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Privatization of social services: Quality differences in Swedish elderly care


  • Stolt, Ragnar
  • Blomqvist, Paula
  • Winblad, Ulrika


One of the major policy trends in recent decades has been the privatization of social services. This trend has also reached Sweden, a welfare state with health care and social service sectors that previously had almost no private providers. One of the most affected areas is elderly care, i.e. home-help services and residential care provided to citizens older than 65 years, where the proportion of private providers increased from 1% in 1990 to 16% in 2010. The ongoing privatization in Sweden and many other countries has raised important questions regarding the consequences of this policy transformation. In this paper, we present a cross-sectional study comparing the quality of services in private and public elderly care. Using statistics from 2007 displaying a variety of quality dimensions covering over 99% of all elderly care residents in Sweden, we were able to show that privatization is indeed associated with significant quality differences. Structural quality factors such as the number of employees per resident was significantly smaller (-9%) in private elderly care. On the other hand, the proportion of residents participating in the formulation of their care plan (+7%), the proportion of elderly with a reasonable duration between evening meal and breakfast (+15%), and the proportion of elderly offered different food alternatives (+26%) were significantly in favour of private contractors. Our conclusion is that private care providers seem to emphasize service aspects rather than structural prerequisites for good care.

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  • Stolt, Ragnar & Blomqvist, Paula & Winblad, Ulrika, 2011. "Privatization of social services: Quality differences in Swedish elderly care," Social Science & Medicine, Elsevier, vol. 72(4), pages 560-567, February.
  • Handle: RePEc:eee:socmed:v:72:y:2011:i:4:p:560-567

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    References listed on IDEAS

    1. Hillel Schmid, 2003. "Rethinking the policy of contracting out Social Services to non-governmental organizations," Public Management Review, Taylor & Francis Journals, vol. 5(3), pages 307-323, September.
    2. Germà Bel & Mildred Warner, 2008. "Challenging Issues in Local Privatization," Environment and Planning C, , vol. 26(1), pages 104-109, February.
    3. Vining, Aidan R. & Globerman, Steven, 1999. "Contracting-out health care services: a conceptual framework," Health Policy, Elsevier, vol. 46(2), pages 77-96, January.
    4. Stolt, Ragnar & Winblad, Ulrika, 2009. "Mechanisms behind privatization: A case study of private growth in Swedish elderly care," Social Science & Medicine, Elsevier, vol. 68(5), pages 903-911, March.
    5. Jeffry M. Netter & William L. Megginson, 2001. "From State to Market: A Survey of Empirical Studies on Privatization," Journal of Economic Literature, American Economic Association, vol. 39(2), pages 321-389, June.
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    Cited by:

    1. Thomas Akintayo & Niina Häkälä & Katja Ropponen & Elsa Paronen & Sari Rissanen, 2016. "Predictive Factors for Voluntary and/or Paid Work among Adults in their Sixties," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 128(3), pages 1387-1404, September.
    2. Barron, David N. & West, Elizabeth, 2017. "The quasi-market for adult residential care in the UK: Do for-profit, not-for-profit or public sector residential care and nursing homes provide better quality care?," Social Science & Medicine, Elsevier, vol. 179(C), pages 137-146.
    3. Meinow, Bettina & Parker, Marti G. & Thorslund, Mats, 2011. "Consumers of eldercare in Sweden: The semblance of choice," Social Science & Medicine, Elsevier, vol. 73(9), pages 1285-1289.
    4. Wisell, Kristin & Winblad, Ulrika & Sporrong, Sofia Kälvemark, 2015. "Reregulation of the Swedish pharmacy sector—A qualitative content analysis of the political rationale," Health Policy, Elsevier, vol. 119(5), pages 648-653.


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