Exit, voice and indifference – older people as consumers of Swedish home care services

Abstract

ABSTRACTSweden has in the last 20 years undergone an extensive process of marketisation of its home care sector. Where the public sector once was the only provider of home care services, there is now a wide array of different, private alternatives for older people to choose from, using their publicly funded voucher. The publicly funded home care services in Sweden are, in other words, to a large extent organised according to the principles of a quasi-market. Older people with care needs are therefore now considered to be consumers of home care since they are expected to make an informed choice of home care provider according to their own preferences. This paper studies the extent to which older people with care needs assume this role and how they do it, using Hirschman's well-known theory on ‘exit, voice and loyalty’ and theory on the difference between care and market logic. The study is based on results from a research project using telephone interviews to ask a large number of older people in three Swedish cities about their experience of making this choice. The results show that they had difficulty understanding how to choose and what the purpose of the choice was. The conclusion of this study suggests some possible reasons why policy makers in Sweden continue to favour the freedom-of-choice model in spite of these poor results.