The marketisation of care: Rationales and consequences in Nordic and liberal care regimes (original) (raw)
Related papers
The Political Construction of Elder Care Markets: Comparing Denmark, Finland and Italy
Social Policy & Administration, 2016
In Europe over the last two decades, marketization has become an important policy option in elderly care. Comparative studies predominantly adopt an institutional perspective and analyse the politics and policies of marketization. This analysis takes a step back and examines the fundamental ideas underpinning the policies of marketization, using the 'What's the problem' approach by Carol Bacchi. The central question is how the market was discursively framed as the solution to the perceived problems of three different systems of elderly care, and how such processes are similar or different across the three countries. The analysis includes two extreme types of elderly care systems, the Nordic public systems in Denmark and Finland and the Southern European family based model in Italy. Empirically, the analysis offers interesting insights into processes of constructing and legitimating markets at the level of discourse; this occurs by defining specific problem representations, underlying assumptions and silences. In all three countries, marketization is presented as a solution which builds on rather than challenges dominant ideas of care. Conceptually, in addition to its institutions, it is crucial to understand the ideas behind the marketization of elderly care. Ideas emerge as a key leverage for making policies and practices of marketization acceptable and which decision makers and other influential political/societal actors use in policy and public debates. The importance of ideas is further underlined by the fact they do not necessarily relate to the institutions of elderly care systems in a linear way.
The marketization of care: Global challenges and national responses in Australia
Care is a social necessity for life. Ensuring access to appropriate care at crucial points in the life course became a political necessity soon after the mid-20th century, as the right to suitable care became recognized as a fundamental entitlement of citizenship in most advanced capitalist economies. Over recent decades there has been a shift away from more traditional welfare state forms of public services towards increasingly marketized systems of provision. Changes in the provision of care in the public domain are associated with an increasing reliance on private capital and competition between a variety of providers, with public agencies competing alongside private for-profit and not-for-profit agencies. Drawing on care theory, historical sociology and political economic analysis, this article examines the conflicting tensions that shape aged care under marketization. Using Australia as a case study, it is argued that as private capital and resources take the place of scarce public resources and enable expenditure cuts to be presented as innovation, better services and more 'consumer choice', it is not the market but the finance, regulation and management work of the state that is the essential determinant of the assistance previously provided through non-market processes.
The need to ensure access to long-term care for older people is now acknowledged as a major public responsibility in all developed nations, although the way in which governments have responded to this responsibility has varied over time and place. Over the last three decades there has been a shift away from more traditional forms of public services towards increasingly marketized systems of provision. These are associated with an increasing reliance on private capital and competition between a variety of providers, with public agencies competing alongside private for-profit and not for-profit non-government agencies. As care has become increasingly commodified, are being reconfigured as active consumers while employment of staff is increasingly insecure. Drawing on care theory as well as historical sociology, political economic analysis and an analysis of changes in governance this paper examines the conflicting tensions that shape aged care. Using Australia as a case study, it is argued that aged care is increasingly the site of ongoing struggle over governance on a number of fronts. In particular, at the level of the overall systems that provide care there are tensions between the need to ensure adequate public oversight and the pressures for a more atomised and decentralised governance by the market. In regard to how service providers operate, tensions are evident as larger commercially-focused bodies, both privately owned and non-profit, increasingly take over space historically occupied by government and small locally based non-profit providers.
Experiences with the privatization of home care: evidence from Denmark
Nordic Journal of Social Research, 2011
Processes of privatization in home care for the elderly in Denmark have primarily taken the form of outsourcing public-care provisions. The content and quality of services have in principle remained the same, but the providers of services have changed. The welfare state has continued to bear the major responsibility for the provision of elderly care, while outsourcing has allowed clients to choose between public and private providers of care. The major aim of outsourcing has been to empower the frail elderly by providing them with exit-opportunities through a construction of this group as consumers of welfare-state provisions. The central government in Denmark has produced the public-service reform, but the municipalities bear the administrative and financial responsibility for care for the elderly. Further, national policymakers have decided that local authorities (municipalities) must provide to individuals requiring care the opportunities to choose. With this background in mind, this article analyses how national, top-down ideas and the 'politics of choice' have created tensions locally in the form of municipal resistance and blockages. The article draws on case studies in two Danish municipalities, whereby central politicians and administrative leaders have been interviewed. We have identified four areas of tensions: 1) those between liberal and libertarian ideas and values versus local political orientations and practices; 2) new tensions and lines of demarcation among political actors, where old political conflicts no longer holds; 3) tensions between promises and actual delivery, due to insufficient control of private contractors; and 4) those between market principles and the professional ethics of care providers.
Going to market! An exploration of markets in social care
Administration, 2016
One of the most striking reconfigurations of Irish social care has been the entry of private for-profit companies into a sector previously regarded as outside the market. This article examines the policy context that has given rise to these developments and the impact of marketisation on both the quality of care provision and the employment conditions of the workforce. Whether for-profit provision of care is a positive development is the subject of intense debate, and the arguments for and against are outlined alongside a range of empirical evidence. International research evidence is not convincing about the capacity of markets to deliver on quality or efficiencies. The article concludes with recommendations for further research to enable analysis and debate in the Irish context.
2005
Much of social care of older people now takes place in the context of a market. As a result the welfare of many people is fundamentally dependent on the success of that market in terms of both availability of services and quality of care. This paper considers the functioning of that market to date and the challenges it is likely to face in the future. Social care is unlike most other markets in terms of the nature of the product, characteristics of consumers, the relationship between prices, fees and charges, and the dominant role and influence of the public sector. This paper starts by describing and defining what we mean by social care and the context in which the markets have developed. The extent and nature of the market are then outlined in terms of levels, distribution and types funding, the development of the commissioning role by public bodies and the impact on the market of changes in the regulatory system. The role of and involvement of service users as consumers in this m...
Financialization of Eldercare in a Nordic Welfare State
Journal of Social Policy
The increasing presence of for-profit service providers in publicly-funded eldercare has transformed care in Nordic welfare states which have a strong tradition of public care provision. Macro-level research on care policies has mainly focused on public institutions, national policies, and marketization. The financialization of eldercare has not received much scholarly attention, and existing studies mostly focus on the UK. The financialization of eldercare refers to the ways in which care is both a site of profit extraction and financial engineering. The Nordic system is relatively universal, and, with rapidly ageing demographics, there is a secured demand for eldercare services. However, these services have been heavily marketized over the past two decades, opening up lucrative possibilities for financialized actors who have established a stronghold over the markets. We analyse these processes through selected empirical examples from Finland, and argue that the financialization of...
Social Policy & Administration, 2015
This article analyzes the transformation of Swedish residential care for children from a regionally coordinated, public social service system into a thin, but highly profitable, national spot market in which large corporations have a growing presence. Marketization and privatization are theorized as complex processes, through which the institutional structure and logics of this small, but significant, social policy field changed profoundly. Using official documents, register data, media reports and existing research, three consecutive phases in the development of the children's home market are identified since the early 1980s. Change was driven on one hand by policies inspired by New Public Management, which shifted public authority horizontally to the private sector, and vertically to local authorities (funding) and to the state (regulation). On the other hand were the responses of local authorities and private actors to the changing incentives that policy shifts entailed. During the first two phases, both the proportion and size of for-profit providers increased, and the model of family-like care was replaced by a professional model. Cutting across the trend of privatization in the third phase was establishment of a parallel system of homes for unaccompanied refugee childrenmostly in public ownership. Similarities with privatization in the English system of children's care homes are noted. By showing how the Swedish market for residential care has been created by policy and by actors' responses to those reforms, the article provides a foundation for thinking through how the predictable, significant and well-documented problems of such care markets might be addressed.
Convergent Care Regimes? Australia, Canada, Finland and Sweden
This article is about the transnational movement of policy discourses on childcare. It considers whether the spread of neoliberal ideas with their emphasis on marketisation, on the one hand, and a social investment discourse on the other, are leading to convergence in childcare arrangements in Nordic countries (Finland and Sweden) and liberal Anglo-Saxon countries (Australia and Canada). We find points of convergence around both themes at the level of policy discourse and continued diversity in the way these ideas are translated into actual policies. In other words, convergence is mediated by institutions and political realignments.