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Extended freedom attained?: A case study of a free-choice market system in community mental health care.
Umeå University, Faculty of Social Sciences, Department of Social Work.
Umeå University, Faculty of Social Sciences, Department of Social Work.ORCID iD: 0000-0002-6330-5640
2013 (English)Conference paper, Abstract (Other academic)
Abstract [en]

Background/Objectives Systems for freedom of choice within mental health has been implemented in several western countries to increase citizens’ freedom of choice, conduce diversification in service and providers of service, reduce inequalities by providing equitable choice to all users while contribute higher quality of service and facilitate efficient use of public funds. In Sweden “Act of Free Choice Systems” (2008:962) was introduced in 2009, and optional for municipalities to use. Community mental health is organized within the municipalities. The aim of this study is to describe the process of designing and constructing a market of free choice within community mental health, and analyse what kind of freedom of choice the citizen in need of community mental health have, in the example of Daily occupation.

Methods A case study was conducted in Stockholm, the capital of Sweden, where free choice was implemented in January 2010. The study consists of semi-structured interviews with twenty-eight actors’ involved in the process, complemented with political documents. Interviews were conducted 2009 and 2012. To analyse the material direct content analysis was used, and theories regarding quasi-markets, market design and regulation of markets were applied.

Results The design and construction of the market of community mental health have determined the degree of clients’ freedom of choice. The volume of the market was regulated by national legislation, but sometimes influenced by the local political budget, and users sometimes appealed their decisions in court to have their rights assessed by law. Admission rules set by authorities concerning management and staff qualifications, financial stability and technical documentation equipment, determined which providers could enter the market. Many user-led organisations were not able to enter due to the admission rules. Quality regulation was developed by authorities to examine providers within the system. The client should be provided neutral and rich information, though full information was hard to access.

Discussion/Conclusion Freedom of choice seems to have been both extended and reduced by the design and construction of the new system. All users theoretically had the same possibilities to choose providers in the system. However the construction limited the actual client choice significantly.

Place, publisher, year, edition, pages
2013. 184-184 p.
Keyword [en]
freedom of choice, market design, market construction, community mental health
National Category
Social Work
URN: urn:nbn:se:umu:diva-95157OAI: diva2:757671
Tenth International Conference of the European Network for Mental Health Service Evaluation (ENMESH),October 3-5, 2013, Polo Zanotto, Verona, Italy
Forte, Swedish Research Council for Health, Working Life and Welfare, 2010-0142

Available from: 2014-10-23 Created: 2014-10-23 Last updated: 2015-08-14Bibliographically approved

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Andersson, MariaMarkström, Urban
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