Experiences of marketised welfare organisations among addiction treatment staff in Sweden

Background: New public management (NPM) steering was gradually introduced in Swedish addiction treatment from the late 1980s, with the introduction of purchaser-provider models and performance management, and certain aspects, such as public procurement and competition with private, for-profit providers were normalized in the 2000s. This development has implied a strengthened market logic and new demands on the treatment system and its professionals, along with the ones given by traditional social and health care legislations and a welfare state model that previously relied little on the market.
Our research project ‘title ’first applied a qualitative research design and explored tensions that have arisen between different logics and how staff in the addiction treatment organizations handles these conflicts. While marketization has eliminated some low-quality services, increased cost-awareness and implied more structured treatment methods, it has also challenged treatment system values such as continuity and coordination of treatment, and professional autonomy and trust. Staff manage these conflicts in different ways, such as for example withdrawal or protest, and by referring to social and health legislations and national authorities to support their professional ethics. This qualitative data formed the basis for a web-survey among treatment professionals to be launched nationwide in the Spring of 2019. The aim of this study is to analyze the proliferation of experienced advantages and disadvantages with marketized welfare organizations, and experienced tensions and strategies to handle inconsistences in the Swedish addiction treatment system.
Methods: The web-survey will target treatment professionals and managers in public and private (not-for profit and for-profit) treatment organizations across Sweden (estimated N˜500-1000). The data will be statistically analyzed to compare the experiences of different professions (social workers, nurses, medical doctors, etc.) and organizations (health-care, social services, enterprises, NGO:s etc.) with more or less marketized organizational models.
Results and conclusions: The web-survey will be analyzed in the summer of 2019 to be presented in October. Marketization of welfare services has become increasingly controversial. We expect that our results will contribute to a more informed discussion about the future organization of addiction treatment.

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