Abstract
BackgroundIn the literature there are only few empirical studies that analyse the decision makers’ reasoning to contract out health care and social services to private sector. However, the decisions on the delivery patterns of health care and social services are considered to be of great importance as they have a potential to influence citizens’ access to services and even affect their health. This study contributes to filling this cap by exploring the frames used by Finnish local authorities as they talk about contracting out of primary health care and elderly care services. Contracting with the private sector has gained increasing popularity, in Finland, during the past decade, as a practise of organising health care and social services.MethodsInterview data drawn from six municipalities through thematic group interviews were used. The data were analysed applying frame analysis in order to reveal the underlying reasoning for the decisions.ResultsFive argumentation frames were found: Rational reasoning; Pragmatic realism; Promoting diversity among providers; Good for the municipality; Good for the local people. The interviewees saw contracting with the private sector mostly as a means to improve the performance of public providers, to improve service quality and efficiency and to boost the local economy. The decisions to contract out were mainly argued through the good for the municipal administration, political and ideological commitments, available resources and existing institutions.ConclusionsThis study suggests that the policy makers use a number of grounds to justify their decisions on contracting out. Most of the arguments were related to the benefits of the municipality rather than on what is best for the local people. The citizens were offered the role of active consumers who are willing to purchase services also out-of-pocket. This development has a potential to endanger the affordability of the services and lead to undermining some of the traditional principles of the Nordic welfare state.
Highlights
In the literature there are only few empirical studies that analyse the decision makers’ reasoning to contract out health care and social services to private sector
This paper addresses the types of framings used by local Finnish authorities when they argue about contracting out primary health care and elderly care services to the private sector
The aim of this study is to explore the argumentation frames used by local politicians and civil servants when they argue about contracting out health care and social services
Summary
In the literature there are only few empirical studies that analyse the decision makers’ reasoning to contract out health care and social services to private sector. This paper addresses the types of framings used by local Finnish authorities when they argue about contracting out primary health care and elderly care services to the private sector. The developments towards increasing privatization in the welfare have been described as a long historical process reflecting the broad transformations in the western societies influenced by economic and cultural changes and policy diffusion [6]. These societal changes have been suggested to create an environment in which the public-private boundaries may start to melt [7] and through which health care and social service systems might become more private in nature [3]. The decisions on the delivery patterns may be seen, to be of great importance as they have a potential to influence citizens’ access to services and even affect their health [12]
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