The Healthcare Voucher: Emergence, Formation and Dissemination

Market-inspired healthcare reforms have been introduced in Sweden: Freedom of Choice in Healthcare in 1989 and the National Healthcare Guarantee in 2005. After the general election 2006 the idea of the Healthcare Voucher has followed. Built on a theoretical framework composed of Foucault's concept of 'discursive formation' supported by Butler's concept of the ‘performativity of discourse’ the purpose is to analyse the emergence, formation and dissemination of this idea into healthcare in Sweden. The Voucher is disseminated in a form reminiscent of a chain linking a series of texts, referring to each other and building on each other's formulations strengthening each other's messages. It circulates under designations such as healthcare voucher and money and seems to be disseminated by being combined with 'freedom of choice' forming the theme customer choice. The Healthcare Voucher then becomes a means of being able to realise an idea of a political nature, building markets in healthcare. The paper offers a way of analysing how ideas influence the policy agenda, in particular for the voucher/s. Distinctions could be made between the voucher idea and 'money following the patient' in quasi markets. A critical issue in introducing choice and competition, not explored here, is the issue of ‘cream skimming’