Experiences with the privatization of home care: evidence from Denmark

Abstract

Processes of privatization in home care for the elderly in Denmark have primarily taken the form of outsourcing public-care provisions. The content and quality of services have in principle remained the same, but the providers of services have changed. The welfare state has continued to bear the major responsibility for the provision of elderly care, while outsourcing has allowed clients to choose between public and private providers of care. The major aim of outsourcing has been to empower the frail elderly by providing them with exit-opportunities through a construction of this group as consumers of welfare-state provisions. The central government in Denmark has produced the public-service reform, but the municipalities bear the administrative and financial responsibility for care for the elderly. Further, national policymakers have decided that local authorities (municipalities) must provide to individuals requiring care the opportunities to choose. With this background in mind, this article analyses how national, top-down ideas and the ‘politics of choice' have created tensions locally in the form of municipal resistance and blockages. The article draws on case studies in two Danish municipalities, whereby central politicians and administrative leaders have been interviewed. We have identified four areas of tensions: 1) those between liberal and libertarian ideas and values versus local political orientations and practices; 2) new tensions and lines of demarcation among political actors, where old political conflicts no longer holds; 3) tensions between promises and actual delivery, due to insufficient control of private contractors; and 4) those between market principles and the professional ethics of care providers.

Keywords

• elderly care
• home care
• free choice
• marketization
• privatization
• political conflicts