Why no Third Sector in Swedish Elder Care?
is predominantly comprised of for-profit companies. Non-profit actors such as
foundation and voluntary associations have not increased their share since the
early 1990s. This means that a desired diversity has been largely absent while the
choices available to the elderly is limited, which has come to be seen as a
problem of both conservative and social democratic governments. The project
examines the factors that influence the expansion of non-profit activities in the
elder care on both national and local level. By systematically investigating the
three hypothesized explanatory factors
1) political goals with respect to the nonprofit sector
2) the legal framework which regulates its activity in the elder care sector and
3) the historical role played by this sector prior to the development of
modern public systems for elder care
The project will contribute to a deeper understanding of the differing conditions for the non-profit sector both at the
national and local levels of governance. Methodologically international
comparative studies will be made in Sweden, Great Britain and Finland. The aim
is to explain why non-profit operators have been able to establish themselves
there, but not in Sweden, despite similar care in general. In addition, a websurvey
and case studies will be conducted in Swedish municipalities to find out
what hinders the establishment of non-profit actors.
2011-2016
The aim of this project has been investigate why the non-profit sector in Swedish elder care is so small, compared to other countries, and why it has remained underdeveloped even during recent decades, when there has been a political effort to increase its role. In 2015, its share of the total size of the elder care sector in Sweden, measured as the number of employees, was about 2.5%. This low figure, which has not increased since the early 1990s, is remarkable not least in light of the privatization trend that Swedish elder care has undergone, where the share of private care providers increased from 2-3% in 1993 to just above 20% in 2015. The marked increase in the share of private providers in the area after 1990 has thus been made up almost exclusively of commercially oriented firms.
The results from the project indicate that the small size of the non-profit sector in Swedish elder care should be understood as the outcome of at least three factors: the historically weak role of the church as a provider of social services in Sweden after the reformation in 1571, the insistence of Social Democratic reformers in the 1940s that the modern social service system they constructed be public and universal, which led to a further marginalization of the existing voluntary sector; and the adoption of New Public Management (NPM)-inspired legislation in the 1990s , when policy makers sought to re-introduce private providers in the area. That the legislation was inspired by the NPM doctrine implied that it was geared towards market-creation and economic efficiency, seeking create, above all, better conditions for competition and private entrepreneurship. This led to non-profit organizations having to compete with commercially oriented providers for public contracts; a competition that they in most cases have tended to lose. The fact that the non-profit sector in the area was already very small, with most organizations running relatively small-scale operations and having little interest in expansion or adoption of more competitive management practices, added to its difficulties to assert itself on what in effect became a highly competitive market for the delivery of elder care. Hence, it can be argued that it was a combination of these three circimstances, e.g. the weak historical legacy of the non-profit sector, policy choices during the post-war era in order to promote universalism, and the pro-competition regulation introduced after 1990, that has led to the continued marginalization of the non-profit sector in Swedish elder care.
The implication of this finding is that it might be hard to "re-create" a vital non-profit sector once it has been reduced. In addition, our results demonstrate how difficult it may be for non-profit organizations to compete on market terms with commercially oriented firms, especially if they have not had prior experience of formal contracting and public procurement processes. One a more general level, the project raises questions about the possibility of combining fully universalist welfare policies, which remains a central policy goal in Sweden, with a diversity of private care providers.
Publications
Blomqvist, P., Mankell, A., Winblad, U. (2015). ”Varför så få ideella aktörer inom äldreomsorgen?”. I: Anders Bäckström (red.) Välfärdsinsatser på religiös grund Skellefteå: Artos & Norma Bokförlag, s. 165-195.
Winblad U, Blomqvist P. (2013). ”Kundvalsmodeller i äldreomsorgen – kan de äldre välja?”. I: Rönnberg L, Strandberg U, Wihlborg E, Winblad U (red.) (2013). När förvaltning blir business – marknadens utmaningar för demokratin och välfärden. Linköping: Linköping University Electronic Press, s. 57-75.
Blomqvist, P. “NPM I välfärdsstaten – hotas universalismen?”, Statsvetenskaplig tidskrift, vol. 118, nr 1, s. 39-67.
Blomqvist, P. & Winblad, U., “Why no non-profits? The marketization of Swedish elder care” Inskickad till tidskriften Non-profit and Voluntary Sector Quarterly.
Konferensbidrag
Blomqvist, P., Mankell, A., Winblad, U. “Between the Market and the State: Non-Profit Organizations in Swedish Social Services”, Konferensbidrag presenterat på Normacare (Nordic research network on marketization in Eldercare), Stockholm 19-20 November, 2015.
Blomqvist, P., Mankell, A., Winblad, U.“Between the Market and the State: Non-Profit Organizations in Swedish Social Services”, Konferensbidrag presenterat vid Svenska Statsvetenskapliga förbundets årsmöte (Swepsa), Stockholm, 14-16 oktober 2015.
Winblad, U., Blomqvist, P. “Why no non-profits? The marketization of Swedish elder care”, konferensbidrag presenterat på Statsvetenskapliga förbundets årsmöte (Swepsa), Växsjö, 26-28 september 2012.
Blomqvist, P., Winblad, U. ”Privatiseringen av svensk äldreomsorg - vilka är effekterna?” Konkurrens och marknadsanpassning i offentlig förvaltning, Statsvetenskapliga årsmötet (Swepsa), Växsjö, 26-28 September 2012.
Winblad, U., Blomqvist, P. “Why no non-profits? The marketization of Swedish elder care”, konferensbidrag presenterat på Normacare, Stockholm, 30-31 januari 2012.
Winblad, U., Blomqvist, P. “Why no non-profits? The marketization of Swedish elder care”, konferensbidrag presenterat på the 5th Nordic Conference on Health Organization and Management, Köpenhamn, 13-14 januari 2011.