber

Hall, P. (2020). Tillväxten av managementbyråkrati – ett hot mot välfärdsstaten? Ehn, P. & Sundström, G. (red.). Statlig förvaltningspolitik för 2020-talet: en forskningsantologi. Stockholm: Statskontoret. https://www.statskontoret.se/siteassets/rapporter-pdf/2020/oos38.pdf

Hartman, L. (2011). Konkurrensens konsekvenser. Vad händer med svensk välfärd. Stockholm: SNS förlag.

Hjort, M. (2019). Fler kommuner privatiserar sin hemtjänst. Kommunalarbetaren, 24 oktober 2019. https://ka.se/2019/10/24/fler-kommuner-privatiserar-sin-hemtjanst/

Hood, C. (1991). A Public Management for all Seasons. Public Administration, 69(1), 3-19. https://doi.org/10.1111/j.1467-9299.1991.tb00779.x https://doi.org/10.1111/j.1467-9299.1991.tb00779.x

Hsieh, H. F. & Shannon, S. E. (2005). Three Approaches to Qualitative Content Analysis. Qualitative Health Research, 15(9), 1277-1288. https://doi.org/10.1177/1049732305276687 https://doi.org/10.1177/1049732305276687

Hughes, O. E. (2003). Public management and administration. An introduction. New York: Palgrave.

Isaksson, J. (2021). Riktad kvalitativ innehållsanalys. I Klingberg, G. & Hallberg, U. (red.). Kvalitativa metoder helt enkelt! Lund: Studentlitteratur, 283-302.

Johansson, H., Arvidson, M. & Johansson, S. (2015). Welfare Mix as a Contested Terrain: Political Positions on Government-Non-profit Relations at National and Local Levels in a Social Democratic Welfare State. Voluntas, 26(5), 1601-1619. https://doi.org/10.1007/s11266-015-9580-4 https://doi.org/10.1007/s11266-015-9580-4

Jordahl, H. (2013). Välfärdstjänster i privat regi. Framväxt och drivkrafter. Stockholm: SNS förlag.

Karlsson, T. S. (2017). New Public Management: Ett nyliberalt 90-talsfenomen? Lund: Studentlitteratur.

Katzin, M. (2020). Taking Care of Business: A Study of the Governing of Care Choice Systems in Swedish Home Care. Lund: Faculty of Law, Lund University. https://lup.lub.lu.se/search/files/83804502/Mirjam_Katzin_2020_Taking_Care_of_Business.pdf

Kearsey, A. & Varey, R. J. (1998). Manageralist Thinking on Marketing for Public Services. Public Money & Management, 18(2), 51-60. https://doi.org/10.1111/1467-9302.00116 https://doi.org/10.1111/1467-9302.00116

Lundbäck, M. (2012). Varför är det så få idéburna organisationer i välfärden? Rapport 0142. Stockholm: Tillväxtverket.

Lundquist, L. (1998). Demokratins väktare. Ämbetsmännen och vårt offentliga etos. Lund: Studentlitteratur.

Lundquist, L. (1999). Hotet mot den politiska demokratin. Amnå, E. (red.). Demokrati och medborgarskap (SOU 1999:77) Fakta Info Direkt, 225-266.

Lundquist, L. (2014). Etik i offentlig förvaltning. Rothstein, B. (red.). Politik som organisation. Förvaltningspolitikens grundproblem. Lund: Studentlitteratur, 111-134.

Meagher, G. & Szebehely, M. (2013). Marketisation in Nordic eldercare. A research report on legislation, oversight, extent and consequences. Stockholm: Department of Social Work, Stockholm University. http://su.diva-portal.org/smash/get/diva2:667185/FULLTEXT01.pdf

Moberg, Linda (2021). User choice and the changing notion of social citizenship in Swedish elderly care. Nordic Social Work Research. Epub ahead of print. https://doi.org/10.1080/2156857X.2021.1948443 https://doi.org/10.1080/2156857X.2021.1948443

Moberg, L., Blomqvist, P. & Winblad, U. (2016). User choice in Swedish eldercare – conditions for informed choice and enhanced service quality. Journal of European Social Policy, 26(3), 281-295. https://doi.org/10.1177/0958928716645076 https://doi.org/10.1177/0958928716645076

Moore, M. H. (1994). Public Value as the Focus of Strategy. Australian Journal of Public Administration, 53 (3), 296-303. https://doi.org/10.1111/j.1467-8500.1994.tb01467.x https://doi.org/10.1111/j.1467-8500.1994.tb01467.x

Moore, M. H. (1995). Creating public value. Strategic management in government. Cambridge, Mass.: Harvard University Press.

Moore, M. H. (2013). Recognizing Public Value. Berlin: De Gruyter. https://doi.org/10.4159/harvard.9780674067820 https://doi.org/10.4159/harvard.9780674067820

O’Flynn, J. (2007). From New Public Management to public value: Paradigmatic change and managerial implications. Australian Journal of Public Administration, 66(3), 353-366. https://doi.org/10.1111/j.1467-8500.2007.00545.x https://doi.org/10.1111/j.1467-8500.2007.00545.x

Osborne, D. & Gaebler, T. (1992). Reinventing government: How the entrepreneurial spirit is transforming the public sector. Reading, Mass.: Addison-Wesley.

Peters, B. G. (2001). The future of governing. Lawrence: University Press of Kansas.

Pierre, J. (1995). The marketization of the state: Citizens, consumers and the emergence of the public market. Peters, B. G. & Savoie, D. J. (Eds.). Governance in a changing environment. Montreal & Kingston: McGill-Queen's University Press, 55-81.

Pollitt, C. (1990). Managerialism and the public services. The Anglo-American experience. Oxford: Basil Blackwell.

Pollitt, C. (2003). The essential public manager. Philadelphia, Pa.: Open University. https://doi.org/10.1057/9780230625365 https://doi.org/10.1057/9780230625365

Pollitt, C., Van Thiel, S. & Homburg, V. (2007). New Public Management in Europe. Adaptation and alternatives. Basingstoke: Palgrave Macmillan. https://doi.org/10.1057/9780230625365 https://doi.org/10.1057/9780230625365

Prop. 2008/09:29. Lag om valfrihetssystem. https://data.riksdagen.se/fil/B3DDA8BA-B174-4773-A0CF-21A055DCD68D

Rostgaard, T. (2018). Revisiting the public care model: The Danish case of free choice in home care. Christensen, K. & Pilling, D. (red.). The Routledge handbook of social care work around the world. London: Routledge, 29-44. https://doi.org/10.4324/9781315612805-3 https://doi.org/10.4324/9781315612805-3

Salamon, L. M. (1993). The Marketization of Welfare – Changing Nonprofit and For-Profit Roles in the American Welfare-state. Social Service Review, 67(1), 16-39. https://doi.org/10.1086/603963 https://doi.org/10.1086/603963

SFS 2001:453. Socialtjänstlag. http://rkrattsbaser.gov.se/sfst?bet=2001:453

SFS 2008:962. Lag om valfrihetssystem. https://rkrattsbaser.gov.se/sfst?bet=2008:962

Sivesind, K. H. (2017). The Changing Roles of For-Profit and Nonprofit Welfare Provision in Norway, Sweden, and Denmark. Sivesind, K. H. & Saglie, J. (red.). Promoting active citizenship: Markets and choice in Scandinavian welfare. Cham: Springer International Publishing, 33-74. http://dx.doi.org/10.1007/978-3-319-55381-8 https://doi.org/10.1007/978-3-319-55381-8_2

Sivesind, K. H. & Trætteberg, H. S. (2017). Does Out-Contracting of Welfare Services Promote Active Citizenship? Sivesind, K. H. & Saglie, J. (red.). Promoting Active Citizenship Markets and Choice in Scandinavian Welfare. Cham: Springer International Publishing, 1-31. http://dx.doi.org/10.1007/978-3-319-55381-8 https://doi.org/10.1007/978-3-319-55381-8_1

SKR (2020). Beslutsläge LOV-införande. Juli 2020, Sveriges Kommuner och Regioner, http://www.skr.se, hämtad 1 juli 2021.

Swiss, J. E. (1992). Adapting Total Quality Management (TQM) to Government. Public Administration Review, 52(4), 356-362. https://doi.org/10.2307/3110395 https://doi.org/10.2307/3110395

Theobald, H. (2012). Combining welfare mix and New Public Management: The case of long-term care insurance in Germany. International Journal of Social Welfare, (21), 61-74. http://dx.doi.org/10.1111/j.1468-2397.2011.00865.x https://doi.org/10.1111/j.1468-2397.2011.00865.x

Trætteberg, H. S., Sivesind, K. H., Paananen, M. & Hrafnsdóttir, S. (2021). Private Early Childhood Education and Care (ECEC) in the Nordic Countries: Development and governance of the welfare mix. Oslo: Institutt for samfunnsforskning, https://hdl.handle.net/11250/2831519.

Vabø, M., Christensen, K., Jacobsen, F. F. & Trætteberg, H. D. (2013). Marketisation in Norwegian eldercare: preconditions, trends and resistance. Meagher, G. & Szebehely, M. (Eds.), Marketisation in Nordic eldercare. A research report on legislation, oversight, extent and consequences. Stockholm: Department of Social Work, 163-202. http://su.diva-portal.org/smash/get/diva2:667185/FULLTEXT01.pdf

Walsh, K. (1991). Citizens and consumers: Marketing and public sector management. Public Money & Management, 11(2), 9-16. https://doi.org/10.1080/09540969109387649 https://doi.org/10.1080/09540969109387649

Walsh, K. (1994). Marketing and Public Sector Management. European Journal of Marketing, 28(3), 63-71. https://doi.org/10.1108/03090569410057308 https://doi.org/10.1108/03090569410057308

Wamsley, G. L. & Zald, M. N. (1973). The political economy of public organizations. A critique and approach to the study of public administration. Lexington, Mass. https://doi.org/10.2307/974786 https://doi.org/10.2307/974786

Wide, J. & Feltenius, D. (2016). En ren affärsangelägenhet? Pensionärsorganisationerna i den marknadiserade äldreomsorgen. Statsvetenskapliga institutionens skriftserie, Umeå universitet, 1/2016. http://dx.doi.org/10.13140/RG.2.2.20747.62242

Winblad, U., Isaksson, D., Josefsson, K. & Olsson, F. I. (2014). Kvalitetskrav i valfrihetssystem. En analys av förfrågningsunderlag för hemtjänst. Stockholm: Sveriges Kommuner och Landsting.

Winblad, U., Mankell, A. & Olsson, F. (2015). Privatisering av välfärdstjänster: hur garanteras kvalitet i vård och omsorg? Statsvetenskaplig tidskrift, 117(4), 531–554. https://journals.lub.lu.se/st/article/view/15576/14068

Winckler, P. (2000). Etik i velfærdsservicen. Finansministeriet (utg.) Etik, ansvar og værdier i den offentlige sektor – en debatbog. Köpenhamn: Finansministeriet.

Wæraas, A., Bjørnå H. & Moldenæs, T. (2015). Place, Organization, Democracy: Three Strategies for Municipal Branding. Public Management Review, 17(9), 1282-1304. https://doi.org/10.1080/14719037.2014.906965 https://doi.org/10.1080/14719037.2014.906965

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2022-12-14

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