European long-term care marketisation: A political economy framework

The study of European long-term care (LTC) marketisation is dominated by institutional and ideational perspectives. In contrast, political economic theoretical frameworks have received little attention. This is paradoxical, because marketisation is an inherently political economic phenomenon. The financialisation of LTC systems, the growth of private for-profit providers and the rise in cross-national investments are proceeding apace, yet, they have been neglected by conventional approaches. This paper presents a political economy theoretical framework to study LTC marketisation. In contrast to conventional perspectives, it locates the drivers of marketisation within (neoliberal) capitalism; conceives of the state as significantly aligned with the interests of the business sector; interprets ideology as often originating in the material interests of the latter; examines ‘power struggles’ between, in particular, private providers on one hand and the public/non-profit sector and care workers on the other hand. These power struggles take place in LTC financing, privatisation, regulation, financialisation and labour flexibility. In those struggles, private providers assert their power (structural, institutional and instrumental) to shape marketisation; however, they can encounter resistance. The framework also examines the outcomes of marketisation and is illustrated empirically by reference to Irish LTC.