Åke Bergmark

Welfare trends in Sweden: balancing the books for the 1990s

Welfare trends in Sweden: balancing the books for the 1990s : Journal of European Social Policy

Priorities in care and services for elderly people: a path without guidelines?

The growing gap between demands and resources is putting immense pressure on all government spending in Sweden. The gap is especially apparent in care and services for elderly people in light of the rapid aging of the population. The article considers the decisions and priorities concerning resource allocation in the welfare sector in general and in elderly care in particular. The aim is to describe the political and administrative setting and to provide a conceptual structure that outlines the nature of the problem. Various levels of decision making are identified and discussed in the context of political accountability. Current transitions in elderly care are described with respect to service provision, marketisation, coverage rates, and eligibility standards. Basic principles of distribution are highlighted in order to clarify some central concepts of efficiency and justice, and a number of strategies for actual prioritising are identified. The article concludes with an endorsement of more conscious decisions in resource allocation. Existing knowledge and information concerning the effects of various strategies must be utilised, and the values and assumptions used for setting priorities must be made explicit.

Beyond benevolence – solidarity and welfare state transition in Sweden

For many decades the Swedish welfare system has served as an archetype of the modern comprehensive welfare state. When economic recession hit Sweden in the beginning of the 1990s, a period of half a century of continuous expansion and reforms in the welfare sector came to an end. The economic downturn enforced rationing measures in most welfare programs and was accompanied by a move towards privatisation of local welfare services and an endeavour to initiate market incentives in the care-giving systems. The focus was increasingly directed on welfare as a financial burden, and the issue of how diminishing resources should be allocated ranked high on the political agenda. In this article we depart from the concept of solidarity and discuss the development of Swedish welfare and welfare opinion. First, we articulate various representations of the concept of solidarity – societal cohesion, individual support for comprehensive welfare and the amount of universality in the provision of care. Second, we describe some fundamental traits in the route taken by Swedish welfare during the 1990s, focusing especially on care of elderly and the demographic challenge of an ageing population. Third, we summarise the evolution of public opinion regarding welfare provision and discuss the determinants of its variations. The article concludes with a discussion of how the (once salient) features of universalism have been affected by the development during the past decade, and the role of popular support in the route ahead for Swedish welfare.

Unitarian ideals and professional diversity in social work practice—the case of Sweden

Attempts to articulate a common core of social work are numerous as is the claim that there exists a ‘true’ or general social work. This article presents results from research on the organisational settings of Swedish social work. Social work managers in 100 middle sized municipalities have been interviewed by means of an extensive interview manual. Data are analysed using quantitative methods. The results demonstrate that since the 1980s specialisation has become the strongest organisational trend. Functional specialisation (division of child welfare, social assistance and social work with substance abusers) is the standard way of organising social work and in many municipalities specialisation has gone much further. An integrated or generic organisational model, which was the imperative of the 1970s, seems to exist only in the smallest municipalities. Some of the organisational changes can be described as short-lived fashions. Specialisation as such seems, however, to be an institutionalised strategy to solve social problems and as a response to expectations from the environment. These results are discussed against the background of the notion of social work as a coherent profession with an identifiable common core and a mutual arsenal of methods.

Market Reforms in Swedish Health Care: Normative Reorientation and Welfare State Sustainability

Although the impact of market reforms in Swedish health care stands out as not very far-reaching in an international comparison, it represents a route away from the features and basic values normally associated with the Swedish or Scandinavian model. Summarizing the development over the last decades, we may identify signs of sustainability as well as change. Popular support for public provision and a robust institutional structure make far-reaching alterations of existing structures less feasible, although most visible changes this far-incremental though they may be-represent a change in which the normative foundations of the Swedish model are challenged.

Escaping welfare? Social assistance dynamics in Sweden

The article analyses temporal patterns in social assistance receipt in Sweden in the 2000s by looking at which circumstances facilitate versus reduce the possibilities of a person ceasing to be a recipient of social assistance. The analysis is guided by the following questions: What conditions lead people to terminate periods of social assistance receipt? Which factors are central to exits with different subsequent income patterns? How do these explain the different situations of recipients prior to termination? We focus particularly on income maintenance prior to spells of social assistance. We use event history data on monthly social assistance take-up covering the total adult Swedish population for the years 2002–2004. We adopt a gamma mixture model to control for unobserved heterogeneity. The results suggest that previous experience of both employment and social assistance receipt are important determinants for all types of exits from social assistance recipiency. A negative duration dependence is found also when unobserved heterogeneity is controlled for.

Solidarity in Swedish Welfare – Standing the Test of Time?

Swedish welfare has for decades served as a role model foruniversalistic welfare. When the economic recession hit Swedish economyin the beginning of the 1990s, a period of more than 50 years ofcontinuous expansion and reforms in the welfare sector came to an end.Summing up the past decade, we can see that the economic downturnenforced rationing measures in most parts of the welfare state, althoughmost of this took place in the beginning of the decade. Today, most ofthe retrenchment has stopped and in some areas we can see tendencies ofrestoration – but more so in financial benefits than in the caringsectors. In the article this process is discussed as a process ofreallocation where general principles of solidarity become manifest.Various levels of decision making are discussed within the context ofsocio-political action. Current transitions in Swedish health care aredescribed with respect to coverage rates, content, marketisation anddistribution. Basic principles of distribution are highlighted in orderto analyse the meaning of social solidarity in a concrete allocativesetting. The significance of popular opinion – its shifts anddeterminants – is also considered. The article concludes with adiscussion of how the (once salient) features of universalism inwelfare and health care provision have been affected by the developmentsin the past decade in Sweden.

The mismatch between the map and the terrain : Evidence based practice in Sweden

In this article we will give an account of the introduction of evidence-based practice (EBP) in Swedish social work. The Swedish development may serve as an example of what happens when the process is driven by bureaucracy with a strong public funding/back-up rather than by the academy. This is not to say that the Swedish case is unique, but rather that problems and controversies that are well established on the international arena are in Sweden framed in a very particular context. The most far reaching efforts to implement EBP in Swedish social work have been carried out by central bureaucracy. The introduction of EBP may be depicted as a top-down guideline project, with randomized controlled trials as the gold standard. Shortage of evidence paired with political pressure to implement EBP has to a certain extent also brought about dissolution of the basic concept. The article concludes with an elaborated assessment of how current conceptions of EBP relates to professional and contextual conditions of Swedish social work practice. We also address the issue of how to establish what adequate and valid evidence is by suggesting an approach that deviates from predominant evidence hierarchies and polarized extremes.

Care for Elderly People in Sweden

The aging of the population presents a significant challenge for all industrialized nations. Past increases and expected future increases in the older sector of the population put pressure on both the pension systems and the systems for providing medical care and social services. The increasing number of people over the age of 80 will especially increase the demand on these systems.

Embedded in Practice? Swedish Social Work Managers on Sources of Managerial Knowledge

This study focuses on managers in the personal social services and aims to explore these managers’ qualifications and their views on what sources of knowledge have contributed most to their managerial competence. Findings indicate that most managers have undergone in-service managerial training and that a majority appear to rely on sources of knowledge that could be described as practice oriented for attaining managerial competences. This practice orientation is discussed in relation to the character of the in-service managerial training, the knowledge base of social work, and the lack of postgraduate managerial education offered by the Swedish schools of social work.