When 'Choice' and 'Choice' Are not the Same: Institutional Frameworks of Choice in the German Welfare System

The creation and strengthening of welfare markets in Germany means that citizens can increasingly choose among competing providers of welfare goods and services. However, the conditions under which citizens may exercise choice in various fields of social policy are quite different. A major reason for these differences can be found in the public institutions that frame citizens' choice in welfare markets. This article analyses welfare markets in German health care, long-term care, pensions and employment policies, paying special attention to the respective public institutional frameworks. It will be argued that differences between frameworks of choice can be categorized by means of four parameters representing different aspects of public involvement in welfare markets. Depending on the kind and the degree of public involvement, welfare markets may be compatible with 'traditional' notions of public responsibility for citizens' social security.     

The influence of faith‐based organisations on Australian social policy

This historical overview explores the crucial and changing relationships between faith‐based organisations and governments, not only in the implementation of social services but also in the formation of social policy. Historically Australian governments have left large areas of social provision to the non‐government sector. For example, income support for the unemployed was not taken up by governments until World War II and income support for sole parents remained largely a responsibility for non‐government organisations (NGOs) until the 1970s. Prior to governments taking responsibility for income support, most of these NGOs were religious organisations surviving on donations, philanthropic support and limited government funding. It is argued that the dominant, semi‐public role of religious organisations in service delivery and social policy formation is an important but largely overlooked aspect of the Australian historical experience.     

Big Business in a Thin Market: Understanding the Privatization of Residential Care for Children and Youth in Sweden

This article analyzes the transformation of Swedish residential care for children from a regionally coordinated, public social service system into a thin, but highly profitable, national spot market in which large corporations have a growing presence. Marketization and privatization are theorized as complex processes, through which the institutional structure and logics of this small, but significant, social policy field changed profoundly. Using official documents, register data, media reports and existing research, three consecutive phases in the development of the children's home market are identified since the early 1980s. Change was driven on one hand by policies inspired by New Public Management, which shifted public authority horizontally to the private sector, and vertically to local authorities (funding) and to the state (regulation). On the other hand were the responses of local authorities and private actors to the changing incentives that policy shifts entailed. During the first two phases, both the proportion and size of for‐profit providers increased, and the model of family‐like care was replaced by a professional model. Cutting across the trend of privatization in the third phase was establishment of a parallel system of homes for unaccompanied refugee children – mostly in public ownership. Similarities with privatization in the English system of children's care homes are noted. By showing how the Swedish market for residential care has been created by policy and by actors’ responses to those reforms, the article provides a foundation for thinking through how the predictable, significant and well‐documented problems of such care markets might be addressed.     

Market stewardship of quasi‐markets by street level bureaucrats: The role of local area coordinators in the Australian personalisation system

With the rise in popularity of market‐based responses to social policy challenges, the stewardship of quasi‐markets or public service markets, is a key concern for governments worldwide. Debates about how to manage quasi‐markets have focussed on high‐level decision‐making processes. However local actors, in particular street level bureaucrats, are a key part of the complex work of managing quasi‐markets. We examine how street level bureaucrats act as local market stewards in a new quasi‐market for disability care, the Australian National Disability Insurance scheme. We find that the street level bureaucrats, known as local area coordinators, act as shapers of local markets but that their contributions are informal and often restricted by formal structures and processes. For example, we found evidence that the use of key performance indicators can disrupt effective local stewardship efforts towards a procedural approach. We conclude that introducing principles of the polycentric governance approach can improve connections between local market knowledge holders and central decision‐making agencies, thereby improving market stewardship and outcomes.     

‘Best of Both Worlds’? A Comparison of Third Sector Providers in Health Care and Welfare‐to‐Work Markets in Britain

This article compares the welfare markets in primary health care and ‘welfare‐to‐work’ in the UK since the late 1990s. A longitudinal comparison of two different policy areas enables us to study the context in which marketization and the resulting shift of welfare provision takes place. We outline the general background of the market‐based reforms and highlight in what way policymakers have ascribed third sector organizations (TSOs) a number of positive characteristics, particularly the ability to address concerns about well‐known market failures. While consecutive governments promoted these organizations as welfare providers, case studies of two illustrative provider organizations in each policy area reveal a number of problems regarding their distinctiveness in increasingly competitive welfare markets. We conclude that the crisp distinction made by policymakers between the third and other sectors as well as the alleged advantages of the former present a rather naïve picture of a complex reality and argue for a more critical view of third sector characteristics and performance. The third sector is not only characterized by a high degree of fuzziness at the boundaries to other sectors, but even within single organizations, which often undergo significant transformations over time. As a result, policy intentions and practical outcomes are contradictory with TSOs losing their alleged distinctiveness as players in increasingly competitive markets. Furthermore, we contend that detailed longitudinal studies of organizations are essential in the advancement of the discussion of the third sector concept as they provide conceptual insights into organizational change and behaviour.     

The new privatized market: A question of ideology or pragmatism within the Swedish addiction treatment system?

Given its traditions of universal welfarism and social democracy, Sweden had already scored unexpectedly high on New Public Management by the 1980s. Health and welfare services remain primarily tax‐funded, but the production of care is increasingly transferred to a competitive quasi‐market. To what extent can this development be understood in terms of right‐wing governments, and to what extent in terms of other, socioeconomic and pragmatic factors? We examined this question through official statistics on providers of institutional addiction care since 1976, and through the total expenditure and purchases by local‐level municipal social services of interventions for substance users in Sweden in 1999, 2004, 2009, and 2014. We have analyzed the distribution across public and private providers within the addiction treatment system, and whether national developments and local differences across the 290 municipalities—which bear the major treatment responsibility—can be understood in terms of local‐level political majority, population size, and local wealth. The share of purchased services has remained stable, but the treatment system shows increasing financial turnover and an increasing share of for‐profit providers among producers of purchased care, especially in outpatient treatment. While venture capital enterprises emerged as a new actor, non‐governmental organizations lost out in importance. Bourgeois government correlated with larger shares of purchasing and purchases from for‐profit providers. However, purchasing on a market dominated by for‐profit providers has also become the “new normal”, regardless of ideology, and recent years have shown a reversed effect of left‐wing municipalities purchasing more services than right‐wing governments. Pragmatic reasons also influence local‐level purchasing.     

Return of the Nanny: Public Policy towards In‐home Childcare in the UK,Canada and Australia

Research on early childhood education and care (ECEC) policy focuses overwhelmingly on formal, centre‐based provision and, to a lesser extent, on family day care (or childminding) provided in the homes of registered carers. Comparatively little research addresses the policy treatment of care provided in the child's home by nannies and au pairs. This article examines the position of in‐home childcare in Australia, the UK and Canada, and the varied nature and extent of public funding and regulation. Introducing a new dimension into comparative studies of ECEC, it also explores how shifts in migration policy in each country have intersected with ECEC funding and regulation to reshape the recruitment and employment of in‐home child carers. Australia, the UK and Canada are all liberal, market‐oriented countries, but there is considerable diversity in the way governments support and regulate in‐home childcare, their rationales for so doing, and in the connections between childcare and migration. We argue that connecting the analysis of in‐home childcare to migration policies raises new questions about the classification and comparison of ECEC policies.     

Trust and Welfare State Reform: The Example of the NHS

This article discusses the impact of New Public Management on public trust in welfare state institutions, using the example of NHS reform. Discussion of trust in public institutions across political science, psychology and sociology indicates that it is based on both rational/objective considerations (competence and capacity to deliver the service) and affectual/subjective factors (shared values, belief that the trustee shares the trustor's interests). The New Public Management foregrounds individual responsibility and incentives for both suppliers and users of services, in the NHS example in quasi‐markets, management by target and patient choice. These accord with an individualized market rational‐actor model rather than with affective considerations. Analysis of attitude survey data on the NHS confirms that rational/objective and affectual/subjective factors contribute to public trust in this field. However, a comparison between perceptions in England, where the internal market has been vigorously pursued, and Scotland, where the purchaser/provider split was discarded after devolution, indicate that the market does not offer a royal road to perceptions of superior quality in the objective factors. Conversely, the more market‐centred system can make progress in relation to the more subjective affectual factors.     

Rolling Back the African State: Implications for Social Development in Ghana

The New Policy Agenda of the Reagan and Thatcher years has profoundly influenced aid flows from the industrialized countries of North America and Western Europe to the developing nations of sub‐Saharan Africa. The application of neo‐liberal principles to the disbursement of multilateral and bilateral aid for social development has resulted in the diversion of donor funding away from the public sector towards non‐governmental organizations. The consequences of relegating the role of the public sector in social development is explored through qualitative research conducted in Ghana with state‐employed community development workers. The study exposes how severe financial constraint within the state sector distorts the targeting of beneficiaries and social development activity. This differs from findings revealed by interviews with social development workers employed by international non‐governmental organizations. These indicate that such agencies are able to sustain effectively resourced fieldworkers who are in a position to form positive working relationships with beneficiaries. The circumstances of the Department of Community Development and its relationships with non‐governmental agencies in Ghana are used to explore the effects on state‐building of the New Policy Agenda in the sub‐Saharan region.     

Public Opinion against Markets? Attitudes towards Market Distribution of Social Services – A Comparison of 17 Countries

This article studies how citizens view the appropriateness of market criteria for allocating services commonly associated with social citizenship rights and welfare state responsibility. The article focuses specifically on a potential role for the market in the provision of social services. The relationship between welfare policy institutions, socio‐economic class and attitudes is explored by comparing attitudes across 17 countries of the Organisation for Economic Co‐operation and Development, using multilevel modelling and data from the 2009 International Social Survey Programme. Results show that public support for market distribution of services is relatively weak in most countries, a result suggesting that public opinion is unlikely to pose a driving force within ongoing processes of welfare marketization. Still, attitudes are found to vary a lot across countries in tandem with between‐country variation in welfare policy design. First, aggregate public support for market distribution of services is stronger in countries with more private spending on services. Second, class differences in attitudes are larger in countries with more extensive state‐led delivery of services. Together, these results point to the operation of normative feedback‐effects flowing from existing welfare policy arrangements. The theoretical arguments and the empirical results presented in this article suggest that future research exploring the relationship between welfare policy and public opinion from a country‐comparative perspective is well advised to place greater focus on the market institutions that, to varying extents in different countries, act as complements to the state in the administration of social welfare.     

Novel Funding Paradigm for Social Work Services in China: Reflections on the Guangzhou Experience

Three decades of Chinese economic modernization created wonders that transform the living of the population. Yet economic affluence also spawns juggernauts of new social ills, and mounting social tensions emerge from widening inequalities between the wealthy and the less privileged. Local governments are under intense pressure to identify new approaches to addressing new social problems such as rising unemployment, elderly neglect, and juvenile delinquency through social management. This article recapitulates some of the experience of non‐governmental organizations through collaborating with the authorities, in pioneering social work services using new mode of public funding mechanism.     

Narrowing of Public Responsibility in Finland, 1990–2010

Public responsibility in Finland has narrowed in the last 20 years while the sphere of the private sector has been increased. The economic crisis of the early 1990s was not the cause, but an accelerator of public sector/welfare state retrenchment in Finland. Based on which, it was easy for the advocates of neo‐liberal reforms to argue that the changes were a must. The welfare state programmes however, are popular among the Finnish population and therefore large one‐time cutbacks have not been possible beyond the immediate aftermath of the economic crisis. This article looks into three different methods through which the Finnish welfare state has been gradually cut since then: (1) by not raising income transfers along with the rising cost of living and wages; (2) by reducing funding of public services; and, on the other side of the coin (3) through regular tax cuts contracting the revenue side. Welfare state retrenchment in Finland has therefore been achieved in a subtle fashion through slow gradual weakening of social programmes on one hand, and through cuts in revenue on the other that have left proportionally more in the hands of the wealthier. These combined movements have resulted in a drastic reversal in the trend in income inequality in Finland.     

Human Motivation and Professional Practice: of Knights, Knaves and Social Workers

Efforts to improve the efficiency and responsiveness of public services by harnessing the self‐interest of professionals in state agencies have been widely debated in the recent literature on welfare state reform. In the context of social services, one way in which British policy‐makers have sought to effect such changes has been through the “new community care” of the 1990 NHS and Community Care Act. Key to this is the concept of care management, in which the identification of needs and the provision of services are separated, purportedly with a view to improving advocacy, choice and quality for service users. This paper uses data from a wide‐ranging qualitative study of access to social care for older people to examine the success of the policy in these terms, with specific reference to its attempts to harness the rational self‐interest of professionals. While care management removes one potential conflict of interests by separating commissioning and provision, the responsibility of social care professionals to comply with organizational priorities conflicts with their role of advocacy for their clients, a tension rendered all the more problematic by the perceived inadequacy of funding. Moreover, the bureaucracy of the care management process itself further negates the approach's supposedly client‐centred ethos.     

Choice,Competition and Care – Developments in English Social Care and the Impacts on Providers and Older Users of Home Care Services

This article critically examines recent changes in markets for home (domiciliary) care services in England. During the 1990s, the introduction of competition between private (for‐profit and charitable) organizations and local authority providers of long‐term care services aimed to create a ‘mixed economy’ of supply. More recently, care markets have undergone further reforms through the introduction of direct payments and personal budgets. Underpinned by discourses of user choice, these mechanisms aim to offer older people increased control over the public resources for their care, thereby introducing further competitive pressures within local care markets. The article presents early evidence of these changes on:

• The commissioning and contracting of home care services by local authorities and individual older people.
• The experiences and outcomes for individual older people using home care services.

Drawing on evidence from two recent empirical studies, the article describes how the new emphasis on choice and competition is being operationalized within six local care markets. There are suggestions of small increases in user agency and in opportunities for older people to receive more personalized home care, in which the quality of care‐giving relationships can also be optimized. However, the article also presents early evidence of increases in risk and costs associated with the expansion of competition and choice, both for organizations providing home care services and for individual older service users.     

Privatizing Social Services in the U.S.A.

Governmental and private sector social services organizations have traditionally shared important roles for provision and delivery of social services in the United States. Over the past fifty years, however, a predominant position has developed for the public sector, especially through federal funding for social service programmes. Recent challenges to the prevailing role of public sector dominance have been expressed by the proponents for privatization at a time when decreasing federal funds are made available for social service programmes. The analysis presented here examines the potential and problems associated with the privatization strategies offered through load shedding, limited-government arrangements, fee charging and competition. As a macro level approach for a comprehensive system of social service provision and delivery, these privatization strategies raise more questions than immediate solutions. A more optimistic view is taken if privatization leads to a more meaningful balance with increased co-operation between public and private social welfare auspices.     

The Choice Revolution: Privatization of Swedish Welfare Services in the 1990s

During the 1990s, the Swedish welfare state was declared by some to be in a “crisis”, due to both financial strain and loss of political support. Others have argued that the spending cuts and reforms undertaken during this period did slow down the previous increase in social spending, but left the system basically intact. The main argument put forward in this article is that the Swedish welfare state has been and is still undergoing a transforming process whereby it risks losing one of its main characteristics, namely the belief in and institutional support for social egalitarianism. During the 1990s, the public welfare service sector opened up to competing private actors. As a result, the share of private provision grew, both within the health‐care and primary education systems as well as within social service provision. This resulted in a socially segregating dynamic, prompted by the introduction of “consumer choice”. As will be shown in the article, the gradual privatization and market‐orientation of the welfare services undermine previous Swedish notions of a “people's home”, where uniform, high‐quality services are provided by the state to all citizens, regardless of income, social background or cultural orientation.     

Public Satisfaction with the Health System and Popular Support for State Involvement in an East Asian Welfare Regime: Health Policy Legitimacy of Hong Kong

The legitimacy of social policies has gained increasing attention in the past decade, against the backdrop of fiscal austerity and retrenchment in many nations. Policy legitimacy encompasses public preferences for the underlying principles of policies and the actual outcomes as perceived by citizens. Scholarly knowledge concerning the legitimacy of health policy – a major element of modern social policy architecture – is, unfortunately, limited. This article seeks to extend the scholarly debates on health policy legitimacy from the West to Hong Kong, a member of the East Asian welfare state cluster. A bi‐dimensional definition of health policy legitimacy – encompassing both public satisfaction with the health system and the normative expectation as to the extent of state involvement in health care – is adopted. Based on analysis of data collected from a telephone survey of adult Hong Kong citizens between late 2014 and early 2015, the findings of this study demonstrate a fairly high level of satisfaction with the territory's health system, but popular support for government responsibility presents a clear residual characteristic. The study also tests the self‐interest thesis and the ideology thesis – major theoretical frameworks for explaining social policy legitimacy – in the Hong Kong context. Egalitarian ideology and trust in government are closely related to both public satisfaction with the system and popular support for governmental provision of care. However, the self‐interest thesis receives partial support. The findings are interpreted in the context of Hong Kong's health system arrangements, while implications for the territory's ongoing health policy reform are discussed.     

Including migrant skills in a knowledge economy: The politics of recognition of foreign qualifications,work experience and industry courses

The lack of skilled labour pushes mature knowledge economies towards importing skills. Previous studies have shown that migrants' economic and social integration in their host societies depend on the recognition of their skills. Yet, the degree to which the certificates of migrants and their practical experience are recognised and additional training is offered, is contested. Interests conflict not only between unions and employers, but also among employers and unions themselves. We argue that social partners' preferences on foreign qualification recognition (FQR), recognition of experience and industry-wide training (in the following: FQR and related measures) are mainly determined by the existence of occupational labour markets. An occupational labour market segments the labour market and subsequently restricts access to these segments. FQR and related measures constitute a regulated avenue into these occupational labour markets, protecting these labour markets from an uncontrolled influx of workers. Empirically, this contribution compares whether and how hospitality and construction industries—two sectors that depend heavily on migrants and difficult to organise due to seasonal activity—recognise and remunerate foreign skills. The construction sector recognises and remunerates foreign skills to a much larger extent than the hospitality industry. Adopting the method of difference and based on expert interviews, the paper shows that the more social partners protect their domestic occupational labour market, the more they also support FQR and related measures. The article discusses the implications for migrants' wages and social inclusion, contributing to the analysis of socio-economic tensions in mature knowledge economies.     

Labour Markets,Care Regimes and Foreign Care Worker Policies in East Asia

This article analyzes the politics of foreign care worker policies in Japan, Korea and Taiwan. In the face of socio‐demographic challenges, these countries have responded differently to the increasing demand for hiring foreign care workers, creating distinct policies with respect to the origins of the foreign care workforce, the size of the foreign care workforce in the labour market, and job specifications. In this article, I argue that the interaction of female employment patterns, the public provision (or lack) of social care, and labour market policies in the care service sector determines the diverging political pathways of foreign care worker policies in these three countries over the past two decades.     

Public health care in the balance: exploring popular support for health care systems in the European Union

Which factors explain intra‐ and inter‐country variations in levels of public support for national health care systems within the European Union, and why? We propose that public opinion towards public health care is dependent on (1) the type of welfare state regime to which the various European welfare states belong, (2) typical features of the national care system and (3) individual social and demographic characteristics, which are related to self‐interest or morality oriented motives. To assess the explanatory power of these factors, data from the Eurobarometer survey series are analysed. Support for public health care appears to be particularly positively related to social‐democratic attributes of welfare states, whereas support drops with increasing degrees of liberalism and conservatism. Further, support for public health care proves to be associated with wider coverage and public funding of national care services. We also find higher levels of support in countries with scarce social services for children and the elderly, and larger proportions of female (part‐time) employment. Lastly, with respect to individual characteristics, we find remarkably little evidence for self‐interest oriented motives affecting the preference for solidary health care arrangements.