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Policy makers are applying market-inspired competition and financial incentives to drive efficiency in healthcare. However, a lack of knowledge exists about the process whereby incentives are filtered through organizations to influence staff motivation, and the key role of managers is often overlooked. The purpose of this paper is to explore the strategies managers use as intermediaries between financial incentives and the individual motivation of staff. The authors use empirical data from a local case in Swedish specialized care.

The authors conducted an exploratory qualitative case study of a patient-choice reform, including financial incentives, in specialized orthopedics in Sweden. In total, 17 interviews were conducted with professionals in managerial positions, representing six healthcare providers. A hypo-deductive, thematic approach was used to analyze the data.

The results show that managers applied alignment strategies to make the incentive model motivating for staff. The managers’ strategies are characterized by attempts to align external rewards with professional values based on their contextual and practical knowledge. Managers occasionally overruled the financial logic of the model to safeguard patient needs and expressed an interest in having a closer dialogue with policy makers about improvements.

Externally imposed incentives do not automatically motivate healthcare staff. Managers in healthcare play key roles as intermediaries by aligning external rewards with professional values. Managers’ multiple perspectives on healthcare practices and professional culture can also be utilized to improve policy and as a source of knowledge in partnership with policy makers.

The purpose of the paper is to describe and analyze differences in patients' quality perceptions of private and public primary care centers in Sweden.

The article explores the differences in quality perceptions between patients of public and private primary care centers based on data from a large patient survey in Sweden. The survey covers seven dimensions, and in this paper the measure Overall impression was used for the comparison. With more than 80,000 valid responses, the survey covers all primary care centers in Sweden which allowed for a detailed analysis of differences in quality perceptions among patients from the different categories of owners.

The article contributes with a detailed description of different types of private owners: not-for-profit and for profit, as well as corporate groups and independent care centers. The results show a higher quality perception for independent centers compared to both public and corporate groups.

The small number of not-for-profit centers (21 out of 1,117 centers) does not allow for clear conclusions for this group. The results, however, indicate an even higher patient quality perception for not-for-profit centers. The study focus on describing differences in quality perceptions between the owner categories. Future research can contribute with explanations to why independent care centers receive higher patient satisfaction.

The results from the study have policy implications both in a Swedish as well as international perspective. The differentiation between different types of private owners made in this paper opens up for interesting discussions on privatization of healthcare and how it affects patient satisfaction.

The main contribution of the paper is the detailed comparison of different categories of private owners and the public owners.

Many countries today, especially in Europe, provide publicly funded public services in quasi-markets. As these markets commercialize, agencies of various types are providing technologies that support citizens’ choice of services. Citizens’ use of technologies for service provision is studied as e-government under labels of channel management, e-service uptake or adoption. In contrast, by using actor–network theory (ANT), the purpose of this paper is to focus on the marketing devices that are used to enroll citizens to choose technologies in a context with large penetration of quasi-market arrangements.

Based on a Swedish case study, this paper uses qualitative data from 11 occurrences of technologies to support citizens’ choice (“market devices”) in education, healthcare and public pension in an analysis of the means taken (“marketing devices”) to increase their use. The study formulates a tentative typology of these devices.

The marketing devices are intended to attract citizens’ attention to the possibility of choice (e.g. catalogs, postcards and commercials), invite interaction (e.g. various social media platforms), improve the technological support in line with user needs (e.g. user participation in development), increase visibility of technological support (e.g. search optimization) or directly connect citizens to technological support (e.g. via links).

The paper contributes to e-government research through a typology of means taken to increase citizens’ technology use based on selected concepts from ANT, and to a discussion of technologies and humans.