Abstract

Background: Since the 1990s, many welfare states in Europe have introduced or expanded public funding of long-term care (LTC) for older people. This development was characterized by the outsourcing of LTC from the private household, where it has traditionally been provided on an informal and unpaid basis by women, and its transformation into formal, paid and professional work. Furthermore, the restructuring of LTC was based on the introduction or strengthening of market principles.

The analysis of the development of LTC has shown that there are considerable differences between LTC systems in European welfare states. The present study examines to which extent welfare states show cross-national differences with regard to the degree of marketization in their LTC policies. Therefore, the paper develops a typology of LTC markets based on a precise methodological approach that differentiates different degrees of market regulation which forms the basis for the international comparison. Against this background, opportunities and risks for market actors which can arise in the context of the specific institutional design of different types of LTC markets are also reflected.

Methods: The study is based on an innovative analytical approach that systematically differentiates between market regulations on the supply and demand side. Market regulations in the LTC policy are analyzed with regard to market access for LTC providers and consumers as well as in terms of their autonomy with regard to decision-making. On the one hand, such regulations can affect the impact of key market principles such as competition and choice. On the other hand, they define the relative importance of the publicly-funded LTC market in relation to the entire system of LTC provision in a state.

The article is based on an international empirical study. The comparative analysis involves with Germany and Austria two European welfare states that show significant differences in the design of their LTC systems. The study is based on the analysis of documents regarding legislation in the two European welfare states, as well as relevant secondary literature. The focus of the study is limited to national welfare state legislation in the area of LTC. It is not examined how the marketization was implemented and to what extent it actually shapes the structures and practices in the field of LTC.

Results: The results of the study show that the investigated welfare states can be categorized and compared on the basis of the degree of the marketization of their LTC policy. They show different profiles of marketization on the supply and demand side which are associated with different opportunities and risks for market actors.