EuropEan CEntrE • EuropäisChEs ZEntrum • CEntrE EuropÉEn poliCy BriEf oCtoBEr 2014 To Make or to Buy Long-term Care II: Lessons from Quasi- markets in Europe Juliane Winkelmann, Ricardo Rodrigues, Kai Leichsenring Introduction: In search of eficiency the current reality of population ageing has heightened concerns about the iscal sustainability of social protection systems, including long-term care for dependent older people. how to deliver social services in the most eficient manner possible has thus come to occupy centre stage in the minds of policy-makers. Against this backdrop a set of economic theories which gained prominence in the 1980s and came to be known as New Public Management (NPM) were taken on board in several areas of public services, including long-term care. With eficiency as its core objective, it stipulated the introduction of increased competition, con- tractualisation and performance measurement. In parallel, a strong con- sumerism discourse advocated for users of long-term care services to be empowered to make their own choices, which reinforced the calls for the introduction of user choice. By this wave of marketisation of long-term care, the provision of services for frail older people has come to rely on increasingly diversiied provider markets including for-proit, non-proit and public providers in most European countries. At the same time, the high complexity of long-term care and the dificulty of deining clearly measurable outcomes have posed particular challenges to policy-makers to steer and regulate quasi-markets in this sector by means of competi- tive tendering and contracts. this policy Brief is the second part of a trilogy dedicated to the reliance on markets for the delivery of long-term care, or in other words to the ‘make or buy’ decision in long-term care. 1 this second policy Brief will focus on evidence from four selected European countries on existing experiences with competition and choice in long-term care systems to 1 All three Policy Briefs draw from the Report ‘ ”Make or Buy” – Long-term Care Services in Sweden: Lessons for Policy”, edited by the European Centre, that is a result of research generously funded under a grant from the Swedish Ministry of Health and Social Affairs (Rodrigues, Leichsenring & Winkelmann, 2014). Ricardo Rodrigues is head of “health and Care”, Kai Leichsenring and Juliane Winkelmann are researchers at the European Centre for Social Welfare Policy and Research,Vienna http://www.euro.centre.org/rodrigues http://www.euro.centre.org/leichsenring http://www.euro.centre.org/winkelmann Policy Briefs are a publication series providing a synthesis of topics of research and policy advice on which European Centre researchers have been working recently. series Editor is Pieter Vanhuysse, Deputy Director and head of research vanhuysse@euro.centre.org Keywords: Competition, User Choice, Markets, Long-term Care