Priorities in care and services for elderly people: a path without guidelines?

The growing gap between demands and resources is putting immense pressure o n all government spending in Sweden. Tbe gap is especially apparent in cars and services for elderly people in light of the rapid aging of the populat ion. The article considers the decisions and priorities concerning resource allocation in the welfare sector in general and in elderly rare in particu lar. The aim is to describe the political and administrative setting and to provide it conceptual structure that outlines the nature of the problem. V arious levels of decision making are identified and discussed in the contex t of political accountability. Current transitions in elderly care are desc ribed with respect to service provision, marketisation, coverage rates, and eligibility standards. Basic principles of distribution an highlighted in order to clarify some central concepts of efficiency and justice, and a num ber of strategies for actual prioritising are identified. The article concl udes with an endorsement of more conscious decisions in resource allocation . Existing knowledge and information concerning the effects of various stra tegies must be utilised, and the values and assumptions used far setting pr iorities must be made explicit.