To Make or to Buy Long-term Care? Part III: Quality Assurance to Avoid Market-failure

With the implementation of New Public Management (NPM), market-oriented governance, deregulation, competition and strengthened user-choice eventually reached also the area of long-term care provision during the 1990s. In contrast to the classical neo-liberal postulations towards deregulation, however, both theoretical considerations and the emerging practice across Europe have shown the imminent necessity to increase efforts in quality assurance in the context of competitive markets in long-term care. This Policy Brief dwells on experiences in a number of European countries on existing practices of quality assurance in long-term care delivery. It outlines caveats of defining and assessing quality in long-term care and its implications for ‘make-or-buy’ decisions. Current trends and challenges in quality assurance and quality development are presented to provide policy lessons on the ‘make or buy’ decision and its impact on outcomes for users and the organisation of care markets. This Policy Brief is the final part of a trilogy dedicated to the reliance on markets for the delivery of long-term care (see also Part I and Part II). It draws on the Report ‘”Make or Buy” – Long-term Care Services in Sweden: Lessons for Policy’, edited by the European Centre, which is a result of research generously funded under a grant from the Swedish Ministry of Health and Social Affairs.