Elder care is a policy field which only in recent decades has gained broad recognition among welfare scholars as a sector of its own, distinct from areas like health care or social work. Elder care refers to non-medical assistance with activities of daily living (ADL) directed to those over a certain age, usually 65. It covers a wide range of activities related to house-keeping, food preparation and intimate personal care. The aim of elder care is not to cure, but to provide safety, comfort and as much autonomy as possible for elderly persons who cannot manage daily life on their own.

In this chapter, we describe the emerging policy field of elder care and the specific features which condition policy implementation in this sector. We review recent reform trends and provide an overview over the so far rather scarce literature which describes how reforms in this sector have been implemented and what appears to be common barriers in this regard. In reviewing the recent literature on implementation in elder care, we focus particularly on reforms aimed at improving integration between elder and health care services, as this is an area which has attracted a lot of scholarly attention in recent years. The last section of the chapter summarizes the experiences from implementing reforms in the elder care sector, highlighting key lessons so far.

Primary care can be seen as a sub-system within health care, distinct in its orientation towards generalist and person-centered care and typically provided by general practitioners (GPs). Like health care in general, primary care provision in many countries has undergone processes of marketization in recent decades in order to promote competition and economic efficiency. In most cases, primary care can be seen as a quasi-market in that provision is primarily private while funding and regulation is public. At the same time, policy-makers have often sought to steer primary care directly, for instance by increasing its integration with other types of health services or making it more accessible to patients. A third trend is the use of evidence and performance indicators to promote quality development and professionalization in this area. These partly conflicting policy trends have led to primary care in Europe being governed by a mix of policy instruments which are not always well aligned. The complexity in governance applies also to the Nordic countries, where the organization of primary care displays a wide variety, despite that fact that health care systems in this region are usually described as similar. This raises the question what, exactly, determines the construction of quasi markets in this area and which political trade-offs are involved in the process? To address the question, we undertake in the paper a comparative analysis of primary care markets in three Nordic countries: Sweden, Norway and Denmark. By constructing an analytical framework, we highlight both differences and similarities in the way primary care services are provided across the three cases. Reviewing recent reforms, we also discuss which political motives and choices that have underpinned market-making in this area and how Nordic policy-makers have sought to balance market elements against goals like population health and social equity. Theoretically, the paper draws on concepts like marketization and market-making, which are applied to the area of primary care.

Welfare associations (Wohlfahrtsverbände) have traditionally played an important oligopolistic role in the provision of public services in Germany. In addition to the oligopolistic provision of public services, they also have a strong role in the formulation and implementation of policies. This dense partnership between welfare associations and the state has often been labelled ‘neo-corporatism’.

In the wake of reforms in the 1990s, established corporatist strutures of co-production have been challenged by new forms of citizen engagement and private for-profit actors contesting the old ‘oligopolies’ of welfare production.

As a consequence new forms of co-production emerged in Germany: besides the traditional corporatist mode of co-production, new forms of competitive co-production were established between welfare associations, for-profit enterprises and new voluntary organizations - the traditional corporatist structures were now accompanied by co-production driven by quasi-market competition.

A hybridity approach shows how welfare assications have transformend to a polycentric acting network being able to operate simultaneously in these new environments of co-production, which in turn have different effects on these environments:

While individual organisations of this network react in some environments according to isomorphic patterns and copy organisational models, they develop at the same time individually and innovative in other environments. The extent to which welfare associations act isomorphically or not depends on the (un-)certainty of the environment in which they operate.

Two different directions of effect between welfare associations and their environment can be derived from this: While their development is determined within the framework of isomorphic patterns in uncertain environments (quasi-markets), they develop innovatively and are able to shape socio-political structures in certain environments. They have an effect on the structures surrounding them.

The shaping potential of welfare associations is reflected along their impact on society (e.g. poverty policy). In the sociopolitical system, welfare associations have created a new form of corporatism, that I define as "confrontational corporatism", which, unlike its predecessors, is no longer characterized by cooperative coexistence, but by opposition between politics and welfare associations. Central to this is that this confrontational attitude can avoid destabilizing the socio-political system through social forces. Welfare associations become (again) a quasi- non-governmental organization.

The study examines the intermediary role played by non-governmental organizations (NGOs) in co-production within the context of public service ecosystems. Recent literature, notably Haug (2023), has highlighted the significance of NPOs as co-production intermediaries. This research contributes particularly to the panel theme of “The role of society/the community in building welfare policies”, as well as “New approaches to evidence-based welfare policies”.

Our interest lies in understanding the intermediary function of NPOs in co-production, wherein they promote welfare and leverage their reference group's experiential knowledge to enhance the value of public service ecosystems (Trischler et al., 2023). However, the recognition of the importance of NPOs is not consistently acknowledged by public service organizations (Tuurnas et al. 2022). Moreover, the performance of collaborative efforts may be more difficult to measure (Douglas & Schiffelers, 2021; Waardenburg et al., 2022), as effects may arise in forms that do not bend into numbers or figures.

In light of this, the central question emerges: how do NPOs contribute value to the public service ecosystem? A comprehensive understanding of this is imperative for fostering sustainable and well-resourced collaborations (Danbi & Bryson, 2022).

Empirical data for this study is drawn from the context of a Nordic welfare state, specifically Finland. The dataset comprises 16 expert interviews with representatives from NPOs operating in the social and health services sector. Employing frame analysis, we depict NPOs actions across various co-production settings and illuminate these actions in the context of value creation. Consequently, we identified 20 sub-frames of TSO work, from which three overarching frames emerged: NPOs’ value through connecting people to communities for empowerment, supporting the public service system through collaboration, and strengthening the ideals of civil society for democracy and inclusion.

Haug, N. (2023). Actor roles in co-production—Introducing intermediaries: Findings from a systematic literature review, Public Administration, https://doi.org/10.1111/padm.12965

Seo, D., & Bryson, J. M. (2022). Resource development and use in a nonprofit collaboration. Public Performance & Management Review, 45(5), 1181-1213.

Jaspers, S., & Steen, T. (2021). Does co-production lead to the creation of public value? Balancing the dimensions of public value creation in urban mobility planning. Administration & Society, 53(4), 619-646.

Trischler, J., Røhnebæk, M., Edvardsson B. & Bård Tronvoll (2023). Advancing Public Service Logic: moving towards an ecosystemic framework for value creation in the public service context, Public Management Review, DOI: 10.1080/14719037.2023.2229836

Tuurnas, S., Paananen, H. & Tynkkynen, L-K., (2023). Agile, institutionalised and dependency-driven: Multifaceted forms of collaboration agencies of third-sector organisations, Voluntas, 34, 573–584

(2023).