No abstract

The objective of this article is to analyse whether the increased reliance on marketisation in the provision of social care challenges the universality of eldercare in Sweden, Denmark, Finland and Norway. The study focuses on national reforms for contracting out and user choice of provider, analysing their consequences for four universalistic dimensions: (i) equal inclusion, (ii) public funding, (iii) public provision and (iv) comprehensive usage. The findings suggest that, although need-based inclusion and public funding remain key principles in all four countries, there is an increased reliance on private provision in Sweden, Denmark and Finland. In addition, the introduction of topping-up services challenges the dimension of comprehensive usage by enabling users with economic resources to turn to the private market to increase the comprehensiveness and quality of their care.

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.

This article deals with the 2009 user choice reform in Swedish elderly care. It analyses how the tension between choice and older citizens' equal access to good quality care was dealt with by the policymakers who introduced it. Three overarching research questions are addressed in the analysis: (i) what role and responsibilities did the Swedish user choice reform assign to the users and how did the policymakers view users' ability to make an informed choice? (ii) How did the policymakers view the role and responsibilities of the local authorities and what tools were the local authorities given to ensure access to good quality elderly care for all citizens? (iii) Can the new user choice reform be said to contain a new notion of social citizenship for older people in Sweden? The findings suggest that while the user choice reform encouraged users to allocate resources and make free choices between providers, it also required users to become more responsible to ensure service quality. The reform also advocated that the local authorities should steer their elderly care sectors through partly new governance tools and secure quality foremost through the entering of contracts with authorized providers. The paper argues that, because of these required new roles and responsibilities, the Swedish user choice reform entails a more libertarian notion of social citizenship, requiring users to take on greater responsibility for their own well-being and protection against risks.

The professionalization of social care workers is a policy goal in many welfare states. At the same time, professionalization risks being undermined by enhanced audit. The objective of this article is to analyze whether the audit processes adopted in Swedish eldercare and childcare support or undermine the professionalization of the occupations working there, i.e., nurses, nursing assistants, preschool teachers, and preschool assistants. In particular, we investigate whether the three main forms of audit-standardsetting, inspections, and quality measurements-support or undermine the occupations' ability to achieve professional closure and enhance their external and internal autonomy. The findings suggest that audit processes in eldercare risk undermining professionalization, while in childcare the pattern is reversed: audit appears supportive of professionalization, at least for preschool teachers. This finding suggests that audit processes do not have to be detrimental to professionalization.