Privat och offentligt i svensk alkoholistvård : Arbetsfördelning, samverkan och styrning under 1900-talet

Sammanfattning: The question of responsibility within Swedish alcoholism treatment, as part of the social services, is the focus of this thesis. A point of departure was the debate on privatisation within the alcohol and drug abuse treatment sector. The first part of the book aims at describing and characterising the division of labour between different providers in Swedish alcoholism treatment. The main sources include official reports, government bills and parliamentary debates, from the early century until present days. The views of a few important voluntary organisations on the treatment system are also included. The conclusion is that the church, voluntary organisations, and private initiatives have always been important in the provision of treatment and have continuously exerted an influence on treatment policy. Nor has there existed a strict division of labour between different types of principals or responsible organisations. The increase of private providers from the mid-1980s could be viewed as an extension of this co-operative tradition. In the second part of the thesis, the aim is to assess the impact of market mentality and the new managerialism on this tradition within the treatment system. A study was carried out during the period 1996-1997 in four municipalities, two larger towns and two suburbs, of which two had adopted a purchaser-provider split within the administration of alcohol and drug abuse treatment. The municipalities were analyzed as quasi-markets. Representatives of purchasers and providers were interviewed, the interviews supplemented with written material from the municipalities. All municipalities were familiar with the market-oriented thinking and had some experience of pruchaser-ptovider models within their individually developed administrations. The attitudes towards the new administrative models were clearly pragmatic in all research sites. The market orientation had reinforced an emphasis on economic efficiency in the social policy debate. A new distance between the municipal purchaser and different providers was visible. On the other hand, a social rights thinking was still present in the municipalities. Different co-operative projects, and a growing acknowledgement of the importance of trust and close co-operation to ensure quality within treatment, may indicate that the present formalised and economically determined relations are transitory problems of the decentralised social policy.