Editorial Introduction

Abstract

‘Choice, choice and more choice’ has been a buzzword in many welfare states around Europe in recent years. This has transformed the welfare states in the direction of a more market-oriented approach, changed users into consumers and increased the emphasis on private providers. Expectation of higher responsiveness from the provider has been part of the reasons for change. Delivery of welfare services has in many countries seen a split between who finances and who provides. Furthermore, the starting point for this development has been the constant focus on increased effectiveness of the public sector in all types of welfare states. The boundary between the public and private sectors is consequently less distinct than it used to be. More choice has been linked to an increase in competition between welfare providers, including also areas with public delivery only, ensuring intra-organizational competition. Competition has been introduced in various ways, including the application of per-user funding, vouchers and tax credits. However, the establishment of free choice has rarely been associated with an analysis of the consequences of introducing choice. These consequences relate to whether free choice in fact increases competitiveness, improves efficiency, changes user empowerment or has an impact on equality of access to central welfare services. Neglected in the analysis has thus often been the possibly negative impact of choice, including the potential increase in stress when people are obliged to choose. Questions about whether transaction costs have increased more than any possible efficiency gain have received more scant attention. This issue of Social Policy & Administration describes and analyses recent change with regard to free choice from a theoretical and empirical perspective. Theoretically, this is done by discussing conditions for choice and, especially, the Third Way understanding of the impact of choice. Empirically, it is done by concrete analysis of a variety of choices in the welfare states in Europe, and also of specific sectors (such as education, health, day care and long-term care) in the welfare states, including choice of provider and type of services. Gender implications and the impact of choice are also central to several articles in this Special Issue. The combination of theoretical and empirical articles, within different spheres of the welfare states, informs us about core changes in the welfare states including the actual use of choice, and why choice is used or not used. Empirical analysis is needed because equality, for example, cannot only be understood and measured with regard to economic parameters. Analysis is needed also to study equality of access and the possibility of using choice, including the possibility of having an informed free choice. The relationship to the New Public Management and change in the public sector has also been central for several of the articles. The Special Issue starts with an article by Bent Greve setting the scene for what type of conditions need to be fulfilled in order to ensure an informed choice for users, without negative impact on equality, especially in access to services. One of the conclusions of the article is that, although certain conditions that need to be fulfilled can be presented, empirical analysis – sector by sector, provision by provision – is necessary in order to ascertain the precise impact on equality, efficiency and cost related to free choice. Julian Le Grand has been one of the proponents of the expansion of choice in Third Way politics in the UK. He was also among the first to analyse the conditions that must be fulfilled in a quasi-market in order to ensure a properly functioning choice system. In the article by Ian Greener and Martin Powell, Le Grand's earlier and later writings in relation to choice and quasi-markets are explored. This article thus at the same time provides a strong overview of one of UK's leading social policy analysts, and also reflects upon why changes in the original positions of Le Grand, especially from 1992 to 2007, have taken place. Le Grand's historical worry concerning equality of access and the functioning of welfare markets has presumably changed towards an understanding that competition in itself within the public sector ‘serves the public interest better than trusting professionals’. Greener and Powell thus argue that focus seemingly has changed from the critique of market-based reform to one of public sector delivery. One of the sectors where choice has been expanded in several countries is education. In the UK, voice is now seen as central for the user's ability to influence the educational sector, as Deborah Wilson argues in her article. The analysis is carried out by going back to Hirschman's original work on exit, voice and loyalty, which is then applied to the English educational sector. In this way the article shows how to interpret and use classical understanding in a modern context. The article argues that, although voice and choice should be able to complement each other, this has not been the case in the UK, or at least only for a limited number of users. The meaning of quality in the service can also be understood differently, and thus the risk is that those more able to express their views might be more readily listened to by producers. This will implicitly and avoidably imply a new kind of inequality in the welfare states. What choice is and when choice is not really a choice is, with a focus on Germany, the central core of the article by Florian Blank. The article offers a precise and clear overview of recent reform, especially from an institutional perspective. The article also argues that, although choice has not been at the forefront of the debate, it has gradually been introduced. Differences in the ways choice works are related to how closely it resembles the market's way of working, whether it is voluntary or obligatory, and the range of choices open to users. Quality of choice is also influenced by these institutional frames, which also include the way resources are calculated and distributed within the different spheres of social policies. We move from Germany to Italy, where Paolo Graziano raises the question of whether recent reforms in the Italian welfare state have increased real choice for citizens. Thus, for example, the change in the pension system implies that the gross replacement rate will decline significantly, especially for those not using the option of saving in a supplementary occupational pension system. The option for choice might thus be an option for a lower pension and, thereby, imply new inequalities in the welfare states. Opportunity and choice might therefore be possible only for a more limited group in society. The impact of choice is also the focus of the next article, by Melanie Eichler and Birgit Pfau-Effinger, who ask the question why, despite more choice in care for elderly people in Germany, it is still the case that the majority of those needing care are looked after by family members. Cultural values embedded in who has the responsibilities in the families, it is argued, are the main basis for this. Family care is perceived by the users as the best-quality care, making choice or use of choice a less relevant issue. This is documented by qualitative analysis using 33 interviews with women carrying out care for families in the years 2004 and 2005. The article thus highlights that choice in itself is not sufficient to change attitudes and behaviour, and that this also should be taken into consideration when implementing choice. Furthermore, trust and good personal relations can be highly important, especially with regard to care. A comparative analysis of the impact of choice, especially for people with disabilities, when moving towards cash-for-care is analysed by Kirstein Rummery. The article includes a comparison between the UK, the Netherlands, France, Italy, Austria and the USA. A clear conclusion is that market solutions can offer positive effects for both users and carers if the state continues to have a strong impact and influence on the programmes, at the same time providing users and providers with the possibility of exercising choice and control. If, on the other hand, this does not happen, there will be a negative impact on gender equality, and certain users might have difficulties. Cash-for-care seems to be especially suited to the young and better-educated. This points to the dilemma between the possible negative impact on social division and the empowerment of some users. The risk for individuals when choice systems offer exit options from previously mandatory programmes is analysed in the article by Menno Fenger. The possible consequences in relation to adverse selection are examined in relation to welfare policies in four European countries: the Netherlands, Spain, Sweden and the UK. The impact of opting out is different in each of these areas. Pensions are a case where opt-out has been prominent, but despite this no clear pattern of adverse selection has been observed. Still, opting out has only been introduced in a more limited way in recent years in the four countries, and might in the years to come be a consequence of more choice in welfare states around Europe. Choice and the freedom to choose lifestyle are analysed through a study by Steven Saxonberg of how the promotion of gender equality might have an impact on choice in families. Differences in family policy, including access to day care and parental leave, have an impact on the choices families can make. The more gender-neutral Nordic welfare states have been better able to pursue real freedom of choice in daily life. Welfare services can thus influence the possibility of having a real free choice within the family and between men and women in the welfare states. The articles taken together point towards remarkable change in welfare states in Europe – changes that imply new dividing lines caused by the use of markets and marketization as a consequence of more choice, but also implying that those not able to make choices in an informed way run the risk of less-good service. Inequalities in income or occupation could thus be expanded to be inequalities in the ability to manage choice. The risk is that social cohesion will be reduced given that, for some, choice is an option and has a positive impact. For others, more choice is less and might imply social exclusion. Choice can therefore have positive empowerment elements for the users. However, the risk observed in several European countries has been profound, for example, in that it implies new dividing lines of inequality and that choice is not possible for all. In particular, the ability to make an informed choice based upon clear and systematic information is far from the case for everybody. An eye on the possible negative impact of increasing choice, due to market failure, is thus still essential.