To Make or to Buy Long-term Care? Part II: Lessons from Quasi-markets in Europe

Market-oriented governance and a strong consumerism discourse have stipulated increased competition and choice in the provision of long-term care services. This re-organisation of long-term care markets that was shaped by the entry of new for-profit and non-profit providers and welfare mixes faced policy-makers with new challenges in steering and regulating service provision. This Policy Brief reviews underlying political arguments and evidence on the experiences of four selected countries in the introduction of quasi-markets. By tracking countries’ individual pathways we show how choice and competition were regulated by means of contracts, competitive tendering and purchaser-provider split in certain care sectors. The Policy Brief thus provides lessons for policy-makers on the impact of the ‘make or buy’ decision on outcomes for users, on quality of care, and on the organisation of care markets and reveals lessons on benefits and unresolved tensions of mixed care economies. This Policy Brief is the second part of a trilogy dedicated to the reliance on markets for the delivery of long-term care. The first Policy Brief reviewed some of the theoretical insights regarding the make or buy decision as applied to long-term care and the third will address mechanisms to assess and manage quality. This trilogy is based on research funded by the Swedish Ministry of Health and Social Affairs.