Active citizenship, public sector and the markets: Freedom of choice as a state project in health care

Abstract

Changing statehood concerns not only the spatial and territorial structures of the state but entails also reconceptualisations and reworking of citizenship. However, studies on state transformation have focused less on the ways in which the reconfigurations of the idea of citizenship are entangled with the political restructuring processes of the state. This article develops such an approach by inquiring into the ways in which state spatialities and forms of citizenship are reconstituted in health care reforms. This is empirically concretised in the context of Finland by analysing freedom of choice in health care as a political technology of re-regulation through which state power is redirected. It is also demonstrated that freedom of choice works as a technology of subjectification designed to construct ‘desirable’ citizen-subjects. The paper suggests that the reconstitution of state power and the production of new forms of citizenship are mutually constitutive of the socio-spatial transformation of the state, and that their entanglement may be examined through a context-sensitive analysis of tangible policy reforms.