Customer-choice organization of elderly-care: comparing local level processes in Sweden and Italy

Many European countries have been undergoing significant restructuring of the public sector for at least the last two decades, due to the influence of the NPM reform discourse. The general intent of NPM reforms consists in shaping the public sector in a more business-like fashion dealing with the need of increasing efficiency and effectiveness in service provision. Since long (Hood, 1991) it has been discussed whether it is a kind of management useful “for all seasons”, and all context. The debate has gone back and forth. The last few years, critical books on the public sector reforms have been published (cf Dibben et al, 2004). Others have argued that New Public Management (NPM) is middle aging (Hood & Peters, 2004) or even dead (Dunleavy et al, 2005). Still, NPM inspired reforms are still being implemented “out there” in many countries. In this paper, we will compare the implementation in two such countries, Sweden and Italy.As this trend is spreading, it is also being transformed (Christensen & Lagreid, 2001) or translated (Czarniawska, 2005) in different ways depending on the peculiarities at local level.Typically NPM-based reforms discourse posit the need of a different institutional structure of the public sector: the role of the government is seen as the one of enabler and regulator of a complex institutional setting of public service providers. Along this way, complex and diversified arrangements of service delivery take place, ranging from public administrations and public enterprises provision to bottom-up, local level initiatives. In particular, market-driven reforms have stimulated the idea of unbundling services provision, in the effort of a more rationalistic use of taxpayers' resources. Public services previously offered by large municipal entities have been redeployed in market-like settings, administered both by purpose built entities that play as a direct emanation controlled by local municipalities or by private agents acting on the market. In this scenario public entrepreneurship tends to assume different configurations, according to the ways in which NPM principles have been implemented in different contexts. The remainder of this paper will be structured as follows. First we outline our theoretical framework based on previous studies of NPM and of new institutional perspectives within organization studies. Thereafter, we present the purpose othe this research before presenting the contextual peculiarities of the countries studied. Then, we specify the research questions, before discussing our methodology. The cases are subsequently presented one at a time, followed by discussion and conclusions.