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Freedom of choice or cost efficiency?: the implementation of a free-choice market system in community mental health services in Sweden
Umeå University, Faculty of Social Sciences, Department of Social Work.ORCID iD: 0000-0001-9836-6446
Lunds universitet.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
Umeå University, Faculty of Social Sciences, Department of Social Work.ORCID iD: 0000-0002-6330-5640
2016 (English)In: Scandinavian Journal of Disability Research, ISSN 1501-7419, E-ISSN 1745-3011, Vol. 18, no 2, 129-141 p.Article in journal (Refereed) Published
Abstract [en]

This case study investigates the implementation of a free-choice market system in community mental health services using the example of day centres for people with psychiatric disabilities. It was conducted in a major city that was about to implement a free-choice market system due to a new legislation that made it feasible. Eighteen semi-structured interviews were conducted. Agents situated in different parts of the organization were interviewed one year before and two years after the free-choice system was launched in 2010. Data showed a top–down political process. A majority of the intentions of the legislation advocated individual autonomy as the market system's main purpose; only one concerned organizational efficiency. Data reflected, however, that financial efficiency dominated the agents' experiences of the implemented system. The twofold market purpose was clearly reflected in the interviews. Front-line staff hoped for improvements mainly for the users, whereas managers mainly focused on the market as a resource allocator.

Place, publisher, year, edition, pages
2016. Vol. 18, no 2, 129-141 p.
Keyword [en]
community mental health, free-choice market system, implementation
National Category
Social Work
Identifiers
URN: urn:nbn:se:umu:diva-95156DOI: 10.1080/15017419.2014.995220ISI: 000377393000004OAI: oai:DiVA.org:umu-95156DiVA: diva2:757659
Projects
Daglig sysselsättning för personer med psykisk funktionsnedsättnintg. En studie om verksamhetsområdets karaktär och om reformers påverkan.
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2010-0142
Available from: 2014-10-23 Created: 2014-10-23 Last updated: 2017-12-05Bibliographically approved
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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