The Growth and Consequences of Quasi-markets in Long-Term Care

This chapter investigates how the extension of markets in Western Europe’s long-term care (LTC) systems has shaped the provision of care over the most recent decades. The chapter pays attention to the provision of formal LTC, with a special focus on public and private relationships, taking into consideration the relevance of national and regional contexts. The chapter outlines relevant conflicts that quasi-markets and New Public Management (NPM) logics have brought to care economies. It shows the extent to which the impact of quasi-markets on care provision is mediated by specific market dynamics, such as who is available to provide good quality care and political economy contexts, including power relations between different actors. The chapter’s last section explores the introduction of quasi-markets in nursing homes in Germany, Italy, Spain, and the United Kingdom in relation to two main issues: the impact of market structures and concentration dynamics on determining outcomes and the capacity to monitor, regulate, and hold private actors accountable in these four countries. The authors draw the conclusion that concentration dynamics in the nursing home sector should be carefully assessed, especially when it comes to understanding how investment capacity and capital accumulation affect public control. The exploration of recent quasi-market dynamics in the nursing home sector of the four countries studied here poses the fundamental question of how to reconcile the interests of powerful market actors and the responsibility of the state toward providing for good social care for all.