Taking Care of Business: A Study of the Governing of Care Choice Systems in Swedish Home Care

This study provides an account of the introduction of care choice systems into the provision of home care by Swedish municipalities. Care choice systems in elder care are at the centre of a conflict about the broader principles of the welfare state. Studying them is thus a way of revealing the outlines of this conflict. In this thesis, I show how the introduction of care choice systems changes the nature of public administration, the strategies officials deploy, and the tools they use. This helps to deepen the understanding of how quasi- market reforms transform public administration at the municipal level, while providing insight into the legal strategies used by public authorities in governing welfare. The thesis also provides new insights into how parts of the Swedish model have evolved during the last decade.Methodologically, the study is based on an in-depth empirical investigation of the roles ‘public law’ and ‘private law’ play in realizing and shaping new forms of governing. I pursue a ‘law in practice’ approach grounded in a Foucauldian methodology, combined with a theoretical discussion of the outcomes of the study. One central finding of the study is that quasi-marketization leads not to a simple deregulation of public sector services, but rather to a reconfiguration of the relationship between state and capital. This entails new ways of governing, such as contractualization and standardization, as well as a new role for public administration and bureaucracy. The legal strategies adopted by the municipalities are complex and, in general, aim at regulating the private providers through the contract almost as if they were part of the municipality, while at the same time treating the municipal provider as if it was a private company.The introduction of care choice systems has created new and specific conflicts and contradictions in the governing of home care for older persons. The municipal responsibility for the quality of elder care, the need to ensure the system has political legitimacy, and a political will to support small businesses combine to produce a situation in which public spending on welfare is channelled into the support and monitoring of businesses within the sector. To an increasing extent, public officials who’s job it is to enforce regulations and monitor private actors end up ‘taking care of business’. Crucially, this leads to a situation in which low- quality services and fraudulent behaviour cannot properly be dealt with. It is clear that, despite the great amount of work that the public authorities put into constructing, supporting, and monitoring the quasi-market, many apparent problems still remain