Marketisation of care within the Nordic context: Private care provision for older people in Finland

Abstract

This dissertation focuses on the ongoing development in the use of private so- cial care services for older people in Finland by asking the following questions at two levels. (1) At the municipality level, to what extent do municipalities in- volve private providers in organising care services for older people, and what are the determining factors that are associated with the outsourcing of publicly funded care services? (2) At the individual level, to what extent do older people use private care services, and how do people who use private care services dif- fer from people who use traditional public care services? (3) Also at the indi- vidual level, why do older people choose to use private care services, and is this a free or a forced choice? Quantitative data from the Sotkanet Indicator Bank and Statistics Finland was used to examine the municipality-level research questions. The data covers all 311 municipalities in Finland for the period 2001– 2015. A two-wave longitudinal survey ‘Arki, apu ja palvelut’ was used to an- swer the individual-level research questions. The data was collected from peo- ple aged over 74 years in 2010 and 2015 in the cities of Jyväskylä and Tampere. The results show that the share of outsourced public home care visits and service housing have increased considerably. An increase in care needs (i.e., demand for care) among the ageing population in a municipality is one of the main influencing factors behind outsourcing, particularly for service housing. At the individual level, one third of respondents utilised private care services, and these users had significantly higher incomes and educations as well as bet- ter health than those using public services alone. Older people chose private services because of the services’ are easily accessible, and their own additional needs for services. Although the majority of users used private care out of free choice, a substantial number of users used private services out of forced choice. Overall the findings show that private care provision is no longer a marginal phenomenon in Finland. There has been a steep and steady growth in the use of private provision for older people at the municipality level (i.e., through out- sourcing) as well as among older people. In short, it is apparent that social care services for older people in Finland have been clearly affected by the marketisa- tion of care. Keywords: Marketisation, private services, older people, service use, municipal- ity, Finland.