Marketization and the Quality of Residential Elderly Care in Sweden

Abstract

Against a backdrop of increased levels of marketization of welfare services in OECD countries, this article aims to shed light on the separate effects of private ownership and competition on service quality. Using residential elderly care in Sweden as our case, we leverage unique panel data of ownership and competition against a set of indicators, pertaining to the structure, process and outcome dimensions of care quality. The main finding of our analyses is that competition does surprisingly little for quality: private entrepreneurs perform neither better nor worse under stiff competition and the quality of care is approximately the same in those nursing homes that are exposed to competition from private actors as in those that are not.