Freedom of choice or cost efficiency? The implementation of a free-choice market system in community mental health services in Sweden

Maria Andersson; Mona Eklund; Mikael Sandlund; Urban Markström

doi:10.1080/15017419.2014.995220

Freedom of choice or cost efficiency? The implementation of a free-choice market system in community mental health services in Sweden

Scandinavian Journal of Disability Research

Volume 18 (2016): Issue 2

By: Maria Andersson, Mona Eklund, Mikael Sandlund and Urban Markström

Open Access

|Jan 2016

Abstract

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.

References

Brody, C. M., N. Bellows, M. Campbell, and M. Potts. 2013. “The Impact of Vouchers on the Use and Quality of Health Care in Developing Countries: A Systematic Review.” Global Public Health 8 (4): 363–388. doi:10.1080/17441692.2012.759254.
Open DOI Search in Google Scholar Back to article
Brunsson, N., and I. Hägg. 1992. Marknadens makt. Stockholm: SNS (Studieförb. Näringsliv och samhälle).
Search in Google Scholar Back to article
Defourny, J., A. Henry, S. Nassaut, and M. Nyssens. 2010. “Does the Mission of Providers Matter on a Quasi-market? The Case of the Belgian ‘Service Voucher’.” Annals of Public & Cooperative Economics 81 (4): 583–610. doi:10.1111/j.1467-8292.2010.00423.x.
Open DOI Search in Google Scholar Back to article
Denters, B., O. Van Heffen, J. Huisman, and P.-J. Klok. 2003. “Introduction: The Emergence of New Forms of Governance.” In The Rise of Interactive Governance and Quasi-markets Library of Public Policy and Public Administration, Volume 8, edited by B. Denters, O. Van Heffen, J. Huisman, and P.-J. Klok, 3–14. Dordrecht: Kluwer Academic.
Search in Google Scholar Back to article
DiMaggio, P. J., and W. W. Powell. 1983. “The Iron Cage Revisited: Institutional Isomorphism and Collective Rationality in Organizational Fields.” American Sociological Review 48 (2): 147–160. doi:10.2307/2095101.
Open DOI Search in Google Scholar Back to article
Drake, R. E., G. R. Bond, and D. R. Becker. 2012. Individual Placement and Support: An Evidence-Based Approach to Supported Employment. Oxford: Oxford University Press.
Search in Google Scholar Back to article
Dovemark, M. 2007. Ansvar – hur lätt är det?: om ansvar, flexibilitet och valfrihet I en föränderlig skola. Lund: Studentlitteratur.
Search in Google Scholar Back to article
Eklund, M., and C. Tjörnstrand. 2013. “Psychiatric Rehabilitation in Community-based Day Centres: Motivation and Satisfaction.” Scandinavian Journal of Occupational Therapy 20 (6): 438–445. doi:10.3109/11038128.2013.805428.
Open DOI Search in Google Scholar Back to article
Finn, D. 2009. “The ‘Welfare Market’ and the Flexible New Deal: Lessons from Other Countries.” Local Economy 24 (1): 38–45. doi:10.1080/02690940802645471.
Open DOI Search in Google Scholar Back to article
Friedman, M., and R. D. Friedman. 1980. Free to Choose: A Personal Statement. New York: HBJ.
Search in Google Scholar Back to article
Graneheim, U. H., and B. Lundman. 2004. “Qualitative Content Analysis in Nursing Research: Concepts, Procedures and Measures to Achieve Trustworthiness.” Nurse Education Today 24 (2): 105–112. doi:10.1016/j.nedt.2003.10.001.
Open DOI Search in Google Scholar Back to article
Hartman, L. 2011. Konkurrensens konsekvenser: vad händer med svensk välfärd. Stockholm: SNS förlag.
Search in Google Scholar Back to article
Hill, M. J., and P. L. Hupe. 2009. Implementing Public Policy: An Introduction to the Study of Operational Governance. Los Angeles: Sage.
Search in Google Scholar Back to article
Hsieh, H.-F., and S. E. Shannon. 2005. “Three Approaches to Qualitative Content Analysis.” Qualitative Health Research 15 (9): 1277–1288. doi: 10.1177/1049732305276687
Open DOI Search in Google Scholar Back to article
Kondra, A. Z., and C. R. Hinings. 1998. “Organizational Diversity and Change in Institutional Theory.” Organization Studies 19 (5): 743–767. doi:10.1177/017084069801900502.
Open DOI Search in Google Scholar Back to article
Le Grand, J., and W. Bartlett. 1993. Quasi-markets and Social Policy. London: Macmillan.
Search in Google Scholar Back to article
Lövgren, V., and K. Hamreby. 2010. “Factors of Importance in the World of Work for Young People with Intellectual Disabilities.” Scandinavian Journal of Disability Research 13 (2): 91–117. doi: 10.1080/15017419.2010.490742
Open DOI Search in Google Scholar Back to article
Meyer, J. W., and B. Rowan. 1977. “Institutionalized Organizations: Formal Structure as Myth and Ceremony.” American Journal of Sociology 83 (2): 340–363. doi:10.1086/226550.
Open DOI Search in Google Scholar Back to article
Meyer, M. 2010. “Social Movement Service Organizations.” In Human Services as Complex Organizations, edited by Y. Hasenfeld, 533–550. Los Angeles: Sage.
Search in Google Scholar Back to article
Mol, A. 2008. The Logic of Care: Health and the Problem of Patient Choice. Abingdon, Oxon: Routledge.
Search in Google Scholar Back to article
Norén, L. 2003. Valfrihet till varje pris: om design av kundvalsmarknader inom skola och omsorg. Göteborg: BAS.
Search in Google Scholar Back to article
Pache, A.-C. and F. Santos. 2013. “Inside the Hybrid Organization: Selective Coupling as a Response to Conflicting Institutional Logics.” Academy of Management Journal 56 (4): 972–1001. doi:10.5465/amj.2011.0405.
Open DOI Search in Google Scholar Back to article
Ritchie, J., and J. Lewis. 2003. Qualitative Research Practice: A Guide for Social Science Students and Researchers. London: Sage.
Search in Google Scholar Back to article
Rose, N. 1996. “Governing ‘Advanced’ Liberal Democracies.” In Foucault and Political Reason: Liberalism, Neo-liberalism, and Rationalities of Government, edited by A. Barry, T. Osborne, and N. Rose, 37–64. Chicago: University of Chicago Press.
Search in Google Scholar Back to article
Rosenberg, D. 2009. Psychiatric Disability in the Community: Surveying the Social Landscape in the Post-deinstitutional Era. Umeå: Print och media Umeå universitet.
Search in Google Scholar Back to article
Saario, M. 2010. Sysselsättning inom psykiatrin – en översyn [Daily Occupation in Mental Health Services – A Review]. Stockholms stad: Socialtjänst – och arbetsmarknadsförvaltningen.
Search in Google Scholar Back to article
Sabatier, P. A. 1986. “Top-down and Bottom-up Approaches to Implementation Research: A Critical Analysis and Suggested Synthesis.” Journal of Public Policy 6 (1): 21–48. doi:10.1017/S0143814X00003846.
Open DOI Search in Google Scholar Back to article
SFS 2008:962. Act on Free Choice Systems. Stockholm: Ministry of Health and Social Affairs.
Search in Google Scholar Back to article
SOU 2008:15. LOV att välja – Lag Om Valfrihetssystem (Permission to Choose – Act on Free Choice Systems). Statens offentliga utredningar, Frittvalsutredningen. Stockholm: Edita Sverige AB.
Search in Google Scholar Back to article
Spall, P., C. McDonald, and D. Zetlin. 2005. “Fixing the System? The Experience of Service Users of the Quasi-market in Disability Services in Australia.” Health & Social Care in the Community 13 (1): 56–63. doi:10.1111/j.1365-2524.2005.00529.x.
Open DOI Search in Google Scholar Back to article
Stockholms stad. 2012a. “Hitta och jämför sysselsättningar [Find and Compare Day Center Activities].” Accessed July 31. http://www.stockholm.se/-/Jamfor.
Search in Google Scholar Back to article
Stockholms stad. 2012b. “Startpunkten Östermalm – träffverksamhet [Starting Point Östermalm – Meeting Place].” Accessed October 31. http://www.stockholm.se/-/Serviceenhetsdetaljer/?enhet=06a021db2627453c89baee8d36b8e30a.
Search in Google Scholar Back to article
Stockholms stad. 2013. “Hitta och jämför sysselsättningar [Find and Compare Day Center Activities].” Accessed January 21. http://www.stockholm.se/-/Jamfor/?enhetstyp=c3ee698346bb427b8702780bf5b5aff9&slumpfro=2072379650.
Search in Google Scholar Back to article
Struyven, L., and G. Steurs. 2005. “Design and Redesign of a Quasi-market for the Reintegration of Jobseekers: Empirical Evidence from Australia and the Netherlands.” Journal of European Social Policy 15 (3): 211–229. doi:10.1177/0958928705054083.
Open DOI Search in Google Scholar Back to article
Tjörnstrand, C., U. Bejerholm, and M. Eklund. 2011. “Participation in Day Centres for People with Psychiatric Disabilities: Characteristics of Occupations.” Scandinavian Journal of Occupational Therapy 18 (4): 243–253. doi: 10.3109/11038128.2011.583938
Open DOI Search in Google Scholar Back to article
Wahlbeck, K., and D. McDaid. 2012. “Actions to Alleviate the Mental Health Impact of the Economic Crisis.” World Psychiatry 11 (3): 139–145. doi: 10.1002/j.2051-5545.2012.tb00114.x
Open DOI Search in Google Scholar Back to article
Yin, R. K. 2003. Case Study Research: Design and Methods. Thousand Oaks, CA: Sage.
Search in Google Scholar Back to article

Articles in this issue

DOI: https://doi.org/10.1080/15017419.2014.995220 | Journal eISSN: 1745-3011

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Language: English

Page range: 129 - 141

Submitted on: Apr 3, 2014

Accepted on: Oct 7, 2014

Published on: Jan 2, 2016

Published by: Stockholm University Press

In partnership with: Paradigm Publishing Services

Keywords:

community mental health,

free-choice market system,

implementation

© 2016 Maria Andersson, Mona Eklund, Mikael Sandlund, Urban Markström, published by Stockholm University Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 18 (2016): Issue 2