2.3 How has procurement changed delivery of longterm care in Europe? Societal and cultural traditions as well as economic and political pathways are shaping the way in which LTC and related individual and societal needs are being addressed and met in different countries. To identify typologies it is therefore necessary to select, describe and analyse a range of categories and indicators. For this, EspingAndersen’s seminal work on Liberal, Conservative and Social Democratic welfare regimes is often taken as a starting point (Esping-Andersen, 1990).
Our questionnaire aimed at identifying current trends in European countries regarding these changes. Almost 30% of respondents reported an increase in provision from private for-profit providers in LTC over the past decade. Public provision only increased in Spain (following the 2006 Dependency and Autonomy Promotion Act) and Switzerland. Respondents explained how in some countries (e.g. FI, LT, IT), the share of not-forprofit providers increased, within a market that was already characterised by a steady growth of providers, as well as market consolidation and concentration of some of them. The original idea of market-oriented governance – to achieve lower prices and more user choice by competition – has thus been undermined in several countries due to the concentration of provision in some large providers.
Further research has identified different ‘care regimes’ depending on the degree of public service provision, the mix of cash benefits and inkind services, the role of informal carers (family responsibilities), coverage and funding issues or the specific mix of public, private, home and third sector provision of care. New Public Management and the rise of market-oriented provision have contributed to some dynamic changes of this mix in most countries.
Figure 7 Market shares of different types of providers in residential care in selected Member States, around 2016
Source: Eurofound, 2017, 17.2 Note: ‘Private’ means both for-profit and not-for-profit as some countries do not distinguish between these two types of providers.
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