2025/03/15 by Janna Goijaerts, Natascha van der Zwan, Jet Bussemaker · 1 voice
Health Professions · Economics, Econometrics and Finance · #Primary Care and Health Outcomes #Healthcare Policy and Management #Health Systems, Economic Evaluations, Quality of Life
paper · doi:10.1332/03055736y2025d000000066
openalex publication_date 2025/03/15 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/16
Social services are an increasingly important part of the welfare state. According to existing scholarship, services should be preventative, tailored and complementary. Yet, in practice, these service delivery preconditions or goals are often found lacking. Managers in street-level organisations can influence this discrepancy, by either alleviating or further enhancing it. That is the issue we explore, by asking how the discrepancy between formal policy goals and actual service delivery is perceived and articulated by middle managers whose work includes the discretionary translation of policy on paper to their employees at the street level. To address this question, we conducted a vignette interview study among middle managers from a variety of welfare state organisations in the Netherlands. Instead of focusing on one type of service, we focus on several types of services delivered to recipients with a combination of socio-economic and health problems. The results show that the three preconditions of service delivery are perceived to be not or only partly present in service delivery practice in the Netherlands. We distinguish three ways in which middle managers articulate the ambiguous work within this discrepancy. First, they equate prevention with early identification and accessibility of services. Second, they internalise a discourse on customisation. Third, they substitute complementarity for collaboration. Given that the span of influence of the middle managers includes the individual level more than the organisational and system levels, we argue that these articulations could reinforce the existing emphasis on the service precondition tailoring at the expense of complementarity and prevention.