Monitoring Contracted Care in Sweden: Towards a Network Strategy

 In the 1990s, organizational mechanisms such as public procurement and user choice led to an entry of new private care providers in to Swedish elder care.  Similar debates can be found in the literature on public... [ view full abstract ]

 In the 1990s, organizational mechanisms such as public procurement and user choice led to an entry of new private care providers in to Swedish elder care.  Similar debates can be found in the literature on public contracting. So far, however, there has been a lack of data to provide support for either position. 

In this paper, we address the debate regarding the effects of contracting in welfare services by systematically examining the experiences from the elder care sector in Sweden. Drawing on a new and unique data set, we link ownership (public, non-profit, for profit) to a range of quality measures in elder care on both structural, processual and outcome level. The empirical results in the paper point to that there is in fact no relationship between ownership and care quality, which indicates that for-profit care providers do not offer either higher or lower quality, generally speaking, than public or non-profit ones. In the concluding discussion, we raise different explanations for this outcome, which contradicts most previous research on contracting and privatization in elder care. We point to the specific regulatory context in the Swedish case, where private actors become firmly embedded in local public systems for care provision, where they are subject to continuous monitoring through both formal and informal channels. A drawback of this form of extensively regulated markets may be, however, that incentives for quality development become weaker.