Democratic Accountability in Strategic Coordination Bodies - An Investigation of Governance in Swedish Elder Care.

Staffan Johansson,Andreas Liljegren

doi:10.5334/ijic.4207

Staffan Johansson, Andreas Liljegren

Open Access

https://doi.org/10.5334/ijic.4207

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Abstract

The establishment of strategic coordination bodies with members from different agencies and that are governed by various laws and regulations can be understood as an answer to the demand for improved coordinated care for citizens with complex needs, such as frail older people. However, this demand raises fundamental questions of democratic control and accountability in the modern welfare state. Although these issues are addressed in current literature on network governance, they have not been investigated empirically very much.The aim of this paper is to investigate coordination bodies as important actors in integrated care, and especially to investigate how the members of these governance networks perceive their own influence and how they are held accountable by their principals.This study is conceptually built on theories of network governance and accountability. The empirical investigation is based on a survey with 545 respondents from 73 different coordination bodies in Sweden. The analysis shows that there seems to be an imbalance between perceived influence and perceived demands from different stakeholders to account for the services. This imbalance provides an opening for a discussion of how to improve the current situation for vulnerable groups and about new perspectives on accountability and power in the modern welfare state.

Highlights

Problem statement The coordination problems that occur around frail older people with multi-morbidity and around other vulnerable citizens with complex needs seem to be similar in many countries, regardless of which kind of welfare policies are applied [1]
Extensive research in the area of social policy shows that the services that are provided to many groups of vulnerable citizens with complex needs require effective coordination, in part because the responsible agencies belong to different principals and are governed by different laws and regulations [2,3,4]
Art. 2, page 5 of 10 throughout the entire county; others were responsible for some part of the county; and others were only responsible for a single geographical municipality, they held the responsibility for both social services and healthcare

Summary

Introduction

Problem statement The coordination problems that occur around frail older people with multi-morbidity and around other vulnerable citizens with complex needs seem to be similar in many countries, regardless of which kind of welfare policies are applied [1]. Extensive research in the area of social policy shows that the services that are provided to many groups of vulnerable citizens with complex needs require effective coordination, in part because the responsible agencies belong to different principals and are governed by different laws and regulations [2,3,4]. The Swedish government is one of many national governments that have launched policies for frail older persons with multi-morbidity, with the aim of preventing vulnerable citizens from “falling through the cracks” in the welfare system. It can be noted that the program has many similarities with ideas and evidence identified in previous research [see 6, 7]

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