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Competing Logics and Idealistic Professionalism: Development of a Swedish Community Mental Health Serivce Market
Umeå University, Faculty of Social Sciences, Department of Social Work.ORCID iD: 0000-0001-9836-6446
Umeå University, Faculty of Social Sciences, Department of Social Work.ORCID iD: 0000-0002-6330-5640
(English)Manuscript (preprint) (Other academic)
Abstract [en]

The aim of this study was to explore the longitudinal development of an organisational fieldafter the implementation of a freedom-of-choice system in terms of the range and characteristicsof providers and services as well as the dynamics and professionalism that appeared as a resultof these changes. Our findings suggest that the expected effects of the reform in terms of varietyof providers and services within the organizational field did not materialise due to a lack ofmarket competition. Providers complemented each other rather than competed with each other,and the logics of care, choice, and advocacy challenged each other within the quasi-market. Allinformants described financial conditions in the market as extremely strained. Strong personalcommitment characterized providers entering and exiting the market, and this strongcommitment suggests a nuanced professionalism we refer to as idealistic professionalism. Agap was found between policy goals and experiences among stakeholders, and efficiency wasfound to be the policy goal achieved most often in practice. This raises the questions of howthe Swedish community mental health service market will develop in the future and what theimplications are for the participants.

Keyword [en]
community nmental health service market, development, logics, professionalism
National Category
Social Sciences
Identifiers
URN: urn:nbn:se:umu:diva-135017OAI: oai:DiVA.org:umu-135017DiVA: diva2:1095818
Available from: 2017-05-16 Created: 2017-05-16 Last updated: 2017-05-18
In thesis
1. Choice as governance in community mental health services
Open this publication in new window or tab >>Choice as governance in community mental health services
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In 2009, the Act on Freedom of Choice Systems (SFS 2008:962) wasestablished in Sweden, and this enabled municipalities to organise services aschoice models. This thesis describes and analyses the implementation of afreedom of choice system within community mental health services. Daycentre services were in focus, and a case study was conducted of a majormunicipality that sought to be a “world-class city” in regard to citizens’ choice.The experiences of policy makers, managers, professionals, and participantswere explored in interviews, and documents on a national, municipal, and citydistrict level, as well as homepages of providers of community mental healthservices, were all part of the study and were analysed using content-analysismethods.

The results showed that the freedom of choice system aimed for two objectives– improvements at the individual level and financial efficiency. In practice,financial efficiency was experienced as the main objective. Increased varietyof services was aimed for by the competitive model, but such variety was notobserved. Instead, services tended to be more similar than specialised.Concerning new providers, they were characterised as committedprofessionals running companies with strained economies. Participantsaffected by the reform expressed anxiety and worries due to theunpredictability and uncertainty embedded in the competitive choice model.Choice within the system concerned where to go, whereas participantsemphasised a wish to be able to influence the choice aspects of who carriedout the service and how much time to attend the services.

The conclusion was that the freedom of choice system was implemented as atechnology of governance to increase financial efficiency of services.Individual choice was not experienced as increased in any aspect except forthe choice of where to go. Instead, freedom of choice actually appeared todecrease due to standardisation and hierarchical structures. Aspects that werefound to be relevant when designing freedom of choice systems aiming toincrease individual freedom of choice were to address predictability andcontinuity, to address sustainable financial premises, to analyse the predictedimpact of administrative systems that are to be used, and to avoid the use of“hidden goals” in the policy-making process.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2017. 93 p.
Series
Studier i socialt arbete vid Umeå universitet : avhandlings- och skriftserie, ISSN 0283-300X ; 85
Keyword
freedom of choice systems, community mental health services
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-135018 (URN)978-91-7601-718-0 (ISBN)
Public defence
2017-06-09, Hörsal D, Samhällsvetarhuset, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2017-05-19 Created: 2017-05-16 Last updated: 2017-05-18Bibliographically approved

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Citation style
  • apa
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Output format
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