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Marketisation in Nordic Eldercare Eds. Gabrielle Meagher and Marta Meagher and Eds. Gabrielle Szebehely Stockholm Studies in Social Work 30 ISSN 0281-2851 ISBN 978- 91-637-3213-3 Department of Social Work The Nordic countries share a tradition of universal, tax-financed eldercare services, centred on public provision. Yet Nordic eldercare has not escaped Stockholm Studies in Social Work 30 the influence of the global wave of marketisation in recent years. Market- inspired measures, such as competitive tendering and user choice mo- Marketisation in Nordic eldercare: dels, have been introduced in all Nordic countries, and in some countries, a research report on legislation, oversight, extent and consequences there has been an increase of private, for-profit provision of care services. This report is the first effort to comprehensively document the process Edited by Gabrielle Meagher and Marta Szebehely of marketisation in Sweden, Finland, Denmark and Norway. The report seeks to answer the following questions: What kinds of market reforms Marketisation in Nordic eldercare: a research report on legislation, oversight, extent consequences and oversight, report legislation, on a research eldercare: Nordic in Marketisation have been carried out in Nordic eldercare systems? What is the extent of privately provided services? How is the quality of marketised eldercare monitored? What has the impact of marketisation been on users of elder- Stockholm 2013 care, on care workers and on eldercare systems? Are marketisation trends similar in the four countries, or are there major differences between them? The report also includes analyses of aspects of marketisation in Canada and the United States, where there is a longer history of markets in care. These contributions offer some perhaps salutary warnings for the Nordic countries about the risks of increasing competition and private provision in eldercare. The authors of this report, representing seven countries, are all mem- bers of the Nordic Research Network on Marketisation in Eldercare (Normacare). The report has been edited by Professor Gabrielle Meagher, University of Sydney and Professor Marta Szebehely, Stockholm Univer- sity. Our hope is that the report will provide both a foundation and an inspiration for further research on change in Nordic eldercare. Bildyta Department of Social Work Stockholm University S-106 91 Stockholm www.socarb.su.se Stockholm Studies in Social Work Marketisation in Nordic eldercare: a research report on legislation, oversight, extent and consequences Edited by Gabrielle Meagher and Marta Szebehely SSW 30 Marketisation in Nordic eldercare: a research report on legislation, oversight, extent and consequences Edited by Gabrielle Meagher and Marta Szebehely © 2013 individual authors ISSN 0281-2851 ISBN 978-91-637-3213-3 Printed in Sweden by US-AB, Stockholm 2013 Distributor: Department of Social Work, Stockholm University Contents Contributors ...................................................................................................................... 9 Preface ............................................................................................................................ 11 Chapter 1 Mapping marketisation: concepts and goals .................................. 13 Anneli Anttonen and Gabrielle Meagher 1. Introduction .................................................................................................................. 13 2. Why study marketisation? .............................................................................................. 14 3. Defining marketisation .................................................................................................. 16 4. Mapping and comparing marketisation in four Nordic countries ....................................... 18 References ....................................................................................................................... 21 Chapter 2 Marketising trends in Swedish eldercare: competition, choice and calls for stricter regulation ...................................................................... 23 Sara Erlandsson, Palle Storm, Anneli Stranz, Marta Szebehely and Gun-Britt Trydegård 1. Introduction .................................................................................................................. 23 2. Legislation and instruments of marketisation ................................................................... 26 3. Regulations and oversight of public and private providers ................................................ 33 4. The extent of marketisation in Sweden ............................................................................ 47 5. Consequences of marketisation ...................................................................................... 57 6. Concluding discussion ................................................................................................... 70 References ....................................................................................................................... 75 Chapter 3 Marketisation of eldercare in Finland: legal frames, outsourcing practices and the rapid growth of for-profit services ................... 85 Olli Karsio and Anneli Anttonen 1. Introduction .................................................................................................................. 85 2. Finnish eldercare services: general traits ......................................................................... 86 3. Eldercare service provision in Finland ............................................................................ 88 4. Legislation and other instruments of marketisation .......................................................... 92 5. Regulation and oversight ............................................................................................. 104 6. Extent of marketisation ................................................................................................ 107 7. Some consequences ..................................................................................................... 115 8. Conclusion ................................................................................................................. 117 References ..................................................................................................................... 120 Appendix 1 .................................................................................................................... 125 Chapter 4 Marketisation in eldercare in Denmark: free choice and the quest for quality and efficiency .................................................................... 127 Tilde Marie Bertelsen and Tine Rostgaard 1. Introduction ................................................................................................................ 127 2. Eldercare in Denmark .................................................................................................. 128 3. Legislation enabling and regulating marketisation .......................................................... 130 4. Instruments and models of marketisation ...................................................................... 132 5. Forms of regulation and oversight of providers .............................................................. 140 6. Extent of marketisation in eldercare .............................................................................. 142 7. Consequences of introducing marketisation ................................................................... 152 8. Conclusion ................................................................................................................. 156 References ..................................................................................................................... 157 Chapter 5 Marketisation in Norwegian eldercare: preconditions, trends and resistance .............................................................................................. 163 Mia Vabø, Karen Christensen, Frode Fadnes Jacobsen and Håkon Dalby Trætteberg 1. Introduction ................................................................................................................ 163 2. The institutional and legal context of Norwegian eldercare ............................................. 164 3. Competing trajectories of reform .................................................................................. 166 4. Laws and regulations of relevance for marketisation........................................................... 175 5. The scope of private provision ..................................................................................... 179 6. Marketisation – a contested issue .................................................................................. 185 7. Impacts of marketisation – also a contested issue ........................................................... 188 8. Discussion and conclusion ........................................................................................... 195 References ..................................................................................................................... 197 Chapter 6 The regulatory trap: Reflections on the vicious cycle of regulation in Canadian residential care ........................................................ 203 Albert Banerjee 1. Introduction: the trap of regulating care work ................................................................ 203 2. The paradox of regulation: tensions between regulation
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