Patient organizations such as those in Sweden face individualization processes on two fronts, both in their own voluntary sector and in the healthcare sector. The aim of this study is to investigate how the patient organizations are handling the two-front individualization process internally in their organizations, as well as externally towards a more patient-centred healthcare system.With more diverse stakeholders and individual patients given increased influence, we would expect a corresponding adjustment in the strategies of the patient organizations. The article’s focus is on the organizations’ representative role, and theories on advocacy strategies are used to identify the nature of the patient organizations’ advocacy work. To find out how adjustments are made, 17 semi-structured interviews were conducted with representatives from local branches of three large Swedish patient organizations. The interviews show a low tendency to adjust as a response to this two-front individualization and illustrate a paralyzed rather than modified behaviour in these organizations. Individualization being a global trend, we believe these results are of interest to scholars of collective participation in all parts of the world.

Over the last two decades, the inclusion of patient voices and public values in the field of health care through deliberation has become increasingly emphasized, by patients as well as policy-makers. This is achieved not only through individual patient participation but also through patient interest organizations. Geographical representation within national interest organizations is especially important in a decentralized, multilevel policy field such as Swedish health care, allowing representation from all regions to be present in national advocacy. Using Pitkin’s conceptualization of political representation,this study aims to characterize the shaping of representation among Swedish federative patient organizations, in a time of professionalization and centralization of civil society.The results show that patient organization representation has functioning mechanisms for all studied aspects of representation; however, the nature of the substantive representation seems to contain a challenge from a democratic perspective. This leads us to a discussion about management, rooted in democratic ideals but simultaneously strongly characterized by more managerial ideals, and the contradiction of democracy and actionable management.

The concept of coproduction has increasingly been adopted by health services research, practice and policy. The focus of this type of coproduction is at the individual level. However, a large literature has for decades explored the values and logics that come with coproduction at a collective level. This article combines the different theories of coproduction by studying Japanese healthcare cooperative organizations, where the individual-level, healthcare-related type of coproduction exists along with more collective forms such as community- and organizational coproduction. The study aims to establish this three-part typology of coproduction, and how the different types of coproduction relate to self estimated service quality. The study uses survey data from 2016–2017 collected at four cooperative hospitals in Japan, covering both staff and patients. Individual coproduction stands out with the strongest positive correlation with service quality. However, all three types of coproduction had strong and positive correlations with service quality. An important finding is that the relationship between service quality and the collective forms of coproduction were experienced differently by patients and staff. This finding underlines the importance of using a multi-stakeholder perspective when studying collective forms of coproduction in healthcare.

It is, today, widely accepted that market structures, logics, identities and activities are spreading throughout society, including civil society and its organisations. Scholars increasingly use the marketisation concept to describe these tendencies. This paper reviews the meaning attached to this concept, when used in the context of civil society. A sample of 210 peer-reviewed articles in civil society studies published between 1993 and 2017 is explored in an analysis that suggests that marketisation is being used with much variation in the literature. The analysis also shows that apart from more generic descriptions of persistent attempts to privatise and commodify various goods and services, few articles seem to involve more detailed definitions or profound conceptual arguments. Taken together, this indicates a development where the concept of marketisation runs the risk of losing its analytical powers. To avoid this, the paper proposes a stricter and more transparent use of the term ‘marketisation’ and suggests ways to further develop this concept in research.