DIFFICULT DECISIONS ON CARE AND SERVICES FOR ELDERLY PEOPLE - THE DILEMMA OF SETTING PRIORITIES IN THE WELFARE-STATE

The aging of the population combined with restricted economic resource s is leading to an increasing gap between care needs and care resource s. The first strategy to cope with this growing disparity is often the rather noncontroversial attempt to optimize the use of the resources. At some point in time, however, more crucial decisions are needed. Fo ur levels of decision-making in the system of care services may be ide ntified - from decisions regarding national resource allocation to dec isions regarding individual users. The different conditions for making decisions and setting priorities at each level must be considered whe n studying the decisionmaking process and the consequences - including the repercussions for other levels and sectors. With Sweden as a case , four trends in decisionmaking can be seen: decentralization of many controversial decisions; redefining of the lines of responsibility bet ween sectors; increasing inequality in the accessibility, cost, and qu ality of care; and a general lack of public discussion and debate abou t central welfare issues.