The Swedish Addiction Treatment System: Government, Steering and Organisation. Technical Report
2019
Welfare
systems in Sweden and internationally have gone through major changes regarding
modes of operation and means of government in New Public Management (NPM)
reforms, which have sought to balance autonomy and control. There is a lively
debate about NPM, but research is scarce. NPM indicates improved performances
but also unintended consequences and inconsistencies concerning ideas, demands
on the services and performance incentives – such as tensions between medical
and social professional autonomy and knowledge on the one hand and
administrative control, auditing and a growing bureaucracy (e.g., procurement,
inspections, documentation) on the other. The research project used addiction
treatment with different organisations and professions as a case for studying
the impact of NPM on the daily work in regional health care and municipal
social services organisations.
We
charted the broad steering and organisation of addiction treatment. We analysed
the extent to which tendencies of NPM have conveyed advantages or created
conflicting logics by comparing addiction treatment in three regions and six
municipalities with varying degrees of NPM. The study used official statistics,
documents, interviews and a web survey. A total of 85 interviews were made with
93 individual state, regional and local policy-makers and officials (including
the previously unstudied procurers) and public and private care providers (managers
and treatment professionals) in 2017–2018. The interviews formed the basis for
a web survey among professionals in Sweden in 2019. Purchasing addiction
services was further examined by observing a large procurement process, by organising
a workshop with Nordic procurement experts, and by interviewing civil servants
in Finland, Denmark and Norway.
The
study shows how addiction treatment is governed and organised, highlighting
developments over time with special emphasis on various NPM features. The
interviews addressed advantages and tensions in the daily work and if and how
professionals seek to adapt to new, perhaps inconsistent, demands. The web survey
allows for comparisons across organisations and professional groups. This technical report presents the
background and aims of the study and describes in detail the Swedish study
setting, and the study design, methods and data sources used.
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