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Inequality in the welfare state?: Local variation in old-age care – the case of Sweden
Stockholm University, Faculty of Social Sciences, Department of Social Work.
Stockholm University, Faculty of Social Sciences, Department of Social Work.
2003 (English)In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 10, no 3, 174-184 p.Article in journal (Refereed) Published
Abstract [en]

This article uses Sweden as an example to describe and analyse municipal variation in services and care for elderly people. Responsibility for these services lies with the municipalities. National statistical data on municipalities are analysed to map out the variations in old-age care; to study compensating factors in the care system; and to explore the connection with municipal structural and political conditions. The overall finding of the bivariate analyses was that most relations with structure and policy were weak or non-existent. The final multivariate model explained only 15% of the variance. The large differences between municipalities makes it more appropriate to talk about a multitude of 'welfare municipalities' rather than one single welfare state. The article concludes that this municipal disparity constitutes a greater threat to the principle of equality in care of the elderly than gender and socio-economic differences.

Place, publisher, year, edition, pages
2003. Vol. 10, no 3, 174-184 p.
Keyword [en]
home help; municipal variation; regional inequality; welfare municipality
National Category
Social Work
URN: urn:nbn:se:su:diva-24361DOI: 10.1111/1468-2397.00170ISI: 000170681900004OAI: diva2:197354
Available from: 2000-11-25 Created: 2000-11-25 Last updated: 2013-07-09Bibliographically approved
In thesis
1. Tradition, Change and Variation: Past and Present Trends in Public Old-age Care
Open this publication in new window or tab >>Tradition, Change and Variation: Past and Present Trends in Public Old-age Care
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim of this dissertation is to describe and analyse how public old-age care in Sweden has developed and changed during the last century. The study applies a provider perspective on how care has been planned and professionally carried out. A broader social policy perspective, studying old-age care at central/national as well as local/municipal level, is also developed. A special focus is directed at the large local variation in care and services for the elderly. The empirical base is comprised of official documents and other public sources, survey data from interviews with elderly recipients of public old-age care, and official statistics on publicly financed and controlled old-age care and services.

Study I addresses the development of old-age care in Sweden during the twentieth century by studying an important occupation in this field – the supervisors and their professional roles, tasks and working conditions. Throughout, the roles of supervisors have followed the prevailing official policy on the proper way to provide care for elderly people in Sweden; from poor relief at the beginning of the 1900s, via a generous level of services in the 1960s and 1970s, to today’s restricted and economy-controlled mode of operation.

Study II describes and compares two main forms of public old-age care in Sweden today, home help services and institutional care. The care-load found in home-based care was comparable to and sometimes even larger than in service-homes and other institutions, indicating that large care needs among elderly people in Sweden today can be met in their homes as well as in institutional settings.

Studies III and IV analyse the local variation in public old-age care in Sweden. During the last decades there has been an overall decline in home help services. The coverage of home help for elderly people shows large differences between municipalities throughout this period, and the relative variation has increased. The local disparity seems to depend more on historical factors, e.g., previous coverage rates, than on the present municipal situation in levels of need or local economy and politics.

In an introductory part the four papers are linked together by an outline of the demographic situation and the social policy model for old-age care in Sweden. Trends that have been apparent over time, e.g. professionalisation and market orientation, are traced and discussed. Conflicts between prevailing ideologies are analysed, in regards to for instance home-based and institution-based care, social and medical culture, and local and central levels of decision-making. ’Welfare municipality’, ‘path dependency’, and ‘decentralisation’ are suggested as a conceptual framework for describing the large and increasing local variations in old-age care. Finally, implications of the four studies with regard to old-age care policy and further research are discussed.

Place, publisher, year, edition, pages
Stockholm: Institutionen för socialt arbete - Socialhögskolan, 2000. 207 p.
Stockholm studies in social work, ISSN 0281-2851 ; 16
Care of elderly people, old-age care, eldercare, Home based care, Institutional care of elderly people, Nordic welfare state, Manager, Supervisor, History, Local traditions, Municipal variation, Regional inequality, Welfare municipality
National Category
Social Work
urn:nbn:se:su:diva-695 (URN)91-7265-182-2 (ISBN)
Public defence
2000-12-16, Aula Svea, Socialhögskolan, Sveaplan, Stockholm, 10:00
Available from: 2000-11-25 Created: 2000-11-25Bibliographically approved

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Trydegård, Gun-BrittThorslund, Mats
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