Marketisation of Nordic Eldercare – Is the Model Still Universal?

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.

Nordic eldercare – Weak universalism becoming weaker?

“…As Anttonen puts it: universalism 'names the redistributive principle behind social policy ' (2002: 71). Nested under this broadest of principles, a range of dimensions of universalism have been identified, the specification and relevance of which varies with policy area (Anttonen et al 2012;Béland et al, 2014;Goul Andersen, 2012;Kröger et al, 2003;Moberg, 2016). Drawing on this prior research, particularly from Anttonen (2002), Goul Andersen 3 (2012) and Vabø and Szebehely (2012), we have identified the following dimensions as ideal-typical for universal eldercare.…”

“…Key variables are whether or not a) private providers operate for-profit, b) the care system is organised by market mechanisms, such as competition for contracts and consumer choice models, and c) market rules enable private providers to offer 'topping up' services. If for-profit providers compete for contracts or customers and are allowed to offer topping up services, the likely result is de-universalising in the form of a wider spread of service quality: lower in many private services, as the profit motive diverts resources from care provision (Ronald et al, 2016), and higher in others, as members of highlyresourced social groups are better able to navigate the market to find the best services, and to use their own resources to top up the publicly-subsidised offering (Moberg 2016). By contrast, deuniversalisation is less likely if private provision takes the form of non-profit organisations offering services within communitarian, rather than competitive institutional arrangements, without the opportunity to top up.…”

Business as usual? Civil society organizations in a marketized Swedish welfare state

“…1 This is evident from the act on system of choice (lagen om valfrihetssystem, hereafter referred to as LOV) which was introduced in 2009. Based on this law, the elderly have the opportunity to choose their provider of home care services (Moberg, 2017). However, it is not mandatory for the municipalities to adopt this freedom-of-choice system, but a majority have chosen to do so (152 out of 290 municipalities in spring 2014) (Feltenius & Wide, 2015;Wide & Feltenius, 2016).…”

Supplemental home care and topping‐up: A shift from service universalism towards a new and privatised public service model?

“…As a result, take‐up of services in the Nordic welfare states is relatively unaffected by class and maintains a relatively high service level. Some would also argue that the public production of services is part of the universalistic dimension which allows for public control over content and quality of care (Anttonen & Sipilä, ; Moberg, ).…”