Freedom of choice or cost efficiency? The implementation of a free-choice market system in
community mental health services in Sweden
Sammanfattning
This case study investigates the implementation of a free-choice market system in community
mental health services using the example of day centres for people with psychiatric disabilities. It
was conducted in a major city that was about to implement a free-choice market system due to a new
legislation that made it feasible. Eighteen semi-structured interviews were conducted. Agents
situated in different parts of the organization were interviewed one year before and two years after
the free-choice system was launched in 2010. Data showed a top-down political process. A majority
of the intentions of the legislation advocated individual autonomy as the market system's main
purpose; only one concerned organizational efficiency. Data reflected, however, that financial
efficiency dominated the agents' experiences of the implemented system. The twofold market
purpose was clearly reflected in the interviews. Front-line staff hoped for improvements mainly for
the users, whereas managers mainly focused on the market as a resource allocator.