How culture influences the strengthening of market principles in conservative welfare states: The case of long-term care policy

Abstract

How much, and in what ways, do cultural ideas contribute to understanding cross-national differences in the extent of long-term care (LTC) policy marketisation? We argue that differences in cultural ideas in the political sphere about ‘ideal’ ways of organising the provision of care shed light on these differences, relatively independently of the governing parties' positions on the left/right spectrum. Our comparative case study of two conservative welfare states, Germany and Austria, supports this argument. LTC policy marketisation in the mid-1990s was, in both cases, based on left-libertarian ideas. While these ideas gained strong political support from parties across the left/right spectrum in Austria, they were combined with etatist ideas in Germany, resulting in a substantially lower potential for marketisation in Germany's LTC policy. Our study also shows that, by contrast with neo-liberal ideas, left-libertarian ideas address care recipients' self-determination and divert attention away from social problems associated with LTC marketisation.