The neoliberal turn and the marketization of care: The transformation of eldercare in Sweden

Abstract

The care for older and disabled people has been described as a core area of the Nordic model. The Nordic countries' welfare model has also been described as women friendly, as women are not forced to make harder choices than men between work and family. The Swedish eldercare system has, during the last several decades, undergone significant changes. Previously, eldercare could be described as universal, meaning a publicly provided, comprehensive, high-quality service available to all citizens according to need and not based on the ability to pay. In later years transformation of eldercare has been influenced by neoliberal politics, which emphasize economic efficiency and cost reduction through competition. Eldercare has become a more diverse multidimensional system, and a private market for home-based eldercare has been created. The numbers of eldercare providers have increased considerably, and new ways of organizing eldercare have been established. In January 2009, the Act on System of Choice in the Public Sector was introduced (in Swedish: Lagen om valfrihetssystem [LOV]). The Act was supposed to provide an opportunity for interested municipalities and county councils to expose their publicly provided services to market competition, and to enable users to choose their providers. This article aims to illustrate how neoliberal reasoning dominated the policy process leading to adoption of the Act on System of Choice in the Public Sector. With the use of a discursive policy analysis the authors specifically explore how neoliberal logic dominated, and also how choice and equality were understood and interpreted in the policy process. They conclude that the neoliberal turn in eldercare claiming to centre on the individual choice of persons in need of care runs the risk of creating unequal care that decentres the eldercare worker and creates precarious work situations.

Professional discretion and length of work experience: what findings from focus groups with care managers in elder care suggest

“…Concurrently with this development, private and competing contractors have been introduced as elder care service providers. The idea being that older people's ability to choose who will provide the services that they are granted will be increased by having private actors from which they can pick and choose as they please (Andersson & Kvist, 2015). The reality does not match this ideal (Moberg, 2017) but that is at least what the intention has been.…”

Determinants of resilience for people ageing in remote places: a case study in northern Australia

“…The concept "successful ageing" is increasingly becoming synonymous with independence and choice (meaning physical self-reliance) (Stones & Gullifer 2016). Governments in Western countries have generally adopted neoliberal health and social policy that favour this discourse (Anderson & Kvist 2015). A major driver of neoliberal policy is concern with the costs associated with an ageing population and the projected growing demand on aged care services.…”

Making a Market out of a Welfare State: Swedish Local Politicians’ Perspectives on Elderly Care Marketisation

“…Since then, several new market policies have been introduced, such as a customer choice model and a tax deduction on household services and personal care. Andersson and Kvist (2015) concluded that the Swedish elderly care system has undergone significant changes during the last several decades from a publicly provided, comprehensive, and high-quality service available to all citizens based on need to a more diverse multidimensional system that has been influenced by neoliberal politics such as NPM.…”

“…The provision of elderly care is viewed as a cornerstone of the Swedish model (Andersson and Kvist 2015;Bergman et al 2016) and consumes a relatively large amount of public resources. For instance, the cost of elderly care services was estimated to be SEK 90 billion in 2008, which is equivalent to 3% of the country's GDP (NBHW 2009).…”