Supplemental home care and topping‐up: A shift from service universalism towards a new and privatised public service model?

Abstract

How does a public service model based on service universalism react to the introduction of market principles of topping up? In a recent so‐called Free Municipality Scheme (an experimental scheme that allowed for greater operational autonomy locally in an effort to reduce state bureaucracy), a number of Danish municipalities were for the first time ever allowed to compete with for‐profit providers of home care in selling supplemental home care services paid entirely by the user. The take‐home message from this experience is that the introduction of supplemental home care entails challenges and eventually wider implications for the public service model, on an economic, organisational and cultural level. Supplemental services represent a new and potentially powerful combination of market and state logics that eventually redirects away from the universalist welfare state and towards a new and increasingly privatised public service model – a model where the service level is determined by the user's capacity to purchase and pay for services. The introduction of such services therefore implies a change of the potential of the Nordic welfare state to ensure equal access regardless of class and income.

Revisiting the Nordic long-term care model for older people—still equal?

“…Topping-up constitutes a parallel market-based care system where personal economic resources are essential for meeting need. A public care system which increasingly refers to or relies on the user to purchase care in order to top-up services therefore has obvious implications for social class inequality (Hjelmar and Rostgaard 2020 ). Not surprisingly, privately purchased help is generally more common among older people with higher incomes (Mathew Puthenparambil et al 2017 ; Rostgaard and Matthiessen 2019 ).…”

The experience of dependence on homecare among people ageing at home

“…Private homecare providers have been an option in addition to public homecare in Denmark and Norway in the past years. Private homecare provision has been introduced in response to a growing demand for standardisation and task orientation in public homecare (Hjelmar and Rostgaard, 2019). Also a political reform in Denmark in 2003 ensured that municipalities must give care recipients the choice of engaging a private homecare provider.…”

Psychophysical burden and lack of support: Reasons for care workers’ intentions to leave their work in the Nordic countries

“…Moreover, the marketisation of care services has significantly changed the entire care sector by, for example, bringing in competition, cost containment and cost‐effective targets for services rather than good‐quality care to meet people's needs. All this has altered the former principles and logic of organising social protection in the Nordic welfare states (Dahl, 2009; Hjelmar & Rostgaard, 2020; Moberg, 2017; Strandell, 2020; Trydegård, 2012).…”

“…Non‐profit third‐sector organisations also played an important role in providing residential care, especially in Finland. During the past two decades, however, market rationalities and for‐profit service providers have entered the care sector (Kröger, 2019; Hjelmar & Rostgaard, 2020; Moberg, 2017). Today, public authorities are still responsible for the LTC system, but the services are increasingly produced by private for‐profit providers, albeit to a smaller extent than in many other European countries.…”