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Exit, voice and indifference – older people as consumers of Swedish home care services

Published online by Cambridge University Press:  24 August 2015

JOHAN VAMSTAD
JOHAN VAMSTAD*
Affiliation:
Ersta Sköndal University College, Stockholm, Sweden.
*
Address for correspondence: Johan Vamstad, Ersta Sköndal University College, Stigbergsgatan 30, 10061 Stockholm, Sweden E-mail: johan.vamstad@esh.se
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Abstract

Sweden has in the last 20 years undergone an extensive process of marketisation of its home care sector. Where the public sector once was the only provider of home care services, there is now a wide array of different, private alternatives for older people to choose from, using their publicly funded voucher. The publicly funded home care services in Sweden are, in other words, to a large extent organised according to the principles of a quasi-market. Older people with care needs are therefore now considered to be consumers of home care since they are expected to make an informed choice of home care provider according to their own preferences. This paper studies the extent to which older people with care needs assume this role and how they do it, using Hirschman's well-known theory on ‘exit, voice and loyalty’ and theory on the difference between care and market logic. The study is based on results from a research project using telephone interviews to ask a large number of older people in three Swedish cities about their experience of making this choice. The results show that they had difficulty understanding how to choose and what the purpose of the choice was. The conclusion of this study suggests some possible reasons why policy makers in Sweden continue to favour the freedom-of-choice model in spite of these poor results.

Keywords

home carequasi-marketfreedom of choiceconsumerwelfare stateSweden
Type
Articles
Information
Ageing & Society , Volume 36 , Issue 10 , November 2016 , pp. 2163 - 2181
Copyright
Copyright © Cambridge University Press 2015 

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References

Andersson, K. and Kvist, E. 2014. The neoliberal turn and the marketization of care: the transformation of eldercare in Sweden. European Journal of Women's Studies. Published online, 12 August, doi:10.1177/1350506814544912.Google Scholar
Berggren, H. and Trägårdh, L. 2006. Är svensken människa? Gemenskap och oberoende i det moderna Sverige [Is the Swede Human? Belonging and Independence in Modern Sweden] . Norstedts förlag, Stockholm.Google Scholar
Brodin, H. 2005. Does Anybody Care? Public and Private Responsibilities in Swedish Eldercare 1940–2000. Umeå University Press, Umeå, Sweden.Google Scholar
Edebalk, P. G. and Svensson, M. 2005. Kundval för äldre och funktionshindrade i Norden [Consumer Choice for Elderly and Impaired in the Nordic Region] . Nordic Council of Ministers, Copenhagen.CrossRefGoogle Scholar
Erlandsson, S., Storm, P., Stranz, A., Szebehely, M. and Trydegård, G. B. 2013. Marketization trends in Swedish eldercare: competition, choice and calls for stricter regulation. In Meagher, G. and Szebehely, M. (eds), Marketization in Nordic Eldercare: A Research Report on Legislation, Oversight, Extent and Consequences. Stockholm University Press, Stockholm, 23–84.Google Scholar
Fotaki, M. 2007. Patient choice in healthcare in England and Sweden: from quasi-market and back to market? A comparative analysis of failure in unlearning. Public Administration, 85, 4, 1059–75.CrossRefGoogle Scholar
Fotaki, M. 2009. Are all consumers the same? Choice in health, social care and education in England and elsewhere. Public Money and Management, 29, 2, 87–94.CrossRefGoogle Scholar
Fotaki, M. and Boyd, A. 2005. From plan to market: a comparison of health and old age care in the UK and Sweden. Public Money and Management, 25, 4, 237–43.CrossRefGoogle Scholar
Hirschman, A. O. 1970. Exit, Voice and Loyalty – Responses in Decline in Firms, Organizations and States. Harvard University Press, Cambridge, Massachusetts.Google Scholar
Hjalmarsson, I. and Wånell, S. E. 2013. Valfrihetens LOV: En studie av vad Lagen om valfrihetssystem betyder för den som har hemtjänst, kommunen och för utförarna [Freedom of Choice and LOV: A Study About What the Act on System of Choice in the Public Sector Means for Users of Home Care, the Municipalities, and the Service Providers] . Stockholm läns äldrecentrum, Stockholm.Google Scholar
Konkurrensverket 2013. Kommunernas valfrihetssystem – med fokus på hemtjänst [The Municipal Freedom of Choice Systems – With Focus on Home Care] . Konkurrensverket, Stockholm.Google Scholar
Meinow, B., Parker, M. G. and Thorslund, M. 2011. Consumers of eldercare in Sweden: the semblance of choice. Social Science and Medicine, 73, 9, 1285–9.CrossRefGoogle ScholarPubMed
Mol, A. 2008. The Logic of Care: Health and the Problem of Patient Choice. Routledge, London.CrossRefGoogle Scholar
Möller, T. 1996. Brukare och klienter i välfärdsstaten – om missnöje och påverkansmöjligheter [Users and Clients in the Welfare State – Dissatisfaction and Chances to Influence] . Norstedts juridik, Stockholm.Google Scholar
Möller, T. 1999. Hälsan tiger still? Om vanmakt, apati och liknöjdhet i svensk demokrati [Good health is quiet? Powerlessness, apathy and indifference in Swedish democracy]. In SOU 1999:113 Medborgarnas erfarenheter [The experiences of the citizens]. Fritzes förlag, Stockholm, 137–166.Google Scholar
Pensionärernas Riksorganisation 2012. LOV, lagen om valfrihetssystem [LOV, the Act on System of Choice in the Public Sector] . Pensionärernas Riksorganisation, Stockholm.Google Scholar
Socialstyrelsen 2012 a. Valfrihetssystem ur ett befolknings och patientperspektiv [System of Choice from a Population and Patient Perspective] . Socialstyrelsen, Stockholm.Google Scholar
Socialstyrelsen 2012 b. Val inom hemtjänst och äldreboende – Fokusgrupper med äldre och anhöriga som valt utförare inom äldreomsorg [Choice in Home Care and Care Homes – Focus Groups with Elderly that Have Chosen Care Provider, and Their Relatives] . Socialstyrelsen, Stockholm.Google Scholar
Socialstyrelsen 2011. Vad vill äldre veta? En sammanställning av studier om äldres val inom äldreomsorgen [What Does the Elderly Want to Know? An Overview of Studies of Choice in Eldercare] . Socialstyrelsen, Stockholm.Google Scholar
Stolt, R., Blomqvist, P. and Winblad, U. 2010. Privatization of social services: quality differences in Swedish elderly care. Social Science and Medicine, 72, 4, 560–7.CrossRefGoogle ScholarPubMed
Sveriges Kommuner och Landsting 2010. Kundval i äldreomsorgen – stärks brukarens ställning i ett valfrihetssystem? [Consumer Choice in Eldercare – Is the Position of the User Strengthened in a Freedom of Choice System?] . Sveriges Kommuner och Landsting, Stockholm.Google Scholar
Szebehely, M. 2011. Insatser för äldre och funktionshindrade i privat regi [Private services for the elderly and impaired]. In Hartman, L. (ed.), Konkurrensens konsekvenser – vad händer i svensk välfärd [The consequenses of competition – what is happening in Swedish welfare?]. SNS förlag, Stockholm, 215–257.Google Scholar
Tronto, J. C. 1993. Moral Boundaries – A Political Argument for an Ethic of Care. Routledge, New York.Google Scholar
Winblad, U. and Blomqvist, P. 2013. Kundvalsmodeller i äldreomsorgen – kan de äldre välja? [Consumer choice models in elder care – can the elderly choose?]. In Rönnberg, L., Strandberg, U., Wihlborg, E. and Winblad, U. (eds), När förvaltning blir business [When public administration becomes business]. Linköping University Press, Linköping, Sweden, 57–76.Google Scholar