User choice and the changing notion of social citizenship in Swedish elderly care

Abstract

ABSTRACT This article deals with the 2009 user choice reform in Swedish elderly care. It analyses how the tension between choice and older citizens’ equal access to good quality care was dealt with by the policymakers who introduced it. Three overarching research questions are addressed in the analysis: (i) what role and responsibilities did the Swedish user choice reform assign to the users and how did the policymakers view users’ ability to make an informed choice? (ii) How did the policymakers view the role and responsibilities of the local authorities and what tools were the local authorities given to ensure access to good quality elderly care for all citizens? (iii) Can the new user choice reform be said to contain a new notion of social citizenship for older people in Sweden? The findings suggest that while the user choice reform encouraged users to allocate resources and make free choices between providers, it also required users to become more responsible to ensure service quality. The reform also advocated that the local authorities should steer their elderly care sectors through partly new governance tools and secure quality foremost through the entering of contracts with authorized providers. The paper argues that, because of these required new roles and responsibilities, the Swedish user choice reform entails a more libertarian notion of social citizenship, requiring users to take on greater responsibility for their own well-being and protection against risks.