From Welfare State to Welfare Society

Over the past 20 years, the production of welfare services in Sweden has undergone far-reaching transformation. Competition and choice have been introduced in a number of areas, and private producers have joined the public sector in providing services. The purpose of this programme was to provide research-based insights that can contribute to improvements in the production system for welfare services.

The projects mainly addressed management and quality control aspects (compensation systems, market dynamics and quality measurement). Together, they provide a description of the change process on the national, county and municipal level, and an analysis of the effects of introducing competition and private producers.

The programme was a collaboration between SNS and the Research Institute of Industrial Economics (IFN).

Publications

Management Quality in the Production of Welfare Services

In this project the quality of management practices in Swedish nursing homes, primary health care centres and schools is assessed. The aim is to gain a better understanding of the level of management quality within the production of welfare services and how public procurement and user choice models should be designed in order to create incentives for quality improvements.

Researchers: Jannis Angelis, associate professor, Industrial Economics and Management, KTH Royal Institute of Technology and IFN; Henrik Jordahl, associate professor, IFN and Uppsala University.

Information and School Choice

In order for school choice to work effectively, parents and students must be well informed and make a choice based on assessments of quality. This report reviews research findings on how different types of information about schools are used by parents and students, but also by teachers, school administrators and funding sources. The report concludes with a discussion of what problems need to be resolved in order to create a well-functioning information system in education.

Researchers: Henrik Jordahl, associate professor of economics, IFN; Gabriel Heller Sahlgren, Centre for Market Reform of Education, Institute of Economic Affairs and IFN.

Effects of User Choice in Primary Care

Swedish primary care is one example of a field in which reforms in recent years have been aimed at strengthening the position of the individual in health care and at increasing diversity among care providers. Since 2010, it is mandatory for the county councils to ensure user choice and freedom of establishment for care providers. The aim of the study is to analyse and discuss effects of user choice in primary care with a particular focus on outcomes in terms of quality of care.

Researcher: Anna Häger Glenngård, PhD in business administration, Lund University.

Compensation in Health Care: Models, Effects, Recommendations

The report gives an overview of the reimbursement models used in Swedish health care. The underlying principles of each model are described and analysed, and a review of the empirical research literature on the effects of models is provided.

Researcher: Peter Lindgren, MD, IVBAR, affiliated with the Medical Management Centre at Karolinska Institutet.

Welfare Services: Authorization, Oversight and Monitoring

The aim of this study is to describe the Swedish regulation of publicly funded welfare services in terms of authorization, oversight and monitoring. The report covers welfare services within the the fields of health care, elderly care, support and service for the disabled, education and youth care.

Researcher: Eva Hagbjer, doctoral student in business management, Department of Accounting and Finance, Stockholm School of Economics.

Private Production of Publicly Funded Services: Driving Forces and Development

The Swedish welfare model is characterized by public funding, as well as by an increasing degree of competition between providers and user choice. How did this model develop? Why are there variations between different parts of the country and between different services? What has been the role of politicians at the national and local level, provider organizations and the users of these services?

This anthology gives a description of the process of privatization of welfare production in Sweden since the 1980s, with a focus on national reforms and local initiatives. Furthermore it explores a number of potential explanations for regional and local variations in the degree of privatization of different services.

Researchers: Mikael Elinder, PhD, Uppsala University; David Isaksson, doctoral student, Uppsala University; Henrik Jordahl, associate professor, IFN; Anders Lindbom, professor, Uppsala University; Heléne Lundqvist, PhD, Stockholm University; Ulrika Winblad, associate professor, Uppsala University; and Richard Öhrvall, doctoral student, Linköping University and IFN.

SNS Analys no. 13. Lessons from the UK on Competition in Health Care

Quality improved when choice was introduced in health care in the UK. That is one of the findings presented in an overview of professor Carol Propper’s research on the lessons from health care reforms in the UK over the past 25 years.

Researcher: Carol Propper, professor of economics at the University of Bristol and Imperial College Business School.

SNS Analys no. 11. Private Providers of Public Job Agency and Rehabilitation Services

There is no clear evidence that private-sector providers of labour market policy measures are better at getting people into jobs than public-sector providers. However, there is some support indicating that private alternatives are better at innovation and individually-tailored solutions.

These are the findings in this overview of two current reports by researchers at the Institute for Evaluation of Labour Market and Education Policy (IFAU), one by Helge Bennmarker, Erik Grönqvist and Björn Öckert and the other by Lisa Laun and Peter Skogman Thoursie.

Author: Richard Öhrvall, doctoral student in political science at Linköping University and IFN.

Previous publications

SNS ANALYS: THE LONG-TERM EFFECTS OF THE FREE-SCHOOL REFORM ON EDUCATIONAL RESULTS The free-school reform meant freedom of choice for the pupils, the establishment of new schools and subjecting the municipal schools to competition. In the study presented here, the economists Anders Böhlmark and Mikael Lindahl investigate what the effects of the reform have been on pupils’ educational results in the short and the long run. They find that the average result improves in municipalities with a larger share of free schools. The improvements include pupils in both municipal schools and free schools. Read more.

PRE-STUDY: THE CONSEQUENCES OF COMPETITION. WHAT IS HAPPENING TO SWEDISH WELFARE? In a programme pre-study, the anthology Konkurrensens konsekvenser. Vad händer med svensk välfärd? (The Consequences of Competition. What is happening to Swedish Welfare?) (Hartman 2011) presented a survey of the extent of privatization within six central areas of welfare: preschool, school, individual and family care, health- and medical care, labour market policy as well as care for the elderly and disabled. An inventory was made of available research and statistics on the effects of competition in the production of welfare services, in terms of quality, cost efficiency and distribution. The most important conclusion of the pre-study was that there is a remarkable lack of knowledge about the effects of competition in the Swedish welfare sector. Read more.

Facts about the project

Previous conferences

November 8-2012: Modeller för upphandling av välfärdstjänster
November 15-2012: Vad säger brukarnöjdhet om kvalitet i välfärdstjänster?
December 4-2012: SNS Analys: Lyfter friskolorna svenska elever?
January 23-2013: Arbetarrörelsen och vinsten i välfärden
March 6 -2013: Så kan information om resultat och kvalitet förändra sjukvården
March 26-2013: SNS Väst: Modeller för upphandling av välfärdstjänster
June 5-2013: Nya ägarregler för fristående skolor
September 6-2013: Konkurrens i sjukvården: Vad kan vi lära av England?
November 6-2013 Privatiseringar i kommuner med vänsterstyre – en splittrad socialdemokrati
November 13-2013 Ny forskningsrapport om privatiseringens framväxt och drivkrafter
January 20-2014 Effekter av LOV på kvalitet, kostnader och effektivitet inom äldreomsorgen
January 29-2014 SNS Malmö/Lund: Välfärdstjänster i privat regi: framväxt och drivkrafter
February 21-2014 Vad har vi lärt av 25 år med privat äldreomsorg?
March 25-2014 Hur säkras välfärdstjänsternas kvalitet?
April 2-2014 Så fungerar den ekonomiska styrningen av hälso- och sjukvården
May 14-2014 eHälsolösningar kan bidra till radikalt förbättrad vård
June 29-2014 SNS i Almedalen: Att styra och leda äldreomsorg. Hur går det till och vad kan förbättras?
October 10-2014 Att styra och leda äldreomsorg. Hur går det till och vad kan förbättras?
December 9-2014 Så förbättrar vi vården för patienter med kroniska sjukdomar
February 16-2015 Ägarprövningsutredningen
June 10-2015 Påverkar skolors styrning och ledning elevernas resultat?
February 25-2016 Att styra och leda en vårdcentral. Hur går det till och vad kan förbättras?

Funding and reference group

The reference group consisted of Catharina Barkman, Stockholm County Council (the chairman of the reference group), Henrik Borelius, Attendo, Mats Brandt, Ministry of Finance, Henrik Brehmer, Capio, Peje Emilsson, Magnora, Leif Eriksson, Täby municipality, Sari Eriksson, Katrineholm municipality, Daniel Forslund, Vinnova, Samir Kamal, EQT, Mats Kinnwall, SKL, Carola Lemne, Praktikertjänst, Magnus Lindquist, Triton, Anna Manhem, Swedish Agency for Economic and Regional Growth, Eva Mörk, Uppsala University/SNS Scientific Council, Fredrik Näslund, Nordic Capital, Anna Pauloff, The Swedish Agency for Public Management, Stefan Stern, Investor, Christina Sterner, Diaverum, Kristina Ström Olsson, Insurance Sweden, Mattias Svantesson, Swedish Schools Inspectorate, Per Törnvall, Nordic Healthcare Group, Hans Wikse, Procuritas and Martin Ärnlöv, Bräcke Diakoni. Additional members might be included later. The project is funded by research grants from AFA Insurance, Sven och Dagmar Saléns stiftelse, Aleris, Axcel, IK Investment Partners, Team Olivia, Valedo Partners and contributions from the reference group.

Time frame

The programme started in 2010 and ended 2016.