Privatisering av välfärdstjänster: hur garanteras kvalitet i vård och omsorg?

Abstract

In recent decades, the Swedish welfare system has come to involve more private actors. Swedish law, however, is still clear that health and social care should be characterized by good quality regardless of its mode of operation. A central concern has been how to politically ensure quality as welfare providers become more numerous and of different types. To what extent are politicians still able to monitor quality within private health- and social care? The article reviews several quality assurance mechanisms that are built into the privatization reforms: how contracts are speci- fied and monitored and how patients use their choices to send signals about care quality. A review of the literature illustrates the difficulty for politicians to formulate good contracts and follow them up. Also, patients’ choices are not a reliable source of information about care quality since they rarely make informed choices. Not being able to monitor quality in a proper way risks creating a legitimacy gap for the entire welfare system.