Vincent J A, Tibbenham A D, Phillips D R
J Soc Policy. 1987 Oct;16(4):435-60. doi: 10.1017/s0047279400016123.
This paper examines the proposition that the welfare policies enacted and legitimized in the name of 'choice' have the effect of increasing the effective choice of service by consumers of welfare. The example of residential care of the elderly is used to illustrate the ways in which privatisation has influenced choices of care for elderly people in Devon. The paper reviews empirical material from two survey of private homes in Devon in order to throw light on the 'myths' and realities of choice in residential accommodation and in other welfare provision available to the elderly in Devon. The paper identifies as the key debate the question of priorities: whether resources should be concentrated on providing suitable residential places for the increasing number of the very disabled elderly or used to increase the alternatives for the larger, more able groups. The latter option can perhaps be reasonably achieved through market mechanisms, whilst the former is more likely to require the specialised skills of social workers and other caring professionals. Although it is possible to argue that the growth in numbers of private old people's homes represents an increase in choice for the elderly, on closer examination this appears too simple an assertion. The expansion of the private sector has not necessarily expanded the range of alternative forms of care. In particular, there seems a major flaw in current policies by which the operation of the DHSS subsidy increases the availability of residential rather than domiciliary care.
本文探讨了以“选择”之名制定并合法化的福利政策是否会增加福利消费者有效服务选择这一命题。以老年人寄宿护理为例，说明私有化如何影响德文郡老年人的护理选择。本文回顾了德文郡两次针对私人养老院的调查的实证材料，以便揭示德文郡老年人在寄宿照料及其他福利服务方面选择的“神话”与现实。本文将优先事项问题确定为关键辩论点：资源应集中用于为越来越多重度残疾老年人提供合适的居住场所，还是用于为规模更大、能力更强的群体增加选择机会。后一种选择或许可通过市场机制合理实现，而前一种选择更可能需要社会工作者和其他护理专业人员的专业技能。尽管可以认为私人养老院数量的增加代表着老年人选择的增多，但仔细审视后会发现这种说法过于简单。私营部门的扩张不一定扩大了替代护理形式的范围。特别是，目前的政策似乎存在一个重大缺陷，即卫生与社会保障部补贴的运作增加了寄宿护理而非家庭护理的可及性。
