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2018 Conference Presentation

Policy developments FinlandSweden

11 September 2018

Integration and freedom of choice in care for older people in Sweden and Finland – Compatible policy options?

Ismo Linnosmaa, The National Institute for Health and Welfare (THL), Finland
Pär Schön, Karolinska Institute, Aging Research Center, Sweden

Sääksvuori, L.The National Institute for Health and Welfare (THL), Finland
Johansson, L. Karolinska Institute, Aging Research Centre, Stockholm, Sweden


Integrated care is high on the health and social care agenda in Finland and Sweden. Integrated care aims at improving efficiency in care provision by introducing coherent and coordinated care services, both between health and social care but also within care systems. A potential obstacle to achieving integrated care in the Finnish and Swedish context is the division of responsibility between health and social care. Without some exceptions, it is typically the case that the local provision of health and social care in Finland and Sweden are organized in a disintegrated manner with separate governance systems.

Another development in Finnish and Swedish care is a strong marketization trend with policies aiming at privatization (i.e., privately provided but still publicly funded), increased freedom of choice, competition, and diversity of care providers. Sweden took the first steps towards freedom of choice and competition in health and social care during the early 1990s, when the new Local Government Act came into effect, in order to make it possible for local governments to outsource the provision of care services to private actors. This act was replaced by the Act on System of Choice in the Public Sector in 2009, facilitating the introduction of customer choice models. Finland is expecting a large social and health care reform with strong emphasis on increasing freedom of choice and marketization in 2021.

In this study we address the question whether policy instruments on integration and marketization are compatible policy options and can be implemented without any adverse outcomes. Our context is the provision of LTC for elderly. We aim at answering these questions by first defining the concepts of integration, freedom of choice and competition. Next, we review and examine existing empirical evidence and experiences that have been accumulated from applying these policy tools in the provision of health and social care services for older people in Sweden and Finland. Finally, we discuss whether Swedish results and experiences can be transferred to Finland to inform policy makers designing the coming reform. Our analysis is based on the existing theoretical and empirical literature on integration, freedom of choice and competition.

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