Marketization, Managerialism and Welfare State Professionalism
Edited by Tanja Klenk and Emmanuele Pavolini
Chapter 2: Marketization and managerialization of long-term care policies in a comparative perspective
Long-term care policies in Western Europe have been considerably (re) defined since the 1980/1990s. While in continental and Southern Europe new policy schemes were introduced, in England and the Nordic countries, where long-term care policies were already established, existing approaches were restructured (see Ranci and Pavolini 2013). Policy reforms have included the (re)definition of universal social rights, that is, the expansion of public support but also processes of targeting in the more developed care systems. Furthermore, a significant change concerns the expansion and/or the reorganization of service provision and the definition of new types of public support, in particular cash-for-care schemes. The new policies were developed against the background of a mix of demographic, social and cultural changes, and embedded in efforts to achieve cost control. Policies of marketization and managerialization form a significant strand of long-term care policy reforms. Developed within an interplay of international concepts and actors, and political institutional structures within the nation states, market-oriented reforms have been established in a wide range of countries allocated to different care or welfare regimes. In the focus of the chapter is the analysis of market-oriented reforms and their effects in a variety of Western European countries against the background of the specificity of the policy field long-term care. In the following, the characteristics of the policy field, which impact on the selection and implementation of market-oriented reforms and their effects, will first be outlined.
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