This article investigates the impact of NPM reforms on two prominent welfare state professions; medical doctors and teachers. The case study context is Sweden, where the impact of NPM led to a series of reforms in health care and education after 1990. The focus in the paper is on professional autonomy, which can be seen as a core trait in professional work. The findings in the article point to both medical doctors and teachers having lost professional autonomy as a result of NPM-reforms, particularly with regards to the dimensions of work organization and evaluation. Autonomy in individual decision-making seems to have been least affected, even if there are indications of this being infringed upon as well. Despite these broad similarities, the loss of autonomy is found to be more pronounced in the case of teachers. One reason behind this difference, which manifests itself in teachers having become subject to higher level of direct administrative control by school managers while at the same time experiencing a more distinct loss of autonomy to evaluate their work, appears to be that medical doctors have been more successful in establishing themselves as experts in relation to new public audit agencies.

This article presents an analytical platform for discussing and analyzing administrative reforms in terms of democracy. First, we present the democratic theory positions represented by output democracy and input democracy. These two positions are used to classify different types of reform. The second explanatory approach on democracy and reforms is transformative, and it applies a mixture of external features, domestic administrative culture, and polity features to understand variations in the democratic aspects of public sector reforms. Central issues are whether these reforms can be seen as alternatives or whether they complement each other in terms of layering processes. Third, we take a broad overview of New Public Management (NPM) and post-NPM reforms and carry out an in-depth analysis of a new administrative policy report by the Norwegian centre-left government. Finally, we discuss briefly the broader comparative implications of our findings.