Centre for the Understanding of Sustainable Prosperity, University of Surrey, Guildford, UK.
Centre for the Understanding of Sustainable Prosperity, University of Surrey, Guildford, UK.
Lancet Healthy Longev. 2022 Apr;3(4):e298-e306. doi: 10.1016/S2666-7568(22)00040-X. Epub 2022 Mar 21.
Long-term care systems across countries within the Organisation for Economic Co-operation and Development have undergone a progressive marketisation and financialisation in recent decades, characterised by the embedding of neoliberal market values such as competition, consumer choice, and the profit motive. In this Personal View, we argue that these make poor guiding principles for the care sector, identifying the dysfunctional dynamics that arise as a result, and reflecting on the clinical implications of each, with a focus on facility-based care. We outline why providers can scarcely respond to competitive forces without compromising care quality. We explain why the promotion of consumer choice cannot effectively motivate improvements to quality of care. And we explore how privatisation opens the door to predatory financial practices. We conclude by considering how far proposals for reform can take us, ultimately arguing for a rejection of neoliberal market ideology, and calling for sector-wide discussions about what principles would be more fitting for a caring economy.
在经济合作与发展组织（OECD）的各个国家，长期护理系统在近几十年经历了渐进式的市场化和金融化，其特点是嵌入了新自由主义市场价值观，如竞争、消费者选择和盈利动机。在本个人观点中，我们认为这些原则并不适合护理行业，指出由此产生的功能失调动态，并反思每一个原则的临床意义，重点是基于机构的护理。我们概述了提供者在不影响护理质量的情况下如何应对竞争压力。我们解释了为什么促进消费者选择并不能有效地激励护理质量的提高。我们探讨了私有化如何为掠夺性金融行为打开大门。最后，我们考虑了改革建议能在多大程度上推动我们前进，最终我们反对新自由主义市场意识形态，并呼吁全行业讨论更适合关怀经济的原则。
