Abstract
This case study investigates the implementation of a free-choice market system in community mental health services using the example of day centres for people with psychiatric disabilities. It was conducted in a major city that was about to implement a free-choice market system due to a new legislation that made it feasible. Eighteen semi-structured interviews were conducted. Agents situated in different parts of the organization were interviewed one year before and two years after the free-choice system was launched in 2010. Data showed a top–down political process. A majority of the intentions of the legislation advocated individual autonomy as the market system's main purpose; only one concerned organizational efficiency. Data reflected, however, that financial efficiency dominated the agents' experiences of the implemented system. The twofold market purpose was clearly reflected in the interviews. Front-line staff hoped for improvements mainly for the users, whereas managers mainly focused on the market as a resource allocator.
Highlights
This article examines the implementation process of a free-choice market model in Swedish community mental health services
The interviews showed that managing agents and community mental health service managers felt they had been closely involved in the implementation process
The other front-line staff, did not consider themselves to be involved in the implementation process in either district
Summary
This article examines the implementation process of a free-choice market model in Swedish community mental health services. Models based on ideas of competing markets have been implemented worldwide (Brody et al 2013; Finn 2009) in hopes that competition between providers would inspire more efficient organizational development and an attentive approach to customers. Known as quasi-markets (Le Grand and Bartlett 1993), are sometimes characterized by the policy objective of increased individual freedom of choice (Defourny et al 2010). This is often accomplished by providing vouchers (Friedman and Friedman 1980) to allow individuals to make personal choices. Quasi-markets are financed by tax money, but the competitive market system opens up service delivery to for-profit and third-sector institutions as well as to the public sector (Defourny et al 2010)
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