Municipal control of external providers within the elderly care

Abstract

Swedish municipalities are today using more and more non-public alternatives to provide public services for their citizens. One area where this is increasing is the area of elderly care. By utilizing some form of purchaser-provider model or a check system where the end users themselves choose a service provider, municipalities are de facto outsourcing the production of elderly care. A problem associated with this is how to control that the services produced externally live up to the demands set by the municipalities.

In my study I found that the main control mechanism is a contract which is usually combined with additional control mechanisms. These include surveys aimed at the end users, a form of inspection which according to research is not very appropriate for the area of elderly care. A more appropriate control mechanism could be a quality control system which is also recommended by the National Board of Health and Welfare. They are however very passive and at the moment not working to enforce tighter regulation within this area. The provider companies themselves are also working with the issue of quality control and are moving towards some form of quality certification. My study indicated significant differences between the municipalities that used external providers, but some form of standardization is likely to occur within this area.