Open the black box: paradoxes and lacunas in Swedish health care reforms.
The idea of using contracting-out as a means for improving public administration dates back to the 1850s, but was then found to be infeasible. The same idea has now become a major building-block in Sweden's health care reforms. Driven by a productivity-focused political discourse and the premises of neoclassical economics, these reforms ignore motivational structures among health care staff. The result may be a delegitimizing of the welfare state from within--either through the extinction of care rationality and its replacement by wage rationality, or, at worst, through the spread of a commercial spirit among health care staff and/or staff frustration at the unavoidable downward adjustments in remuneration rates. The author points to three strategic choices that arise when insights from a labor-process perspective are taken into consideration.
Gustafsson
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Karolinska Institute, Department of Social Medicine and International Health, Sundbyberg, Sweden.
D001291:Attitude of Health Personnel; D003284:Contract Services; D003953:Diagnosis-Related Groups; D004465:Economic Competition; D017598:Efficiency, Organizational; D005639:Frustration; D018166:Health Care Reform / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007588:Job Satisfaction; D009042:Motivation; D011057:Politics; D012456:Salaries and Fringe Benefits; D013222:State Medicine / Q000458:organization & administration*; D013548:Sweden