Privatization of health and welfare services for older adults in Israel: Gains, deficiencies and the multifaceted dilemmas

Abstract

Over the last four decades, the Western world has engaged in the process of privatizing various health and human services, such as incarceration, foster care, hospital services, and services intended for the older population, such as home-based nursing care. The rationale for undertaking this initiative was to relieve the heavy burden that the provision of such services imposes on governments and local authorities, as well as the sincere desire to improve the quality of services through free-market competition. As the process unfolded, the advantages and disadvantages of privatization became apparent, not only in theory but in practice. An especially crucial question that arose was regarding the role of the welfare state and its obligations toward the various population groups that comprise it (as well as differences in the level of commitment among various welfare states). Addressing this question raises a series of dilemmas: the political dilemma (e.g., allocating responsibility for the quality, availability, and costs of the services); the professional dilemma (e.g., the quality of care, the manner and extent of training that is required of various caregivers, the ability to monitor the extent and quality of the services rendered); the social dilemma, which deals with maintaining the principles of social justice and equity (e.g., exercising one's right to the full extent of the law; having access to services in the geographical periphery; and the ability of disadvantaged populations, such as immigrants, to meet the costs of privatized services). As regards the weaker sectors of society, such as older adults, the poor, refugees, and immigrants, there are additional difficulties to consider, as they need assistance in locating these services, meeting the costs, and finding a companion who can help take them to a clinic. Older people have even more needs, above and beyond those mentioned; hence, the impact of the privatization process is even greater in their case. This study examines the advantages and disadvantages of the privatization process in reference to this segment of the population and these dilemmas.