This study investigates the required implementation of the System of Choice in the Swedish County Council of Västerbotten. The System of Choice is a national law with the objective to improve efficiency within primary care in Sweden. This was done by opening the market for more competition and giving the citizens the right to choose where to seek care. The reform was a big change for the organisation of health provision, which had up until the reform been characterized by monopolistic behaviour by county councils as dominant firms. At the time of this study it had been three years since the beginning of Health Choice, which is the name for the reform in Västerbotten. The aim of this research was to find out if the way in which Västerbotten County Council has chosen to shape Health Choice has led to the fulfilment of the objective of increased competition and thus higher motivation to perform quality care. This has been done by examining the development of the Health Choice and its reimbursement system through the eyes of the primary care providers. The study has further looked at the reasons underlying the result and ways to improve it. This area is not new ground for research. The organisation of health care is a popular topic all over the world since the population is growing and becoming older, thus putting increased pressure on the provision of health care (WHO, 2010, p. VI). Research has however showed that the optimal organisation of a reimbursement system for the primary care largely depends upon local conditions (Anell, 2005, p. 61). Since there is little previous in-depth information about the outcome of the Health Choice, the approach of this study has been inductive. Due to this exploratory and explanatory nature of the study a qualitative approach was applied. The data-collection has been done through 14 semi-structured interviews of about an hour each. To be able to catch the effects of the reimbursement system 11 of the interviews were conducted with health centre directors, representing both private and public providers as well as the different regions within the county council. The three other interviews were held with representatives from the county council and the supporting department for the Primary Care Group. The interviews generated transcribed text of 250 pages. This material was sifted and processed using the template analysis approach. The result shows that the county council‟s attitude to the Health Choice has negatively affected how it has been implemented. Too little resources have been spent on the purchasing department that is responsible for the development of the Health Choice and its reimbursement system. These factors have led to an organisation of Health Choice that discourages private providers to enter the primary care market in Västerbotten and there has thus only been a small increase in competition. A complex system with low continuity, lack of information and focus on the wrong things have led to the value of the reimbursement system as a motivational tool for increasing cost effectiveness and quality of care to be low.

This thesis investigates the impacts of user choice in Swedish elderly care on quality and cost as well as the impact of marketisation on the Covid-19 death toll. In the last three decades welfare service provision in Sweden has been increasingly marketised. Since 2009, Swedish municipalities have been able to introduce user choice in elderly care and it has been widely adopted in home care. To investigate the impact of introducing user choice, new insights from econometrics literature is used to estimate a staggered Difference-in-Difference model, using panel data for the years 2003-2019 and the 290 Swedish municipalities. The impact of marketisation on the Covid-19 death toll is estimated through Ordinary Least Squares using a cross-sectional data set. There are three main findings of this thesis. (i) The impact on quality and cost of the introduction of user choice has had heterogeneous effects across adoption groups, calendar time, and exposure length of treatment, and hence, the standard Difference- in-Difference approach is likely to provide biased estimates in this setting. (ii) The introduction of user choice has no clear effect on non-contractible quality measured by mortality rate and fall accidents, nor on cost. However, user choice has increased subjective quality, as measured by user satisfaction. (iii) A higher degree of marketisation in home care is associated with a higher Covid-19 death toll amongst those which had home care.

<p>The overriding purpose of this graduate thesis is to evaluate if municipalities and county councils can deviate from the legislation of public procurement during procurement of customer choice agreements within the health and social care area. The intention of this Quasi-market is to provide the users with competition in terms of quality rather then the general principal rule of economic value.</p><p>My conclusion results in a legal situation without rules of general procedure. So far the authorities make their own regulation in the field of customer choice agreements. The problem lies within the authorization of new contractors and their right to make an appeal against resolutions made by the authorities social care divisions.</p><p>One solution is to legislate within the present law of public procurement. Another way to solve the problem is to create a lex specialis apart from the present public procurement regulation.</p> / <p>Det generella syftet med detta examensarbete är att utreda om kommuner och landsting kan frångå upphandlingsregleringen vid tillsättningar av kundvalsföreträdande tjänster, vilken påverkan kundvalssystem har på mindre oetablerade företag samt hur detta påverkar det traditionella upphandlingssystemet. I samband med att två nya EG-direktiv på upphandlingsområdet inte implementerats i svensk rätt inom den angivna tidsfristen, belyses frågan ur både ett de lege lata- och de lege ferendaperspektiv.</p><p>Uppsatsen uppdelas i tre sammankopplade avsnitt där det första utgör bakgrund för studien. I det andra kapitlet påvisas gällande rätt utifrån ett deskriptivt förhållningssätt för att i det tredje penetrera kundvalssystemet utifrån ett mer praktiskt, analyserande, perspektiv. Denna sammanställning har utmynnat i följande slutsatser.</p><p>Kundvalssystem har sedan starten i början på 1990-talet utvecklats till att bli ett användbart alternativ till traditionella upphandlingsförfaranden och till stor del har frågan om laglig tillämplighet förbisetts. För att upprätthålla ett rättssäkert förfarande bör sannolikt officiella procedurregler skapas för att undvika en splittrad kvalitet och en olikartad bedömning mellan de olika kommunerna och landstingen i Sverige.</p><p>Ett ökat entreprenörskap kan resultera i högre kvalitet och ökad effektivitet, som i förlängningen genererar lägre kostnader. Ur ett genusperspektiv främjar systemet kvinnligt företagande genom att bidra till privatiseringen av den historiskt sett kvinnodominerande yrkeskategorin.</p><p>Jag anser med stöd av det anförda, att kundvalssystemet kan utmynna i en utvidgning av LOU, där ett ytterligare förenklat upphandlingsförfarande tillser att marknaden konkurrensutsätts vilket tryggar sättssäkerheten vid tillsättningen av leverantörerna och ger en möjlighet till överprövning. Alternativet är främst att lagreglera området separat vilket medför en skräddarsydd reglering genom hela förfarandet, men detta kan medföra en längre lagstiftningsprocess.</p>

Since the end of the 1980s, the introduction of market mechanisms in the public sector has been a dominant feature in Sweden. The same is true for the social services in several municipalities, where business style behaviour and organisation, and competition have become salient features of market-oriented social services. The aim of the study is to describe and analyse: the structural conditions for market oriented personal social services; how social workers pursue client centred work in market oriented personal social services; the consequences of this market orientation on the personal social services. The empirical study is a case study of the personal social services in the municipality of Linköping. The purchaser-provider model in Linköping is one of the most advanced and discussed in Sweden. The research comprises a quantitative pilot study and a qualitative main study. The main study is based on twenty semi-structured interviews with experienced social workers and their immediate superiors. The analysis of the interviews reveals that the personal social services are only achieving to a lesser extent the ends that a quasi-market, theoretically, should achieve. The conditions that have to be satisfied to achieve the ends of the quasi-market are only partly met. Bureaucratic control is one important reason why the personal social services are imperfect as a quasi- market. The re-organisation has resulted in a number of, to some extent, positive consequences. The re-organisation has, however, also resulted in some negative consequences. In the thesis these are categorised in terms of fragmentation, antagonism and obscurity. A linguistic change, in market oriented personal social services, appears to have influenced social workers to think and act differently in relation to their work. The most important conclusion drawn from the study is that the market oriented personal social services partly function as a responsive quasi-market for strong, rational and well- informed clients. However, in relation to the most vulnerable, it is failing in many respects. / digitalisering@umu

The overriding purpose of this graduate thesis is to evaluate if municipalities and county councils can deviate from the legislation of public procurement during procurement of customer choice agreements within the health and social care area. The intention of this Quasi-market is to provide the users with competition in terms of quality rather then the general principal rule of economic value. My conclusion results in a legal situation without rules of general procedure. So far the authorities make their own regulation in the field of customer choice agreements. The problem lies within the authorization of new contractors and their right to make an appeal against resolutions made by the authorities social care divisions. One solution is to legislate within the present law of public procurement. Another way to solve the problem is to create a lex specialis apart from the present public procurement regulation. / Det generella syftet med detta examensarbete är att utreda om kommuner och landsting kan frångå upphandlingsregleringen vid tillsättningar av kundvalsföreträdande tjänster, vilken påverkan kundvalssystem har på mindre oetablerade företag samt hur detta påverkar det traditionella upphandlingssystemet. I samband med att två nya EG-direktiv på upphandlingsområdet inte implementerats i svensk rätt inom den angivna tidsfristen, belyses frågan ur både ett de lege lata- och de lege ferendaperspektiv. Uppsatsen uppdelas i tre sammankopplade avsnitt där det första utgör bakgrund för studien. I det andra kapitlet påvisas gällande rätt utifrån ett deskriptivt förhållningssätt för att i det tredje penetrera kundvalssystemet utifrån ett mer praktiskt, analyserande, perspektiv. Denna sammanställning har utmynnat i följande slutsatser. Kundvalssystem har sedan starten i början på 1990-talet utvecklats till att bli ett användbart alternativ till traditionella upphandlingsförfaranden och till stor del har frågan om laglig tillämplighet förbisetts. För att upprätthålla ett rättssäkert förfarande bör sannolikt officiella procedurregler skapas för att undvika en splittrad kvalitet och en olikartad bedömning mellan de olika kommunerna och landstingen i Sverige. Ett ökat entreprenörskap kan resultera i högre kvalitet och ökad effektivitet, som i förlängningen genererar lägre kostnader. Ur ett genusperspektiv främjar systemet kvinnligt företagande genom att bidra till privatiseringen av den historiskt sett kvinnodominerande yrkeskategorin. Jag anser med stöd av det anförda, att kundvalssystemet kan utmynna i en utvidgning av LOU, där ett ytterligare förenklat upphandlingsförfarande tillser att marknaden konkurrensutsätts vilket tryggar sättssäkerheten vid tillsättningen av leverantörerna och ger en möjlighet till överprövning. Alternativet är främst att lagreglera området separat vilket medför en skräddarsydd reglering genom hela förfarandet, men detta kan medföra en längre lagstiftningsprocess.

Il lavoro si propone di rendere conto del ruolo dell’associazionismo di auto-mutuo aiuto (self-help) nel contesto del modello di welfare regionale lombardo, il “quasi mercato”. Questa forma associata vive una nuova stagione di sviluppo e dimostra di essere una delle risposte possibili ai recenti mutamenti dei sistemi di welfare, soprattutto in un contesto socio-demografico caratterizzato dall’invecchiamento della popolazione, dalla riduzione dei componenti delle famiglie e dal prevalere di malattie croniche e di disabilità. L’associazionismo di auto-mutuo aiuto si dimostra una delle risorse emergenti della società civile, capace di trasformare soggetti passivi e marginalizzati in cittadini attivi e responsabili; è più difficile capire quale sia il suo ruolo all’interno della governance locale, in termini di partecipazione. La ricerca presenta un quadro complesso, in cui il self-help riesce a promuovere innovazioni capaci di divenire risorse per il territorio locale, ma anche una certa incapacità di essere valorizzate presso le istituzioni locali, in ragione della fragilità istituzionale di cui soffre ancora questo tipo di associazionismo. / Purpose of the present study is to explain the role played by self-help associations within the Lombardia regional welfare model, the so-called ‘quasi-market’. Such associative forms are undergoing a whole new deal of development and prove to be one of the possible answers to the recent changes typical of the welfare systems, especially in a socio-demographic context characterized by ageing processes, decrease in the number of family members, prevailing of chronic diseases and disabilities. Self-help associations prove to be one of the resources emerging from civil society, able to transform passive subjects into active and responsible citizens. However, it is still difficult to understand what role they play in the local governance, in terms of participation. Major finding of the research is a complex picture, where self-help associations are able, on the one hand, to encourage innovations able in their turn to become resources for the local communities; on the other hand, they still show a certain inability to be fully appreciated by the local institutions because of the institutional fragility that still characterize these specific associations.

Made available in DSpace on 2014-06-11T19:33:30Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-03-08Bitstream added on 2014-06-13T20:05:28Z : No. of bitstreams: 1 souza_sc_dr_mar.pdf: 342666 bytes, checksum: e1c25384de780d5b41981ec451ad40f0 (MD5) / Realizado mediante procedimentos de pesquisa bibliográfica e pesquisa documental, o presente trabalho analisa as evidências da presença do quase-mercado na política educacional brasileira. Analisa, em particular, na legislação e nos documentos de apresentação e divulgação das políticas educacionais, as concepções de gestão, avaliação educacional e formação de professores, buscando identificar possíveis convergências de sentido e compromissos com a implantação de mecanismos de quasemercado. Inicialmente, apresenta uma análise do surgimento do quase-mercado no contexto da nova gestão pública nos países centrais. Na seqüência, examina o movimento de reforma do Estado brasileiro, revelando a emergência do mercado nesse contexto. Apresenta a reforma educacional como elemento da reforma do Estado, evidenciando a similaridade de objetivos. Em seguida, revela as novas articulações entre público, privado e público-não-estatal. Por fim, apresenta os resultados da pesquisa documental apontando as concepções de gestão educacional, avaliação da educação básica e formação de professores e sua convergência com o ideário de implantação de mecanismos de quase-mercado educacional / The present paper examines the evidence for the presence of quasi-market in the Brazilian educational policy through a bibliographic and documentary research. It examines, particularly, in legislation and in documents for presentation and dissemination of the educational policies, management concepts, educational assessment and teacher training, aiming at identifying possible convergences of meaning and commitment to the implementation of quasi-market mechanisms. Initially, it presents an analysis of the quasi-market emergence in the context of new public management in the central countries. Then, it shows the reform movement of the Brazilian state, revealing the emergence of the market in this context. It presents the educational reform as part of the state reform, highlighting the similarity of objectives. After that, it reveals new connections among public, private and public non-state. Finally, it presents the results of the document research pointing the concepts of educational management, evaluation of basic education and training of teachers and their convergence on the ideal deployment of quasi-market mechanisms in education

Orientador: Maria Sylvia Simões Bueno / Banca: Graziela Zambão Abdian Maia / Banca: Iraíde Marques de Freitas Barreiro / Banca: Theresa Maria de Freitas Adrião / Banca: Pedro Ganzeli / Resumo: Realizado mediante procedimentos de pesquisa bibliográfica e pesquisa documental, o presente trabalho analisa as evidências da presença do quase-mercado na política educacional brasileira. Analisa, em particular, na legislação e nos documentos de apresentação e divulgação das políticas educacionais, as concepções de gestão, avaliação educacional e formação de professores, buscando identificar possíveis convergências de sentido e compromissos com a implantação de mecanismos de quasemercado. Inicialmente, apresenta uma análise do surgimento do quase-mercado no contexto da nova gestão pública nos países centrais. Na seqüência, examina o movimento de reforma do Estado brasileiro, revelando a emergência do mercado nesse contexto. Apresenta a reforma educacional como elemento da reforma do Estado, evidenciando a similaridade de objetivos. Em seguida, revela as novas articulações entre público, privado e público-não-estatal. Por fim, apresenta os resultados da pesquisa documental apontando as concepções de gestão educacional, avaliação da educação básica e formação de professores e sua convergência com o ideário de implantação de mecanismos de quase-mercado educacional / Abstract: The present paper examines the evidence for the presence of quasi-market in the Brazilian educational policy through a bibliographic and documentary research. It examines, particularly, in legislation and in documents for presentation and dissemination of the educational policies, management concepts, educational assessment and teacher training, aiming at identifying possible convergences of meaning and commitment to the implementation of quasi-market mechanisms. Initially, it presents an analysis of the quasi-market emergence in the context of new public management in the central countries. Then, it shows the reform movement of the Brazilian state, revealing the emergence of the market in this context. It presents the educational reform as part of the state reform, highlighting the similarity of objectives. After that, it reveals new connections among public, private and public non-state. Finally, it presents the results of the document research pointing the concepts of educational management, evaluation of basic education and training of teachers and their convergence on the ideal deployment of quasi-market mechanisms in education / Doutor

Syftet med denna studie är att förklara varför en segregerad skola läggs ner och vad som händer med elever som ofrivilligt möter en ny skolkultur. Jag vill förtydliga de politiska besluten som legat till grund för förändringen och vilka konsekvenser beslutet får för eleverna. Syftet är också att belysa vilken betydelse en annan skolkultur med ett inkluderande arbetssätt har för de elever som tvingas byta skola mitt under högstadiet.   Som kvalitativ metod för datainsamling har jag valt intervjuer med ansvariga politiker samt med ett antal elever som tvingats byta skola. Dessutom har jag gjort uppföljningar av trivselenkäter och betygsresultat för de berörda eleverna jämfört med de elever i samma årskurs som inte gått på mottagande skola under hela högstadiet.   Politikernas avsikt med att lägga ner skolan var att bryta segregationen och de sjunkande elevresultaten. Man ville också, via en omläggning av flera verksamheter, använda de nyrenoverade lokalerna bättre. Lyckades man då med sitt beslut? Resultatet visar att betygsresultaten förbättrades för de elever som bytt skola, t o m mer än för eleverna i referensgruppen. Eleverna säger att de känner sig välkomna på den nya skolan, de uppskattar framförallt lärarna och tycker att undervisningen är bättre. Men de får inte så många nya vänner och flera säger att de längtar tillbaka till sin gamla skola.   Utifrån studiens resultat kan vi dra följande slutsatser. Politikerna lyckades med sin avsikter och känner sig nöjda med beslutet flera år senare, även om man erkänner att det funnits brister i informationen. Att lägga ner en skola är både ovanligt och äventyrligt. Ur ett elevperspektiv är det inte optimalt att tvingas byta skola mitt under högstadiet. Även om det går bra för deras resultat blir den nya skolan aldrig riktigt deras. / The purpose of this study is to explain why a public high school in Växjö, Sweden, dealing with issues of segregation and falling results, closed down and what happened to the students who involuntarily had to change schools and meet a new school culture. I want to clarify the politicians’ reasons that formed the basis for the decision and the consequences of the decision for the students. The study also aims to highlight the importance of a school culture with an inclusive approach for students who are forced to change schools in the middle of high school.   As qualitative methods for data collection, I have chosen interviews with the politicians and a number of the affected students. Additionally, the students’ results and their well-being (as expressed by the students themselves in surveys) after changing schools were followed and compared to a reference group of students in the same grade who also hadn’t been attending the receiving school from the start of high school.   The politicians’ intent when deciding to close down the school was to break the segregation and the long-term trend of falling results. Moreover, they wanted to improve the usage of some newly renovated facilities through a reorganization of several activities. So, did the politicians achieve what they hoped when drafting this unusual and risky decision? In this study, I show that the affected students improved their grades, their improvement being even larger than the students in the reference group. Additionally, students expressed through the surveys that they felt welcome in the new school, that they appreciated the teachers and found the teaching in their new school better than previously. However, they also expressed troubles making new friends and some were longing to return to their old school.   My conclusions from this study are the following: The politicians succeeded with their intentions and feel satisfied with the decision several years later, although acknowledging that there had been shortcomings regarding the information they distributed to the students and their parents. From a student perspective, it is not optimal to have to change schools in the middle of high school. Even though they improved their grades after the change, they never felt completely at home in their new school.

Cette thèse traite des réformes et des politiques éducatives mises en place au Royaume-Uni après l’arrivée au pouvoir des nouveaux travaillistes en 1997. À la suite de la dévolution, deux Assemblées furent créés en 1999, l’une au Pays de Galles, et l’autre en Irlande du Nord, et l’Écosse se dota d’un Parlement. Cela entraîna la pérennisation des différences qui existaient entre les systèmes éducatifs du Royaume-Uni, la gestion de chaque système éducatif étant confiée à ces nouvelles institutions. La thèse analyse en profondeur les évolutions et les transformations générées au sein des différents systèmes éducatifs entre 1997 et 2010 (période de gouvernance des nouveaux travaillistes), et dégage les divergences et/ou rapprochements qui en ont découlé. Elle montre comment chacune des quatre nations a fait évoluer sa politique éducative, tout en tenant compte des réformes qui furent mises en place par les précédents gouvernements, ces changements ayant déjà profondément bouleversé l’organisation des systèmes éducatifs (New Public Management/autonomie des écoles). Certaines réformes antérieures à la période d’étude, qui modifièrent profondément le modèle de fonctionnement et l’organisation de ces systèmes éducatifs, sont également abordées car les gouvernements du début des années 2000 durent en tenir compte lors de l’élaboration de leurs projets éducatifs. Cette étude comparative tente aussi de définir l’efficacité des réformes en matière de performance scolaire et d’égalité des chances. / This thesis deals with the reforms and education policies that were implemented in the United Kingdom after the arrival of New Labour in 1997. Following devolution, two Assemblies were created in 1999, one in Wales, and one in Northern Ireland, and Scotland had a Parliament. This led to the persistence of the differences that existed between the education systems of the United Kingdom, the management of each education system being entrusted to these new institutions. The thesis analyses in depth the evolutions and the transformations generated within the different education systems between 1997 and 2010 (period of governance of New Labour), and reveals the divergences and/or convergences that ensued. It shows how each of the four nations has changed its education policy, while taking into account the reforms that were put in place by previous governments, these changes having already profoundly changed the organisation of these education systems (New Public Management/Local management of schools). Some reforms, prior to the period under study, which profoundly changed the organisation of these education systems, are also discussed because the governments in the early 2000s had to take them into account when developing their education projects. This comparative study also attempts to define the effectiveness of reforms in school performance and equal opportunities.