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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 universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.ORCID-id: 0000-0001-9836-6446
Lunds universitet.
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.ORCID-id: 0000-0002-6330-5640
2016 (Engelska)Ingår i: Scandinavian Journal of Disability Research, ISSN 1501-7419, E-ISSN 1745-3011, Vol. 18, nr 2, s. 129-141Artikel i tidskrift (Refereegranskat) 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.

Ort, förlag, år, upplaga, sidor
2016. Vol. 18, nr 2, s. 129-141
Nyckelord [en]
community mental health, free-choice market system, implementation
Nationell ämneskategori
Socialt arbete
Identifikatorer
URN: urn:nbn:se:umu:diva-95156DOI: 10.1080/15017419.2014.995220ISI: 000377393000004OAI: oai:DiVA.org:umu-95156DiVA, id: diva2:757659
Projekt
Daglig sysselsättning för personer med psykisk funktionsnedsättnintg. En studie om verksamhetsområdets karaktär och om reformers påverkan.
Forskningsfinansiär
Forte, Forskningsrådet för hälsa, arbetsliv och välfärd, 2010-0142Tillgänglig från: 2014-10-23 Skapad: 2014-10-23 Senast uppdaterad: 2018-06-07Bibliografiskt granskad
Ingår i avhandling
1. Choice as governance in community mental health services
Öppna denna publikation i ny flik eller fönster >>Choice as governance in community mental health services
2017 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
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.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå universitet, 2017. s. 93
Serie
Studier i socialt arbete vid Umeå universitet : avhandlings- och skriftserie, ISSN 0283-300X ; 85
Nyckelord
freedom of choice systems, community mental health services
Nationell ämneskategori
Socialt arbete
Identifikatorer
urn:nbn:se:umu:diva-135018 (URN)978-91-7601-718-0 (ISBN)
Disputation
2017-06-09, Hörsal D, Samhällsvetarhuset, 10:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2017-05-19 Skapad: 2017-05-16 Senast uppdaterad: 2018-06-09Bibliografiskt granskad

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Andersson, MariaSandlund, MikaelMarkström, Urban

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Institutionen för socialt arbetePsykiatri
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Socialt arbete

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