Universalism in flux – Welfare profit-makers’ views towards the institution of welfare universalism

Abstract

In recent decades, the growing influence of profit-making in Finnish healthcare and social services has affected a core institution of the Nordic welfare state – welfare universalism. This study investigates elite views concerning this institution. Drawing on new institutional theory, we analysed qualitative interviews conducted with 22 Finnish owners and managers of private care companies who have earned significant income or wealth in the healthcare and social service sectors. The findings revealed that despite healthcare being framed as an acceptable profit-making domain, interviewees considered universal coverage for and access to basic education and healthcare as normative, established and culturally legitimate forms of universalism. Conversely, interviewees responded to universal social security benefits with strong resistance and recommendations for normative and regulative change. Our analysis shows that Finnish welfare profit-makers construct clear hierarchies between different services traditionally positioned at the core of the universal Nordic model, and their normative assessments of welfare universalism appear to reflect the logic of Finnish welfare policy reforms, which makes them appear rational and morally legitimate. In other words, the interviewees’ understanding of universalism as a normative institution aligns with what is currently possible or not in the regulatory setting of the Finnish welfare state.

Introduction

Nordic countries and their welfare models are often considered global benchmarks for social and economic equality. One key aspect that distinguishes Nordic welfare states from their liberal and conservative counterparts is the institution of universalism (Anttonen, 2002; Esping-Andersen, 1990; Kildal and Kuhnle, 2005). Unlike selectivism, welfare universalism promotes basic social benefits and welfare services that support people from all socio-economic backgrounds (Anttonen, 2002). Thus, the main characteristic of a universal welfare state is the high degree of population coverage: All members of society are, as a matter of social right, beneficiaries of the same welfare schemes (Esping-Andersen, 1990; Kildal and Kuhnle, 2005; Sainsbury, 1988), which implies that most citizens use public services rather than their private alternatives (Anttonen, 2002; Moberg, 2017). However, this core institution of the Nordic welfare state has eroded in recent decades, with many studies describing increased challenges to the normative base of the Nordic model (e.g. Blomqvist, 2004; Frederiksen, 2025; Kuivalainen and Niemelä, 2010; Moberg, 2017). In research, the restructuring of the welfare state has above all been attributed to financial austerity politics (Autto, 2023) and the introduction of market-oriented policies (Anttonen and Karsio, 2017: 233; Kildal and Kuhnle, 2005: 15; Strang et al., 2021), such as outsourcing, user-choice models and competitive tendering, which are regularly discussed under the concept of marketisation.

This study investigates elite views concerning welfare universalism, with a focus on an emerging elite group that plays a key role in reorganising the normative and regulative base of the Nordic model in Finland. The discourses of these elite actors have not yet received scholarly attention, despite their unique relationship with the country's comprehensive welfare system. This group, which we call welfare profit-makers, includes owners and managers of private care companies who have earned significant wealth or income in the welfare sector due to various marketisation reforms that have opened publicly funded care and health services to private profit-making ventures (Kuusela and Tarkiainen, 2025). Essentially, in Finland, the state has gradually devolved its direct responsibility for service provision, promoting competition between suppliers and creating a triangular relationship between citizens, public procurers and private service providers (for other country contexts, see for example Fine and Davidson, 2018; Freedland, 2001). Based on interviews conducted with these welfare profit-makers, we analyse their views concerning welfare universalism as a key institution of the Nordic welfare state. By adopting the conceptual framework of new institutional theory, we assess which kinds of welfare universalisms key actors in for-profit welfare service production wish to maintain and the kinds of institutional changes they envision.

More precisely, we argue that welfare reforms of the past three decades, during which healthcare and social services have been opened more widely to market initiatives in the Nordic countries, have been accompanied by two major institutional shifts. First, these changes have created space for new agents – welfare profit-makers (Kuusela and Tarkiainen, 2025) – who form a new elite group that works at the nexus of the public and private sectors and whose profits often derive from the publicly funded system. Through their market-oriented practice these actors – as institutional entrepreneurs (see, e.g. Leca et al., 2008) – challenge some institutional premises of the Nordic welfare state and its morality (Frederiksen, 2025; Sachweh and Hilmar, 2020). Second, as seen in the discourses of the welfare profit-makers, the different regulative changes inside the welfare state seem to have been coupled with varying changes in the normative and cultural-cognitive institutions of welfare universalism.

Our interviewees form a significant and powerful group of institutional reformers and disruptors in the context of the welfare state. As our interviews demonstrate, these emerging elite actors have been actively involved in collective attempts to change the institutional framework of welfare service production in Finland. Due to their growing institutional power, their views are significant for the entire Nordic model and the moralities upholding or challenging it.

The interviewees presented profit-making and marketisation as rational and legitimate in healthcare and social services that have been opened for marketisation, thereby framing them as services the provision of which should be only partially universal. In contrast, the interviewees argued that access to and the provision of basic education – which is still, in practice, a public good in Finland with no for-profit alternatives – should be strictly universal. Finally, the interviewees suggested that social security benefits should fall almost entirely outside the principle of universalism. These views provide important insights into institutional changes and how welfare universalism is articulated in different ways depending on the welfare policy arena.

Our analysis shows that Finnish welfare profit-makers construct clear hierarchies between different services traditionally positioned at the core of the universal Nordic model, and their normative assessments of welfare universalism appear to reflect the logic of Finnish welfare policy reforms, which makes them appear rational and morally legitimate. In other words, the interviewees’ understanding of universalism as a normative institution aligns with what is currently possible or not in the regulatory setting of the Finnish welfare state.

Welfare universalism as an institution

This study employs new institutional theory to describe how the institution of universalism is (re)articulated by actors who have economically benefitted from the reorganisation of the Nordic welfare state and whose business practices have actively changed and challenged the model. In sociology, institutions are typically understood as a set of ‘social rules that regulate or even enable interaction’ (Gronow, 2008: 351; Scott, 2001). Institutions not only respond to legislation but also operate within a framework of norms, values and assumptions about what constitutes appropriate or acceptable behaviour.

According to new institutional theory, institutions may be understood from at least three perspectives: regulative, normative and cultural-cognitive (Scott, 2001). Regulative institutions (e.g. rules and laws) define what agents may or may not do and affect actors through coercion, while normative institutions (e.g. values and expectations) define what agents should or should not do and define the moral appropriateness of actions. Finally, cultural-cognitive institutions define what is and is not true and what can and cannot be done, which makes actions comprehensible through shared beliefs (Scott, 2001; see also Dixon and Sorsa, 2009; Schmidt, 2010). Such cultural-cognitive institutions do not amount to mere subjective beliefs because, as Gronow (2008) notes, institutionalisation takes place precisely when frameworks of meaning are considered objective facts. Such an understanding of normative and cultural-cognitive institutions resembles many other approaches in sociology and economic sociology, according to which economic and social action is always grounded in a socially and subjectively validated set of social norms and shared moral assumptions (Mau, 2003; Sachweh and Hilmar, 2020). Accordingly, economic behaviour is seen as being embedded in broader social, cultural and moral contexts that regulate behaviour and people's understanding of what is considered a common good, right or wrong, just or unjust (Frederiksen, 2025; Kehr, 2023).

Different institutional agents stress one or another of the institutional perspectives – regulative, normative and cultural-cognitive – when legitimating their own authority and needs for change (Scott, 2008). Some institutional agents attempt to create general cultural-cognitive frameworks and transport ideas, some devise normative prescriptions to guide behaviour and others exercise coercive authority (Scott, 2008). Institutional agents may also initiate institutional change that threaten to subvert existing institutional structures and predominant institutions. In the context of the Nordic welfare state, such subversive agency may, for example, mean promoting market-based practices in welfare provision that change – and reflect changes in – the institutional dimensions of the welfare state (see Covaleski et al., 2013; Jensen and Fersch, 2019).

Welfare universalism is a regulatory, normative and cultural-cognitive institution that is currently in flux in the Nordic countries. In Finland, as in other Nordic countries, most healthcare and social services, as well as basic education, have traditionally been funded with tax revenues and distributed universally by public authorities (Lehto et al., 1999: 104). However, in past decades, Nordic countries have shifted to more market-oriented solutions in public service organisation and welfare policy implementation (Hoppania et al., 2024; Karsio, 2024; Moberg, 2017). Since the 1990s, different Nordic countries have introduced various legislative changes that have allowed public authorities to implement user-choice models and outsource services to private for-profit providers (for a review of such changes in Finland, see Karsio, 2024: 32–41). While still mostly funded by the public sector, healthcare, social services and early childhood education and care (ECEC) are increasingly being provided by profit-seeking private companies. This rapid expansion of for-profit service provision has resulted in a high market concentration of care (Hoppania et al., 2024; Karsio, 2024). For example, in contemporary Finland, three largest companies, Attendo, Esperi Care and Mehiläinen, dominate the markets and employ over half the private workforce in social and healthcare (Hoppania et al., 2024; TEM, 2020, 2021).

The primary function of the Nordic welfare state's universalism has been to protect its members against risks to social security, such as old age, injury, maternity, illness and unemployment (Kildal and Kuhnle, 2005: 15–16). By establishing universal access to basic welfare services and extending social insurance to the entire population, Nordic countries have attempted to promote equality and solidarity between classes and genders (Anttonen, 2002; Lister, 2009). Thus, in the Nordic context, the institution of universalism has typically referred to a form of welfare service distribution in which all people have access to education, economic security, social care and health services (Anttonen et al., 2012: 2–3), although the term ‘all members’ may be misleading since few benefits (e.g. child benefits) are truly universal (Kildal and Kuhnle, 2005: 14).

The Nordic welfare systems claim to promote equality of status by endowing all citizens with similar rights regardless of, for example, their socio-economic status (Esping-Andersen, 1990: 46). Thus, universal public services and relatively generous social security benefits are regarded as societal equalisers (Kovalainen and Österberg-Högstedt, 2011), which have been framed as rational and efficient methods of obtaining safety, stability, social cohesion and economic equality (Frederiksen, 2018: 9).

Accordingly, the Nordic welfare state has traditionally rested on the idea that services ought to be detached from the markets and the purchasing power of its citizens to ensure that all individuals have equal – albeit conditional – access to services (Kovalainen and Österberg-Högstedt, 2011: 60). To be universal, public programmes must also pertain to all societal groups, including high-income individuals who can afford to purchase alternative services (Blomqvist and Palme, 2020: 115; Moberg, 2017). The underlying logic is that if everyone benefits from the model, everyone will – presumably – feel obliged to pay into it (Esping-Andersen, 1990: 51).

By extending social insurance to cover the entire population, Nordic welfare states have also attempted to break away from stigmatising poor relief and dispersed insurance funds (Anttonen et al., 2012). Within the realm of welfare policy, universalism is often contrasted with selective means-testing that targets the poor to ensure that support is provided to those who need it most, as opposed to universal programs that offer benefits to everyone (Anttonen, 2002: 73; Kildal and Kuhnle, 2005: 13). Thus, the core idea of universalism is that benefits should be maintained at a level high enough to obviate the need for targeted measures (Kuivalainen and Niemelä, 2010: 269–270). However, traditionally, Nordic welfare states have reinforced the normalcy of wage work and the work ethos by framing full-time employment as a civic duty (Kettunen, 2001: 239–240). For example, in a qualitative study conducted in Sweden and Denmark, interviewees across the class spectrum perceived unemployed people as ‘lazy’ or ‘too picky’, which reveals a tendency to evaluate this group as less worthy of universal welfare (Frederiksen, 2018: 9, 13). In this spirit, several activation reforms in Finland have introduced welfare conditionality to increase the behavioural requirements for the unemployed individuals to receive benefits (Tarkiainen, 2022).

In terms of actual policies, the Nordic countries have always varied (Sainsbury, 1988: 339), and when, if ever, the Nordic universalism outlined above has been realised in full remains up for debate. For example, in Finland, universal access to public services is guaranteed through professional needs assessment (Karsio, 2024), which tends towards at least some selectivism (Lehto et al., 1999: 115). Additionally, highly autonomous and diverse local authorities have implemented universal aims in diverse ways, resulting in multiple models of universalism (Kalalahti and Varjo, 2021). In Finland, for instance, universalism in older adult care has never been fully realised (Anttonen, 2002: 77), and user fees for services may restrict one's ability to exercise their rights to access (Lehto et al., 1999: 131). In each of the Nordic countries, different policy sectors (e.g. pensions, social insurance, healthcare and education) have retained their universal character in some ways but become less universal in others (Blomqvist and Palme, 2020). For example, Sweden has adopted an extensive school marketisation scheme by opening up tax-financed schools to business interests (Lundahl et al., 2013), whereas Finnish politicians have so far rejected the marketisation of comprehensive schooling by framing its outsourcing as a threat to its universal nature (Kalalahti and Varjo, 2021: 34).

Thus, Nordic welfare universalism varies between countries and policy arenas vis-à-vis its regulatory, normative and cultural-cognitive dimensions. Previous research has also illustrated how the Nordic model and its core institutions have been appropriated and used for various ideological (Kettunen, 2024; Kuisma, 2017: 436, 445) and commercial purposes (Koivunen et al., 2021; Marklund, 2017; Rönnberg and Hinke Dobrochinski Candido, 2023; Strang et al., 2021). It has been argued, for example, that welfare universalism has been replaced or accompanied by competing values and arguments related to economic efficiency (Lundkvist et al., 2017). For Finland, Ruutiainen (2022: 80) specifically argues that the marketisation of care services has been possible because market logic has been successfully presented as compatible with universalism. In Sweden, marketisation has been coupled with a discourse that emphasises excellence, performance, competition, social inclusion and equality (Lundahl et al., 2013). However, different reforms have resulted in claims that welfare universalism is gradually losing its position as the guiding institution upholding the Nordic model, a shift that may have major consequences for the entire model. For example, if differences in the quality of welfare services increase, dissatisfied users may seek market alternatives, thereby weakening the institution of universalism (Blomqvist and Palme, 2020).

The introduction of service vouchers and top-up services has also been identified as a factor that enables users with economic resources to turn to the private market to increase the comprehensiveness and quality of services received (cf. services provided to the broader public; Karsio, 2024: 91; Moberg, 2017), which (re)produces hierarchies and inequalities among service users (Alasuutari et al., 2024: 140). Affluent populations may demand more exclusive parallel service structures for those with the ability to pay (Maarse, 2006: 987), which may in turn contribute to the erosion of the institutions of universalism in the long run, as less affluent people experience more infrequent and irregular access to care (Agartan, 2012). The rise of private health insurance companies, for example, may lead to a divided welfare state in which parts of the population choose private solutions, while the rest remain in the public system (Lapidus, 2022). This outcome is particularly likely in cases where for-profit service providers offer incentives for various forms of user selection (i.e. cherry picking) (Blomqvist and Palme, 2020: 115).

In what follows, we offer a detailed analysis of how Finnish welfare profit-makers who are active in reorganising the regulatory foundations discussed above construct universalism as a normative and cultural-cognitive institution. Our analysis reveals that welfare profit-makers do not offer a total revaluation of universalism; rather, there appear to be clear connections between changes in the regulatory and normative institutions, with understandings of universalism eroding more drastically in sectors that have been opened to marketisation than in those that have not. These findings suggest that in the case of universalism, the three different perspectives on institutions are complementary and form a continuum that extends from conscious rules to assumed cultural scripts (Scott, 2001). In this sense, we show how changes in regulative institutions also imply normative change and how transformations of regulative institutions affect – and bring to light – the underlying normative order of a society and wider horizon of socially shared norms, values and justice principles (Koos and Sachweh, 2019; Mau, 2003; Sachweh and Hilmar, 2020).

Data

Our empirical data are derived from 22 interviews conducted with individuals we identified as welfare profit-makers: Those who have made their fortunes in the social and healthcare sectors by owning or managing significant companies whose clients are largely public procurers and, to a lesser extent, individual service users. We identified our interviewees through public records, starting with annual lists reporting the major acquisitions of private companies published by the business magazine Talouselämä between 2013 and 2023 (except for 2014, when no list was published), contacting the individuals who had established and consequently sold the companies in question. We then identified the largest companies in the sector (by revenue) based on Talouselämä's annual lists of the largest companies in Finland and contacted their CEOs. Finally, we contacted individuals involved in the healthcare and social services sectors who were identified in a previous research project concerning the top 0.1% of earners in Finland as elite practitioners of their field (Kantola and Kuusela, 2024). The inclusion criteria emphasised significant wealth or income at the individual level. Altogether, we contacted 99 individuals; thus, the response rate was relatively low but still acceptable for a hard-to-access group.

The interviewees constitute a multifaceted group, including six who work or have worked in top positions as salaried workers (e.g. CEOs) and 16 (ex-)entrepreneurs. Half of the interviewees worked in healthcare (including dental care) and the other half in social care (e.g. child welfare and older adult care). Fifteen interviewees had educational background in medicine (N = 9), nursing (N = 3) or social care (N = 3), while seven held degrees in business or technology. Seven of the interviewees worked as social and healthcare practitioners at the time of interviewing. Of the 22 interviewees, three identified as women and 19 identified as men, and all resided in different regions of Finland. Informed consent was obtained verbally before commencing the interviews, and the participants received the necessary information concerning the purpose of the research via email before the interviews. Twelve interviews were conducted online, three in person and seven by telephone. Interviews ranged from 52 min to 2 h and 51 min in duration, with the average interview lasting about 1 h and 13 min. The interview schedule included open-ended questions about the interviewee's career trajectory, as well as sets of questions pertaining to the participants’ general views on the Nordic welfare state (i.e. taxation), welfare services and benefits, and the current Finnish political and societal situation. The interviews were recorded and transcribed into 203 pages of transcript data. All participants were assigned article-specific codes.

From the new institutionalist perspective, we perceive our interviewees as institutional entrepreneurs: relatively organised actors with sufficient resources to contribute to the genesis of new institutions in which they see an opportunity to realise the interests that they value (for an overview of the concept, see Leca et al., 2008). Institutional entrepreneurs are those actors to whom the responsibility for changed institutions can be attributed and who play a highly influential role in bringing about institutional change (Hardy and Maguire, 2017).

As the contents of our interviews demonstrate, the interviewees form an increasingly powerful group of individuals who actively introduce, lobby and promote their ideas and aim to secure specific policy outcomes, including attempts to create or remove legislation (Busemeyer and Thelen, 2020). They serve as agents of change who create common goals in terms of the regulative and normative elements of welfare policies, that is, what ‘ought’ to be done (Scott, 2008). For example, they lobby via an interest organisation, Hali (The Finnish Association of Private Care Providers), which advocates for various business, welfare and labour market policy issues that have an impact on both the for-profit and non-profit sectors.

During the interviews, several interviewees described their close connections with national and local politicians and authorities as well as their frequent involvement in the lobbying organisation, Hali. In recent decades, their relative power and leverage over welfare policy have grown as public functions have been delegated to private, for-profit business actors (for other parts of Europe, see Busemeyer and Thelen, 2020; Mercille, 2024). In Finland, similar to Sweden, large for-profit care companies have played an influential role in how the welfare state is organised and public policies implemented (see Blomqvist, 2004).

Data analysis began with coding the data, in other words by identifying passages according to themes derived from the interview questions and from the interviewees’ responses. These broad themes included, for example, welfare state, public sector and life course. Then after, the coded segments were analysed paying attention to coded data passages that dealt with the welfare state's core institutions. Most of the interviewees argued in support of the Nordic model and described it as an ideal, well-kept, innovative system that provides individuals with safety nets while creating opportunities for entrepreneurs to take financial risks in the market (see also Frederiksen, 2018: 10). Most of the interviewees constructed Finland as representative of Nordic exceptionalism (i.e. the happiest and safest countries) and described it as overwhelmingly strong and stable compared to other welfare systems in the world (see also Kantola and Kuusela, 2024; Kuisma, 2017: 442). Only two interviewees challenged the institutional foundations of the Nordic welfare model by constructing it as a myth and a patronising model, while two others expressed considerable uncertainty about their views on the Nordic welfare state.

Overall, the interviewees’ relationships with the Nordic model were highly contradictory. During the interviews, they tended first to self-identify as supporters of the model before immediately constructing it as unbearable and inevitably requiring reform in some areas (for similar results among other elites, see Kantola and Kuusela, 2024). Interviewees often referred to demographic change and financial debt, which they framed as sources of significant ruptures in the Nordic welfare state (e.g. the institution of welfare universalism). In particular, the interviewees referred to the increasing care needs of Finland's ageing population, worsening dependency ratios, care labour shortages and budget cuts (see also Kantola and Kuusela, 2024; Karsio, 2024; Kovalainen, 2021: 66; Kovalainen and Österberg-Högstedt, 2011: 61; Kuisma, 2017).

To deepen the analysis, we focused on how the interviewees made sense of welfare universalism as an institution. The three perspectives on institutions – regulative, normative and cultural-cognitive – identified by Richard W. Scott (2001) provided the lens through which we interpreted and analysed the data. In what follows, we offer a detailed analysis of how the interviewees made sense of welfare universalism as a normative and cultural-cognitive institution amidst a period of market-oriented reforms in the regulative dimensions of the institution. We introduce the three most predominant themes that emerged during these discussions on welfare universalism as an institution: education, healthcare and social security benefits.

Universal education as a common good

The interviewees expressed strong support for universal access to education and for the Nordic ideal of equal opportunity as its underlying goal (see also Kantola and Kuusela, 2024; Kuisma, 2017: 442). In Finland, basic schooling has not permitted for-profit companies to become involved in service production (cf. e.g. ECEC). Thus, despite the selective outcomes of school choice and schools with special emphases, the Finnish comprehensive school has proven resistant to marketisation trends (Simola et al., 2017). As a regulative institutional premise, the entire Finnish population has access to a common and uniform basic education that is free of charge for everyone (Kalalahti and Varjo, 2021).

Our interviewees treated this kind of universal access as a taken-for-granted form of welfare universalism because they regarded universal education as supportive of upward mobility, equal status and social cohesion. For example, one interviewee argued that in Finland, individual class backgrounds have little effect because the free and public educational system grants equal opportunities to all. These views included assumptions about people's family backgrounds having no effect on educational trajectories in Finland:

Regardless of your position in society, if you want to educate yourself, there are education systems and free education [in Finland] [. . .] There are no obstacles – that is, your childhood and the kind of conditions your family lives in don’t necessarily have any effect anymore on the education you get, for example. (Interviewee 5)

The interviewees perceived universal access to education as a matter of social mobility by, for example, referring to Sanna Marin, a former prime minister of Finland, as a ‘superstar’ who made a class journey ‘to the top’ from her unprivileged background. Some interviewees also mentioned wealthy Finnish families and differentiated themselves from those families by arguing that one does not have to be born into these families to succeed in Finland. When referring to the ideal of equal opportunity, the interviewees also referred to their personal life histories, with which they framed their own success as meritocratic:

I say what is good in the Nordic welfare state: With my background, I have had the opportunity to study; I have made my career from such starting points and so on. [. . .] Society has offered me that opportunity. When we talk about everyone having the same opportunity, that's the way it is. Sometimes your family life can be broken, so it is difficult, but in principle, in Finland, it is ensured that the starting point should be [the same for all]. (Interviewee 7)

Although three interviewees portrayed the Finnish schooling system negatively and claimed it does not help students succeed, focusing instead on students with (major) behavioural problems, most interviewees credited the school system with reducing socio-economic inequalities. One interviewee framed the Finnish elementary school (and compulsory universal military service for all men), in particular, as a great equaliser that creates cohesion and ‘class journeys’ that prevent polarisation:

Probably [the best aspects of Finnish society are] primary school and military service [mandatory for all Finnish men]. [. . .] The primary school has been very high quality, and it has been such a great equaliser in all of this. You get the same chance and go through the same good journey, no matter where you come from. After that, of course, you have the opportunity to do whatever you want in Finland. Even if you come from a suburb, you still have the opportunity to apply to [a prestigious Finnish university business degree programme]. It doesn’t matter where you come from. [. . .] If you give – or we give – people the opportunity to distance themselves from each other in such a way that they don’t share a common playing field, of course, it will always lead to polarisation and different bubbles. (Interviewee 14)

Overall, however, the interviewees viewed this type of polarisation and (wealth) inequality as irrelevant due to the equality of opportunities in Finland. In most cases, the interviewees perceived Finland as having maintained small income differences compared to other countries (see also Kuusela, 2022). According to one interviewee, Finnish wealth inequalities were considered alarming only if they led to the buying of common goods, such as education:

You ought to have income differences to some extent. The question is what to do with that difference in income. If someone uses it to buy a slightly more expensive sausage, is that the worst thing in the world? But if you start buying residential areas, education and basic goods like that, then there is a problem. If someone values ​​money and wants to buy cognac instead of jallu [cut brandy], let them do so. (Interviewee 22)

While interviewees celebrated universal free education, they also emphasised the meritocratic ideals of ‘making an effort’ while resisting the idea that educational privileges could be bought in the market (see also Frederiksen, 2018: 12; Frederiksen, 2025).

Overall, most of the welfare profit-makers we interviewed portrayed education as a universal service that should remain universal. Thus, universal education as an institution was perceived as a valued and persistent form of welfare universalism that ought not to be transformed. From the interviewees’ perspectives, one should not be able to buy better educational services. Thus, concerning education, the interviewees valued welfare universalism not only as a regulatory but also as a normative and cultural-cognitive institution.

Inequality as rational and legitimate in healthcare

Overall, the interviewees supported universal access to healthcare, especially ‘high-quality’ specialised healthcare, but they were ready to renegotiate the forms of universalism in primary healthcare. In principle, Finland's healthcare system covers all residents; however, not all members of society are served by the same system but through three parallel healthcare channels: public healthcare (with special care), occupational healthcare (no client fees) and private healthcare (covered by client fees or private insurances). The latter two often allow clients to access both primary and special care sooner than they could in the public healthcare system. This multichannel system has long paved the way for the disintegration of the healthcare as a universal institution because the occupational and private healthcare sectors are easily accessible to those with economic means or good positions in the labour market (Ahola-Launonen, 2016). Occupational healthcare has enabled faster access to both standard and specialist care, thus structurally privileging employed populations.

When expressing support for the principles of universal coverage of public health services, interviewees often used the U.S. insurance-based model as a rhetorical contrast which they strongly opposed. Many interviewees described the U.S. healthcare system as bizarre (see also Frederiksen, 2018: 11; Frederiksen, 2025) and unacceptable:

It is in the interest of all of us that everyone can at least get a certain level of healthcare if they want to. I don’t want us to drift into an American version [where], if you somehow fall outside of society, you won’t get any healthcare or such. For God's sake, we’re not going in that [direction]. (Interviewee 4)

However, interviewees described parallel service structures as justified and argued that, unlike in education, in healthcare users should be able to seek out market alternatives to enhance the quality of the services with money or by obtaining additional coverage through private insurance (see also Kuisma, 2017: 445). Echoing the existing regulatory framework, the interviewees normatively accepted the idea that individuals should not have equal status and access to health and care services but instead that the service level should be allowed to be determined by the individual's purchasing power or position in the labour market. Thus, the interviewees also took for granted and legitimised the existence of the Finnish multichannel system, which creates health inequalities between socio-economic groups and leads to differences in treatment and health outcomes. Only one interviewee noted that universal and equal access forms the basis of the Nordic welfare state's legitimacy and that the existing multichannel system may corrode the will to maintain the system.

Normatively, according to the interviewees, people should have the option to customise their health and care services through consumer choice and voucher models. One interviewee argued that, especially when the public system is in crisis, individuals who can afford to purchase services should not be taking up space in public sector queues:

Well, I think the sad thing about this is that, as I said, we can have someone who earns 14,000 [euros] per month, who queues up there at the [public] healthcare centre and uses the healthcare centre's services. [. . .] I know there are people like that who want to use those public services on principle because they have paid for them with their tax money. Then, if there is a person earning 14,000 [euros] waiting in line for an operation, it will always be taken away from someone else. […] However, such a person, who has worked a lot and paid a high tax rate, has indeed played their role and their part in building the welfare society. (Interviewee 16)

Several interviewees presented similar, seemingly pragmatic, arguments that society will save money if individuals who can afford private healthcare services do so, even though this compromises the institution of universalism. In some cases, interviewees constructed this argument as a solution to an ‘inefficient’ public sector that struggles to provide access to care for all. This view justifies people opting out of the public system and acting as consumers in welfare markets, even when this leads to inequality and selectivity (see Frederiksen, 2025). Related arguments indicate normative and cultural-cognitive beliefs about how the cost of care should be covered:

Hopefully, there will be private services that will make it possible for those with good incomes to pay the share themselves, which will in a way reduce the state's need for public funding. In other words, if you could afford there would be services that you would be willing to pay for. [. . .] But would it be fair for someone who has money to go to a slightly better care home where there is a swimming pool when another one doesn’t have a swimming pool? [. . .] At the same time, if society saves, no one loses. (Interviewee 19)

In contrast, one interviewee saw the current healthcare system as departing from the institution of universalism due to middle-class perceptions that they do not receive enough in return for what they pay in taxes. Several interviewees also viewed public health services without (progressive) client fees as an ‘utopian illusion’ of public health, as, for example, free health services would encourage overuse of services, while others framed client fees as a threat to welfare universalism in cases where they become so high that they prevent low-income groups from using services (Blomqvist and Palme, 2020: 115).

Regarding healthcare, the interviewees’ normative and cultural-cognitive arguments reflected the current regulatory framework of the Finnish healthcare sector. The interviewees presented purchasing power as a legitimate reason to receive better quality or faster access to services, thus challenging the moral assumptions underlying the universalist welfare state, which has traditionally been viewed as institutionalised ‘politics against the markets’ (Esping-Andersen, 1985). In other words, many argued that private alternatives should be used by those who have economic resources to increase the quality and comprehensiveness of services, even if this creates a system that promotes inequalities between service users based on their financial circumstances.

Normative resistance to universal social security benefits

Finally, the interviewees were eager to remove universalism from social security benefits by justifying their views with economic arguments. In particular, they supported the strengthening of welfare conditionality and ‘affluence testing’, that is, restricting eligibility and access to benefits to the wealthy, thus challenging the principle of universalism. The Finnish social security benefit system provides a broad base of social welfare and security nets for its residents throughout the life cycle. Specifically, the system provides access to social insurance and income security through the Social Insurance Institution of Finland (basic level transfers), wellbeing services counties, unemployment funds and pension institutions (earnings-related benefits). In Finland, social security benefits are provided, for example, in circumstances related to illness, childbirth, retirement, unemployment, student status, rehabilitation, inability to work and the loss of a family's wage earner. Child benefit – paid for each child who is a permanent resident in Finland – is the most common and clearest example of universal benefit in Finland and are allocated independent of income.

According to the interviewees, social security benefits and services for adults should mainly be based on reciprocal efforts and contributions. In other words, most of the interviewees expressed the view that social security benefits must be earned. In a significant departure from their opinions on universal education and healthcare, interviewees showed strong support for providing means-tested social security benefits (and social services) only to the deserving and ‘truly needy’ – that is, children, older adults and disabled individuals. When making sense of their views regarding excessive universalism, most of the interviewees referred to unemployment benefits, housing subsidies, income support and child benefits as well as general social services under the Social Welfare Act, such as social work, social rehabilitation, housing services and services for individuals with substance abuse and addiction problems.

In particular, the interviewees stressed the role of work incentives. They identified a system-created ‘mindset’ as the main problem with current social security (see also Kantola and Kuusela, 2024). As an example of a group that does not deserve access to social security benefits, one interviewee described voluntarily unemployed adults as freeloaders who victimise themselves and are pampered by the welfare state and social workers:

Well, for some people [social security] is quite extravagant. [. . .] Some people don’t even bother to apply for unemployment benefits; they would rather be on social assistance. [. . .] And yes, there is a lot of [welfare] abuse in the system. [. . .] If you have a few challenges in life – and who wouldn’t have [challenges] – by emphasising them a little and victimising yourself, you can live quite comfortably within our services. There's always someone who pays the bill when there's a little bump in life and rent money piles up or you spend it on amphetamine. Social workers will give you a voucher. [. . .] What needs updating? The whole system, this social security system, needs a major update. [. . .] So, the question here is how much others pay for other people's lives by working on other people's behalf. [. . .] If you operate with other people's money, with money that is earned by others, you have to be very careful. (Interviewee 18)

Several interviewees identified the need for increased means-testing by giving normative support to activation policies that have made access to unemployment and last-resort social assistance benefits increasingly conditional (see Tarkiainen, 2022). According to some interviewees, the social security benefit and service system is ‘rotten’ because it facilitates service misuse, (excessive) benefits and ‘intergenerationally learned unemployment’, all of which lead to the outsourcing of personal responsibility:

Individual responsibility – could it include more things? [. . .] Is it worth looking in the mirror rather than externalising [responsibility] and blaming society? I don’t know how to describe it. It's such a broad thing, but somehow all this helplessness and laziness and precisely the fact that no responsibility is taken at any level. [. . .] It's a worrying trend on all levels. [. . .] The starting point is that everyone should participate in this society with the abilities they have. Of course, there are the sick, children, the elderly [and] the disabled, who are not fully capable, but every healthy working-age person should participate in something other than living on welfare benefits. [. . .] At least, people who are able to work should work. (Interviewee 13)

Here, the interviewee suggests profound regulative and normative changes to the welfare provision to support only those who are in genuine need. Thus, according to many interviewees, society should not take care of the social problems that they presented as self-inflicted and therefore the responsibility of an individual or their family. Some interviewees viewed Finland as a place where ‘everything is handed out on a plate’ and even criminals are rewarded when they benefit from the ‘pampering’ they receive through rehabilitative social services. This result is not surprising; since the 1980s, social care services and benefits have been the prime target of welfare state critics who have argued that they kill off independent initiative and work ethic (Sipilä, 1997: 2).

Contrary to these views, two interviewees stated that unemployed people deserve motivation, encouragement, respectful treatment and job opportunities. These interviewees expressed empathy towards benefit recipients and described the social security system as sporadic and difficult to navigate, ultimately framing welfare universalism as a means of diminishing absolute poverty. One additional interviewee supported universal basic income as a possible reform that would better meet the needs of social security benefit recipients (see Bay and Pedersen, 2006); however, these arguments were marginal in our data.

Finally, unemployed adults were not the only group that the interviewees considered undeserving, as three interviewees resisted the idea of high-earning individuals receiving universal child benefits. According to them, benefits should be allocated to people in need (e.g. sick, disabled) instead of universally. When constructing the undeservingness of the rich, the interviewees also constructed the opposites: the deserving and needy, including children and older adults. These interviewees presented means-testing as fairer than the universal distribution of public resources to all residents, including those who might not need them, which implies a belief that the current regulative frame requires change. Some interviewees criticised the institution of welfare universalism, calling it ‘sacred’ and taken-for-granted at the cultural-cognitive level:

It is somehow set in stone that even the extremely rich have the right to child benefits. In this society, it would be much more important to give that money to someone who actually needs it, but apparently, it is some kind of universal right that – once written – is such a sacred thing that it can’t be taken away. [. . .] But the most important thing is that no one is homeless, no one dies of hunger, and no one dies of the cold. [. . .] Decent living conditions must be taken care of. In other words, those who have the ability to pay . . . well . . . welfare benefits shouldn’t apply to them. (Interviewee 17)

Another interviewee extended this normative logic to their own family members, whom they argued did not deserve housing benefits, thereby drawing a moral boundary between her family and those who receive benefits and expressing strong support for ‘affluence-tested’ welfare. The interviewee called for a normative discussion of welfare universalism – that is, what society can provide and to whom:

I am a well-off parent. My children live in the middle of [the city] and they get lots of housing allowance. Is it right? Why don’t they live in dorms? That's how we lived when we studied [laughs]. Our system enables this. [. . . ] Somehow, we patronise a lot. We should target benefits to those less well off, who need them [. . .] I don’t want to bury this welfare state. I want us to be able to continue with it, but in the future we need to discuss values. [. . .] In my opinion, we have to cut services based on earnings and restrict those who earn better. [. . .] We must have that conversation about who is entitled to publicly funded services. (Interviewee 10)

While arguing against welfare universalism, three of our interviewees constructed affluent citizens as people who should not be entitled to services or benefits aside from older adult care and early childhood care.

When the interviewees discussed social security benefits and social services, universalism was deconstructed and criticised in all its dimensions as a regulatory, normative and cultural-cognitive institution. Thus, the interviewees envisioned a systemic change in the Nordic welfare model that requires not just cultural and normative shifts, but also legal and regulative changes. Universalism was criticised not only as a rule that defines the provision of services but also as a normative institution identified pejoratively as a ‘sacred thing’ in need of re-evaluation. According to most interviewees, the once-supported universal social security had lost its legitimacy altogether. According to the interviewees, social security benefits should not be designed to provide for all but rather means-tested. This opinion held true for the interviewees whose businesses catered to individuals who relied greatly on numerous social services, such as older adults and disabled individuals.

Conclusion

The universalist welfare model was built on a cross-class alliance. It was built on the idea that in order to keep its legitimacy, all citizens – including the affluent – need to benefit from the system (Esping-Andersen, 1990). Now this alliance might be breaking. Our analysis of 22 in-depth interviews with Finnish welfare profit-makers revealed competing and hierarchical views on the institution of welfare universalism, which is commonly understood as an institution that grants rights, high-quality (free) services and benefits independently of social status and without comprehensive means-testing or conditionality. While the interviewees’ rhetoric approached near consensus on the benefits of the Nordic welfare model, their views on the institutional architecture of the model differed from the abovementioned meaning (see also Kantola and Kuusela, 2024; Kuisma, 2017). As Pauli Kettunen (2001: 247) argues, even critics of the welfare state discuss it as a common national project that ‘we’ built in the past and has since reached its end in a time of globalised economies. At the same time, the Nordic model is often framed by its critics as an ideal-typical utopian dream and antiquated model that has lost touch with twenty-first-century realities (Kuisma, 2017: 437).

Our interviewees belonged to a group with self-evident economic interests in supporting publicly funded profit-making in healthcare and social services. They can be understood as institutional entrepreneurs who help distribute new ideas in the policy sphere (Schmidt, 2010). However, this has not turned them away entirely from the institution of universalism. In our study, these institutional entrepreneurs, who occupy a central role in reorganising the welfare state, actively assessed which services and benefits should remain a universal public responsibility and which should not. While supporting universalism in some areas, the interviewees also justified the individual right to buy better welfare in others (see also Frederiksen, 2025).

Overall, our results highlight the fact that shifts in the institution of universalism are embedded in changes of regulative, normative and cultural-cognitive institutions – and they also require changes in all these institutional dimensions in order to be successful. We analysed how wider institutional forces (regulative, normative and cultural-cognitive) featured in interviewees’ views and found that interviewees supported changes only in certain institutions, reflecting wider macrolevel and regulative changes, which was not unexpected, since people have a tendency to accommodate themselves within given institutional structures (Mau, 2003).

The interviewees were extremely hesitant to abolish universalism in primary education while expressing a strong willingness to reject it in social security benefits. Indeed, they discussed education as a common good that should follow the principle of universalism, whereas they indicated that healthcare, currently open to market actors, should not be limited to universalism and that purchasing healthcare from the market is rational and justified. These distinctions reveal ambivalent struggles over the nature of what is considered common good in the contemporary Nordic setting (see also Frederiksen, 2025; Kehr, 2023). Furthermore, our analysis reveals a hierarchy of deservingness in the interviewees’ argumentation.

Most of the interviewees associated Nordic exceptionalism with free universal educational system and access to healthcare. Regarding education, the interviewees positively associated it with an equalising effect that creates upward mobility and a meritocracy in which everyone – including the interviewees themselves – can succeed despite their class, gender or market position (Esping-Andersen, 1990: 46). The interviewees argued that unlike healthcare and social services, education should not be converted into business enterprises in the name of economic rationality. They also defended education as a core service that promotes equality and cohesion through shared institutional experiences (see also Frederiksen, 2025). Thus, the universal nature of the school system, in which everyone receives equal education and treatment, was supported (Frederiksen, 2018: 7; Kantola and Kuusela, 2024), reflecting also a value of competition, that is, viewing education as a field in which everyone has the equal rights and opportunities to participate in, disregarding any obstacles. However, universal social security benefits and social services were constructed either as being undeserved by the affluent or as being harmful due to their propensity to breed idleness and laziness or hinder initiative and personal responsibility among undeserving adults (see also Kantola and Kuusela, 2024). Here, our results align with previous research on how economic elites in Finland view economic redistribution and the (un)deservingness of the disadvantaged (Kantola and Kuusela, 2024; Kuusela, 2022), but the specific group interviewed in this research plays a more central role in the operations of the welfare model than elites in general as Finnish care policies are largely practiced in companies that they own and manage. For this reason, the views of welfare profit-makers are especially relevant to the future of the welfare state.

Most likely, the support for universal access to healthcare and (certain) social services echoes the interviewees’ own close relationships with contemporary welfare business and its funding mechanisms. Apart from a few interviewees, most did not perceive parallel care systems, service vouchers or top-up services as threats to the Nordic welfare model or the institution of universalism; rather, interviewees framed these as pragmatic solutions to the welfare state's funding crisis and an option for people with the financial means to seek better care from the market. This approach was considered especially legitimate in cases where the public sector might struggle to serve middle-class citizens with scarce resources. Thus, the interviewees considered it morally acceptable to treat people in similar care situations differently (Anttonen and Karsio, 2017). In other words, they agreed that service access and quality should vary according to the service users’ purchasing power, whereas they framed services without client fees as a public health utopia.

Regarding healthcare and social services, the interviewees exhibited a fundamental break from the public health ethos, which emphasises the maintenance and improvement of the health of all people through organised collective efforts. Most of the interviewees were medical, nursing or social care professionals, and even those who were not, were involved in providing healthcare and social services to the public. Still, most did not seem troubled by the prospect of middle-class and affluent citizens buying quicker access and a higher quality of care than citizens who rely solely on public services. On the contrary, they welcomed this possibility despite the fact that timely access to care is an important component of ensuring desirable care outcomes, as delayed access can, for example, lead to worsened health conditions. Hence, the interviewees’ moral sense-making did not challenge existing and potentially worsening health and economic inequalities.

Regarding social benefits and services, interviewees supported selectiveness and means-testing to target the neediest and most deserving citizens based on normative assessments. Conversely, they indicated that the able-bodied adult population should be encouraged towards diligence and personal responsibility by increasing conditionality in welfare policies. The logic of conditionality and the need to prove deservingness seem to rely on the erosion of universalism (Spies-Butcher, 2020), although some interviewees applied this logic by arguing that wealthy individuals do not deserve such benefits either. These interviewees supported more intense targeting and means-testing, thereby challenging the institutional grounding and legitimacy of the universalist welfare state, and they called for more restrictive allocation strategies that would reduce benefit payments to the wealthy and focus on directing payments to the needy. Specifically, the interviewees opposed paying into maintaining destigmatising poor relief; instead, they emphasised activation and responsibilisation. If the majority regard benefit recipients as undeserving, the universal welfare state erodes legitimacy (Bay and Pedersen, 2006: 422); thus, these discussions raise questions about what happens to welfare universalism in the Nordics if social security benefits become characterised as something only marginal groups of people require instead of being relevant for all – or most – members of society at some point in life (see Mau, 2003).

Based on these results, we offer some directions for future research. Our case study does not capture institutional dynamics over time. Therefore, future studies might consider how welfare universalism has continually transformed itself in different policy arenas in different Nordic countries and how regulatory frameworks influence the views of the people the system aims to serve. In terms of the legitimacy of the welfare state and for universalism more generally, future studies could analyse to what extent the higher income individuals share or contest the views of welfare profit-makers. The legitimacy and long-term sustainability of the universal welfare state depend on the moral commitment of the well-off who can also seek private market alternatives. For the future of universal welfare states, it is crucial whether higher income individuals perceive themselves or their relatives as present or future beneficiaries of welfare universalism.