Per Gunnar Edebalk

The flight from universalism

Abstract Up to the beginning of the 1990s Sweden had been considered a paragon welfare state in its realisation of universalist principles and an institutional welfare model. This seems to be changing rapidly. Mass unemployment, welfare expenditure cuts and institutional transformation have introduced several selective mechanisms into the Swedish welfare system, adding up to a retreat from universalism. New forms of selectivity can be seen in all layers of the welfare system, both transfer benefits and social security, public personal social services and the relation between state and voluntary organisations. The shifting of burdens from universal social security and insurance-based welfare onto local means tested systems has already meant a restigmatisation of unemployment, as the unemployed lose eligibility for the insurance-based systems, and an increase in the proportion of people who have to rely on poor relief instead of rights-based welfare, and when unemployment has gone up, so have work requireme...

How Elderly People Rank-Order the Quality Characteristics of Home Services

Various studies have dealt more or less directly with qualitative questions concerning social services provided in the home. While as a result of such studies the general characteristics of home services of importance to elderly people are quite well known, this is not the case regarding the relative importance assigned to such characteristics. Personal interviews using the ‘Multiattribute Utility Technology’ (MAUT) were used. This procedure organises the attributes in a ‘tree’ structure for comparing the relative importance & ranking of different quality attributes. A random sample of 180 receivers of home-help services aged 65 to 95 and living in a rural, small town and city area were interviewed. The interviewed persons were asked to rank-order according to personal importance each grouping of quality attributes. The relative values of the different qualities were determined, using a scale with a range from 0 to 100 points. Continuity, especially Staff Continuity, was the most important quality attribute together with Suitability and Personal Relation. Availability and Influence were the least important quality attributes. The characteristics studied had largely the same relative importance for all older people, irrespective of category.

The withdrawal of the welfare state: elderly care in Sweden in the 1990s

In Sweden, clear changes in the care of the elderly have occurred during the 1990s, with fewer people being provided public care, although greater efforts are now directed towards those most in need of help. Elderly people are cared for increasingly in other ways: by the family, by means of market-provided care, and by voluntary and informal means. Differences between municipalities are considerable. A comparative study was conducted in eight Swedish municipalities, four of them characterized by extensive reorganization of home-help services, and the other four constituting a reference group where such changes had not occurred. The aim was to examine processes of setting local priorities and adjustments in a period of marked structural change. Interviews with local politicians, administrators, professionals, and union representatives, and with the elderly themselves, were the main sources of data. The process of determining the extent and content of home care services in the municipalities was found to be a complex process, one involving a number of partly interdependent factors. Restructuring was found to be greatest in the context of a traditionally strong reliance on home-help services, rather than in the context of institutionalized care, where administrative decision-making and a medical and rehabilitative perspective dominated.

Emergence of a Welfare State - Social Insurance in Sweden in the 1910s

Two important dimensions of the Swedish social insurance system are those of universality (encompassing the entire population) and of compensation for loss of income. The decisions basic to the Swedish social insurance system and thus to the Swedish Welfare State were made during the 1910s. A universal pension insurance system was decided upon in 1913. This was the worlds first universal public insurance system. Pensions were provided both in cases of disability and of a person reaching the age of 67. Important factors explaining this decision were that Sweden had the oldest population in the Western world and thus high expenditures for poor relief, and that as the reporting and taxation of individual incomes had just been introduced it became possible to finance a universal pension system by means of compulsory contributions by the individual (a special earmarked tax). The establishment of a pension insurance system provided the basis for a system of insurance for work-related injuries, in 1916. It included the entire workforce and was the most modern of its kind. The presence of a pension insurance system and insurance for work-related injuries pointed to the need for a sickness insurance system. This was designed to deal with simple cases of injury as well as with more serious cases of illness or injury that could lead to disability. A proposal was presented in 1919. A serious deflationary crisis after the First World War and high levels of unemployment during the period between the two world wars made it impossible to introduce a sickness insurance system. (Less)

Group living for elderly patients with dementia--a cost analysis.

The average labour cost of group living for elderly people suffering from senile dementia amounted to just over SEK 230,000 per patient and year, or SEK 639 per patient and day (24h), in 1992 prices. These figures emerge from our study of 106 group-living units in 46 municipalities in southern Sweden. The average staff density, that is the number of full-time employees on a yearly basis, was 1.06 per patient. The study also shows that the labour cost per patient decreases when the number of patients in a unit increases. Units that form part of other types of residence for the elderly have lower labour costs than detached group-living units (everything else being equal). If individual flats or apartments are large (at least two rooms), a higher staff density was observed. A high degree of functional disability in the individual entails higher staff density and consequently higher labour costs as well. However, in comparison with other forms of caring for the elderly, such disabilities have a less marked effect on labour costs. Everything else being equal, comparatively young residents entail higher labour costs than older ones. The average cost per patient in group-living units amounted to SEK 986 per day. This cost includes the cost of care (labour cost adjusted for flexible salary increments), as well as of capital, operation and maintenance, and food (raw materials). The cost of care amounts to approx. 80% of the estimated cost per patient. The average cost per patient is higher in group-living units than in old peoples homes; but as regards dementia sufferers with some degree of functional disability, the cost of care is probably about the same in both types of accommodation.

Home service costs: The Swedish experience

This article will show that the annual cost of service and care for a receiver of home service in Sweden ranges from SEK 5,000 to SEK 435,000 according to individual disability. In our sample, the average annual cost amounts to slightly less than SEK 100,000. Furthermore, the cost of service and care for pensioners of good mental health is about SEK 50,000 higher than for the group of mentally disabled (everything else being the same). Not quite unexpectedly, the annual cost of service and care decreases when assistance from relatives increases. Without help from relatives, the annual cost increases by approximately SEK 16,000 per individual. The average annual cost is higher for home service receivers who live at home and have an alarm telephone than for those who have not got an alarm telephone (everything else being the same). Alarm telephone systems which require staff for supervision and home visits account for half of the recorded difference in cost. Both living in ones own home with handicap adjustment and living in a service flat mean a lower cost of service and care than living in ones own home without handicap adjustment (everything else being the same). For persons who are in great need of daily help, living at home implies a cost that is slightly more than 20 per cent higher than the cost for living in a service flat.

Poor Relief, Taxes and the First Universal Pension Reform: the origin of the Swedish welfare state reconsidered

In the year 1900, Sweden probably had the oldest population in the contemporary world. It was also the first nation to implement a universal pension system in 1913. The universal character in early social legislation has certainly been decisive for the development of the Swedish welfare state. This alternative has not been self-evident. Why did the reforms turn universal, when the continental model, the Bismarck social security system, was exclusively directed at industrial workers? Research has concentrated on demographic factors and growing demands for social security, or on the fact that Sweden was still a predominantly rural society with about 2,400 local authorities. This article examines the development of social legislation in the light of local government expenditures and incomes, and suggests an overlooked possibility: the formulation of the first universal national social security reform was a redistributional response to uneven distribution of incomes and general expenditures among the rural districts in Sweden.

Ways of Funding and Organising Elderly Care in Sweden

Elderly care in Sweden is an important municipal task and a more specialised care was introduced in 1918. Since then the development of elderly care has evolved in terms of a three stage process and each phase has been characterised by path-dependent processes. Critical junctures have been reached around 1950 and around 1990. Since 1990 the municipalities have been given extended options to organise elderly care and they are now trying to find means of increasing efficiency in elderly care. One possibility has been to privatise parts of the care. The demographic challenge of an ageing population will affect the possibilities to finance elderly care in the future. This will probably lead to a new critical juncture at which the State will take financial responsibility for elderly care and introduce elderly care insurance.

Kundval för äldre och funktionshindrade i Norden. Konsumentperspektivet

Kundval for aldre och personer med funktionshinder diskuteras i de nor-diska landerna och i vissa fall har det ocksa inforts. Kundval i handikapp-omsorgen forekommer da personer med funktionshinder valjer sin per-sonliga assistent. I aldreomsorgen finns det system dar den aldre efter ett bistandsbeslut kan fa valja vem som ska utfora vissa insatser. Nagra svenska kommuner var pionjarer i borjan av 1990-talet nar de inforde kundval i aldreomsorgen. Langst har utvecklingen gatt i Danmark dar ett nationellt reglerat kundvalssystem infordes ar 2003. I Finland infordes ocksa nyligen en lag som reglerar kundvalssystemet i de fall kommuner beslutar att infora det. Denna studie har haft till uppgift att redovisa befintlig kunskap om ef-fekter av kundvalssystem i nordisk aldre- och handikappomsorg. Studien tar sin utgangspunkt i brukarnas perspektiv och ger en beskrivning av hur kundvalsmodellerna ar uppbyggda och vad vi idag vet om modellernas effekter. En central slutsats i studien ar att det hittills genomforts lite veten-skaplig forskning om kundval sett ur ett konsumentperspektiv i de nor-diska landerna. Forskningen karaktariseras av kommunvisa studier som gor det svart att generalisera resultaten – inte minst mot bakgrund av att kundvalet i sin utformning skiljer sig mellan olika kommuner och lander. Begreppet kundval ar mangfacetterat. Brukarens situation blir beroen-de av hur kundvalssystemet ar konstruerat; exempelvis om det for bruka-ren ar obligatoriskt eller frivilligt att valja utforare, vilka tjanster som brukaren kan valja mellan och hur manga utforare som kan vara aktuella. Det saknas kunskap om hur olika ”typmodeller” av kundval fungerar sett ur ett brukarperspektiv.