Privatizing Welfare Services

Lessons from the Swedish Experiment
Oxford University Press
  • erschienen am 11. Januar 2021
  • |
  • 224 Seiten
E-Book | PDF mit Adobe-DRM | Systemvoraussetzungen
978-0-19-263716-1 (ISBN)
Focusing on health care, education, and elderly care, Privatizing Welfare Services draws on extensive research on the consequences of introducing market-based mechanisms to deliver welfare services. Empirical evidence over the last few decades is summarized and condensed to policy lessons. How to balance equity and efficiency is a central theme. The book also addresses the challenges of financing the Swedish model of welfare services as well as the importance of management practices and public opinion. The privatization of service production has occurred despite major political controversy between two competing visions for the welfare state. Successful experiments have spread organically to neighbouring municipalities. What was done well in this process and what were the mistakes? The book addresses the fundamental economic challenges, the trends of the future, and the implications for institutional design.
  • Englisch
  • Oxford
  • |
  • Großbritannien
  • 1,61 MB
978-0-19-263716-1 (9780192637161)
weitere Ausgaben werden ermittelt
  • Cover
  • Privatizing Welfare Services: Lessons from the Swedish Experiment
  • Copyright
  • Foreword
  • Authors' Preface
  • Contents
  • Index of Terms
  • List of Figures
  • List of Tables
  • List of Boxes
  • Chapter 1: Introduction
  • 1.1 Weak Growth and Public Finances Provided a Political Backdrop to Privatization
  • 1.2 Efficiency and Freedom-of-choice were Strong Drivers of Privatization
  • 1.3 The Risks of Privatization
  • 1.4 A Look Under the Hood of the Welfare State
  • 1.5 Profit-ceiling, the Rise of the Sweden Democrats, and Political Polarization
  • 1.6 Inequality and Segregation has Increased-But for Other Reasons than Privatization
  • 1.7 Main Elements of Social Welfare Related to Health Care, Childcare, and Education
  • 1.8 Local Initiatives Often Spurred Privatization
  • 1.9 The Political Economy of Privatization and What the Future May Bring
  • 1.10 How to Read this Book
  • Chapter 2: Quasi-Markets
  • 2.1 Market Models
  • 2.1.1 Freedom-of-choice Model Puts Risk on Providers When They Enter the Market
  • 2.1.2 Outsourcing Model Puts Risk on Providers at the End of Contract
  • 2.1.3 Regulation as an Alternative to Quasi-Markets
  • 2.2 The Profit Motive
  • 2.3 Information and Quality
  • 2.3.1 A Minority of Well-informed Consumers Can Make Markets Function Efficiently
  • 2.4 Political Goals
  • 2.4.1 Plurality of Political Goals is a Major Complicating Factor for Quasi-Markets
  • 2.5 Concluding Comments
  • Chapter 3: Controlling Public Spending and Striving for Efficiency
  • 3.1 Government Spending and the Importance of Welfare Services
  • 3.1.1 Strong Popular Support for the Welfare State
  • 3.1.2 Sweden has Reduced Spending
  • 3.1.3 Spending Pressures From an Ageing Population
  • 3.1.4 Structural Challenges in Welfare Spending
  • 3.1.5 Changing Patterns in Welfare Spending in Sweden 1980-2012
  • 3.2 Revenue
  • 3.3 Public Sector Efficiency
  • 3.3.1 The Debate About the Level of Welfare Services and Subsidies
  • 3.4 Concluding Remarks
  • Chapter 4: Anatomy of Welfare Reforms 1970-2020
  • 4.1 The Rise of Private Alternatives
  • 4.2 Reforms in the Welfare Sector: Centrally Willed But Not Controlled
  • 4.3 Health Care: Massive Expansion of Private Primary Care
  • 4.3.1 Capitation is the Main Financing Model in Primary Care
  • 4.3.2 Private Health Spending and Insurance
  • 4.3.3 For-Profit 'National' Telemedicine: an Unintended Consequence of the Choice Reform
  • 4.4 The Expansion of Preschools
  • 4.5 Independent Schools: the Introduction of a Voucher System
  • 4.5.1 Targeted National Government Grants (Over)Used to Influence Municipalities
  • 4.6 Elderly Care
  • 4.6.1 Large Regional Differences in Private Care for the Elderly
  • 4.7 Personal Assistance for the Disabled: the Most Private Production of All
  • 4.8 Why did the Social Democrats Not Reverse the Privatization of Welfare Services?
  • 4.8.1 Even a Massive Expansion of the Public Sector Fell Short of Demand for Welfare Services
  • 4.8.2 Balance of Power Inside the Social Democratic Party
  • 4.8.3 Reforms to Reverse Privatization May be Costly and Legally Awkward
  • 4.8.4 Municipal Autonomy Limits the National Government
  • 4.9 Concluding Remarks
  • Chapter 5: Profit, Choice, and Competition
  • 5.1 Private Providers: The Operational Level
  • 5.2 Choice and Competition: The System Level
  • 5.2.1 Risks of Segregation and Cream-Skimming
  • 5.3 An Unequal Playing Field Tilted Against the Private Sector
  • 5.3.1 Conflict of Interest in the Public Sector
  • 5.4 Elderly Care
  • 5.4.1 User Satisfaction
  • 5.4.2 Public Sector Scores High in Structural Measures but Private Better in Process Measures
  • 5.4.3 Outcome Quality Measures
  • 5.4.4 Private Sector Displays an Unequivocal Productivity Improvement
  • 5.4.5 Summary of Empirical Findings
  • 5.4.6 Discussion
  • 5.4.7 Staff Shortages and Automation on the Horizon
  • 5.5 Education
  • 5.5.1 Potential Explanations of Sweden's PISA Performance
  • 5.5.2 Voucher System Improved Outcomes in Both Independent and Municipal Schools
  • 5.5.3 Independent Schools at Compulsory Level Perform Well but Benefit from Favourable Student Composition
  • 5.5.4 Mixed Results and Grade Inflation at the Upper-Secondary Level
  • 5.5.5 Independent Schools Slightly Better at PISA
  • 5.5.6 Student Attitudes
  • 5.5.7 Costs
  • 5.5.8 Segregation and Cream-Skimming
  • 5.6 Health Care
  • 5.6.1 Capitation is the Predominant Remuneration Model in Primary Care
  • 5.6.2 Health Care Outcomes
  • 5.6.3 Equality of Care
  • 5.6.4 Pay-for-Performance Models
  • 5.6.5 Summary of Findings
  • 5.7 Concluding Comments
  • Chapter 6: Management of Public and Private Welfare Services
  • 6.1 The Challenges of Controlling and Rewarding Public Sector Employees
  • 6.1.1 Tight Control and Supervision can be Demotivating and Impede Quality
  • 6.1.2 Laboratory Experiments Need not Generalize to the Real World
  • 6.1.3 Mixed Evidence on Pay-for-Performance Schemes
  • 6.2 Measuring Management
  • 6.3 Health Care and Elderly Care
  • 6.3.1 Management Quality has Improved Clinical Outcomes, but Patient Satisfaction is Lower
  • 6.4 Education
  • 6.5 Concluding Remarks
  • Chapter 7: Public Opinion
  • 7.1 Against Profits But Pro-Choice
  • 7.1.1 Parliament More Supportive of Privatization Than the Population at Large
  • 7.2 Tensions Within the Social Democrats
  • 7.3 People Grossly Overestimate the Level of Profits in Welfare Services
  • 7.4 Concluding Remarks
  • Chapter 8: Summary and Conclusions
  • 8.1 Social Protection Balanced Against Incentives for Work and Innovation
  • 8.1.1 Financing Public Welfare in Times of Ageing Populations
  • 8.2 Strengths and Weaknesses of Quasi-Markets
  • 8.3 The Unexpected Origins of the Swedish Experiment
  • 8.3.1 Demand for More Preschools and the Early Privatization Battles
  • 8.3.2 Resistance Against Independent Schools and the Introduction of a Voucher System
  • 8.3.3 Conflict in Privatizing Elderly Care
  • 8.3.4 Privatization of Emergency Hospitals and in Primary Care
  • 8.3.5 Personal Assistance to the Disabled is the Welfare Service with Most Private Providers
  • 8.3.6 Local Initiatives, Not the National Government, Spurred Privatization
  • 8.3.7 Why Has the Social Democratic Party Not Reversed Privatization?
  • 8.4 The Evidence
  • 8.4.1 The Operational Level
  • 8.4.2 No Support for Extreme Pro or Con Views on Privatization
  • 8.4.3 More Vigilance Against Cream-Skimming
  • 8.4.4 School Segregation Due to Residential Segregation
  • 8.4.5 Private vs. Public Elderly Care
  • 8.4.6 Schools Overall More Efficient But Independent Schools Drive Grade Inflation
  • 8.4.7 Improved Productivity in Private Health Care
  • 8.4.8 Telemedicine Improves Access to Health Care But With Increased Economic Tensions
  • 8.4.9 Privatization Can Improve Outcomes, But Quality Control is Needed
  • 8.4.10 More Unannounced Inspections for Both Private and Public Welfare Providers
  • 8.4.11 Better Separation of Roles as Provider and Supervisor
  • 8.4.12 User Choice Can Drive Costs in For-Profit Settings
  • 8.4.13 Insights From Financial Regulation
  • 8.4.14 Quality Enforcement Should Not Neglect Soft Aspects
  • 8.4.15 Subjective Evaluations Should Influence Contract Renewal and Termination
  • 8.4.16 Local Government Should Also be Subject to Independent Audits
  • 8.4.17 Entry Barriers Can be Useful in Freedom-of-Choice Settings
  • 8.5 The Importance of Management
  • 8.5.1 Good Management Shows up in Survival Rates But Not in Patient Satisfaction
  • 8.5.2 Good Management Practices in the Private Sector Yield Results Also in the Public Sector
  • 8.6 Public Opinion and the Future
  • 8.6.1 Voters More Negative Than the Political Parties to For-Profit Welfare Providers
  • 8.6.2 Voters Grossly Overestimate Profits in Welfare Services
  • 8.6.3 What Lies Ahead?
  • References
  • Index

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