Opportunistic behaviour in quasi-markets of home care - A study on the compliance of granted and provided home care hours in Swedish municipalities

Abstract: Building on a theoretical framework of New Public Management and agency theory, the study tests to what extent providers act opportunistically in a quasi-market context of welfare services and what factors affect their propensity to do so. Using individual level data from nine Swedish municipalities with quasi-marketised home care services, the degree of compliance between granted and provided home care is calculated and studied as a proxy for opportunistic behaviour. The findings indicate that users receive, on average, 86% of their granted home care hours. The results also indicate that there is substantial variation in compliance both between municipalities and across individuals within municipalities. Using an OLS regression, the relationship between the degree of compliance, reimbursement model design and the level of need of the user, defined in terms of the amount of granted hours, is examined. The results show that retrospectively determined reimbursement based on provided hours is associated with a higher degree of compliance compared with prospectively determined reimbursement based on granted hours, and that the degree of compliance decreases as the user's need increases.