Users of home-care services in a Nordic welfare state under marketisation: the rich, the poor and the sick

Abstract

Stricter access to public services, outsourcing of municipal services and increasing allocation of public funding for the purchase of private services have resulted in a marketisation wave in Finland. In this context of a Nordic welfare state undergoing marketisation, this paper aims to examine the use of Finnish care services among older people and find out who are using these new kinds of private services. How wide is their use and do the users of private care services differ from those who are using public services? How usual is it to mix both public and private care services? The questionnaire survey data set used here was gathered in 2010 among the population aged 75 and over in the cities of Jyväskylä and Tampere (N = 1436). The methods of analysis used include cross-tabulation, chi-square tests and multinomial logistic regression. The findings showed that among those respondents who used care services (n = 681), 50% used only public services, 24% utilised solely private services and the remaining 26% used both kinds of services. Users of solely private services had significantly higher income and education as well as better health than those using public services only. The users of public services had the lowest education and income levels and usually lived in rented housing. The third group, those mixing both public and private services, reported poorer health than others. The results increase concerns about the development towards a two-tier service system, jeopardising universalistic Nordic principles, and also suggest that older people with the highest needs do not receive adequate services without complementing their public provisions with private services.

A marketization process in dispute: An analysis of serviced housing for the elderly in Finland, 2000–14

“…Most of the previous studies in the literature have underlined marketization as a main trend in Finnish elderly care (cf., Anttonen & Häikiö, ; Burau et al, ; Karsio & Anttonen, ; Puthenparambil & Kröger, ; Puthenparambil, Kröger, & Van, ). However, according to the present study, the share of marketization has actually been slightly decreasing in serviced housing from 2000 to 2014.…”

“…However, Puthenparambil, Kröger, and Van Aerschot (2017), for example, argue that the marketization process has been creating two-tier services within elderly care. In that, public service users have lower levels of both education and income compared to private service users.…”

Looking for the Easy Way Out: Demographic Panic and the Twists and Turns of Long-Term Care Policy in Finland

“…However, this policy has also eroded the basic principle of the Nordic welfare model, universalism and led to the emergence of a two-tier system where older people with low income use publicly provided long-term care services and increasingly family care, while those who can afford it, purchase for-profit services to fill the gaps left by cuts and retargeting of public care. (Mathew Puthenparambil et al 2017. )…”

“…The changes represented decreasing public responsibility for the needs of the older population but they took place without any real policy debate or major modification in legislation. Since the mid-1990s Finland has also experienced widespread outsourcing of municipal care services to for-profit providers, accompanied by increasing out-of-pocket use of private care provisions that has been supported by a new tax rebate scheme (Karsio & Anttonen 2013;Anttonen & Karsio 2017;Mathew Puthenparambil & Kröger 2017). The emergence and continuous growth of the forprofit sector in long-term care has transformed the earlier model that used to be dominated by public provisions.…”

”Man får hjälp då man behöver” - äldre närståendevårdtagares vårdval ur ett livsloppsperspektiv

“…Enligt en annan studie utförd i Finland baserad på samma enkätundersökning visade resultaten att det främst var äldre med högre utbildning, ekonomi och bättre hälsa som använde sig av privata hemvårdtjänster, medan äldre med sva gare ekonomi, lägre utbildningsgrad och sämre hälsa använde offentlig hemvård. De äldre som var mest sjuka använde en kombination av pri vata och offentliga tjänster, vilket väcker frågan huruvida offentlig service inte längre räcker till för omfattande vårdbehov (Puthenparambil, Kröger & Van Aerschot 2015).…”