How marketisation is changing the Nordic model of care for older people (original) (raw)
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The marketisation of care: Rationales and consequences in Nordic and liberal care regimes
Journal of European Social Policy, 2012
The use of markets and market mechanisms to deliver care services is growing in both liberal and social democratic welfare states. This article examines debates and policies concerning the marketisation of eldercare and childcare in Sweden, England and Australia. It shows how market discourses and practices intersect with, reinforce or challenge traditions and existing policies and examines whether care markets deliver user empowerment and greater efficiency. Markets for eldercare and childcare have developed in uneven and context specific ways with varying consequences. Both politics and policy history help to shape market outcomes.
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...
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.
Social and Cultural Geography, 2018
Taking the recent debate on austerity as a starting point, this paper discusses contradictions in current processes of neoliberalisation using the marketisation of elderly care in Switzerland as an example. Just as in other countries, an austerity rationality in public spending and the neoliberal restructuring of public health services paved the way for the emergence of private suppliers of 24 hours home care. These new agencies hire migrant women from Eastern European countries and sell packaged care services to the elderly. In so doing, they play a key role in reconfiguring care according to a market logic. They shape the working conditions of live-in migrant care workers and the definition of care itself as a marketable good. In our paper, we analyse the strategies of these new corporate intermediaries based on a market analysis and on interviews with their representatives. We argue that the marketisation of elderly care in Switzerland is illustrative of today’s neoliberalism in that it combines progressive and regressive aspects and owes its emergence to its ambiguous entanglement with many other discourses. The paper illustrates how the transformation of the home into a new space of commercialised care relies on the production and economic valorisation of social and mobility differentials.
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.
Elderly Care Puzzles in Stockholm: Strategies on formal and informal markets
Nordic Journal of Migration Research, 2013
In "ageing Europe", there have been widespread developments aimed at the privatisation of elderly care. In tandem, the demand for private domestic services is expanding all over Europe, and elderly citizens are a major part of this demand. Simultaneously, migrant women are increasingly considered the solution to the labour force deficit in the wake of the "care crisis". This article explores the dual privatisation process in the context of New Public Management reforms and glocalisation in Stockholm/Sweden: namely, what are the consequences to providers and consumers in the elderly care sector and domestic services? In particular, the article highlights the purchase of informal services among the elderly as a part of the "elderly care puzzle".
Since the 1990s, two distinct processes of marketization in long-term care provision can be found in Sweden and Germany. First, professional long-term care services were restructured inspired by ideas oriented towards New Public Management. Second, tax deduction policies were established to create a new mix of (ir)regular domestic and professional care services. Despite the international character of the development, the existing structure of professional and (ir)regular domestic services at the beginning and the approaches selected, their effects on the infrastructure and on the situation of care (and domestic) workers differ significantly between both countries. In both countries, research findings indicate – however country-specific - patterns of a worsening of working- and employment conditions of care workers embedded in distinct processes of hierarchisation among care workers. The paper aims to compare pre-existing service structures, policy approaches, their effects on servic...
Health & Social Care in The Community, 2015
What is known about this topic • Finland is a Nordic welfare state where citizens are by the constitution entitled to have equal access to care services. • However, recently Finland has undergone marketisation reforms and seen the emergence of forprofit providers in care for older people. • Access to public care has become more difficult and the use of private services has grown rapidly. What this paper adds • Half of all older users of care services in Finland nowadays use private services, a quarter mixing them with public provisions. • Those using only public services have lowest income while those
Care services for older people in Europe - challenges for Labour
2011
This report is published (March 2011) at a time when Europe stands at a crossroads. The economic crisis, austerity measures and the proposed European economic governance package risk not only to increase poverty and social exclusion but to have a devastating impact on the potential to build a sustainable and cohesive Europe. As the report notes, there is growing demand for more and better care services to address the needs of an ageing population. Potentially, Europe has the capacity to create millions of well-paid, good jobs delivering much needed services to older people and people needing long-term care. A regulated, formal care sector has the advantages of achieving high employment rates, quality jobs with decent working and employment conditions and giving possibilities for men and women to combine professional and family responsibilities. It is also often a preferred choice of older people themselves. However, in countries where formal care provisions exist, these risk being d...