To Design Free Choice and Competitive Neutrality

The Construction of a Market in Primary Health Care

Abstract

Free choice and competitive neutrality are often assigned particular importance for successful market reform of public service. The aim of this article is to illuminate the practical work that goes into regulating free choice and competitive neutrality in a primary care market in a Swedish county council. The article asks: How is regulation of free choice and competitive neutrality in the primary care market carried out? Are there any particular challenges in working with this? If so, why? The article presents a qualitative case study and approaches the research questions with a market practice perspective. By studying how the work with a rulebook for authorization of care centers is carried out, detailed knowledge of the market regulatory process is gained. The result illustrates how purchaser officials frame the market with the rulebook. However, the ways free choice and competitive neutrality plays out it practice overflows the market frame. Overflows are caused by multiple, and conflicting, modes of calculations enacted by the rulebook. Therefore, free choice and competitive neutrality does not create the effects that policy-makers have expected in the primary care market.