ABSTRACT

Some standard objections to the marketisation of welfare services apply with particular force to services for the elderly. There are two aspects of the arguments for and against market provision to consider; many of the most influential arguments have been couched in rather general terms, covering but not restricted to services for the elderly. R. Titmuss objected to markets in and marketing of blood products as threats to social solidarity, as well as a threat to the quality of the blood and blood products available to patients. Markets and marketing are, he argued, likely to subvert the relation of trust between health services and their users. Markets are alleged to be inefficient, stimulating waste activities and production, and generating expensive but superfluous insurance companies and other financial bureaucracies. Markets are inherently unable to provide this category of goods for the people who most acutely need and lack them. Healthcare for elderly people is a classic example of this ‘adverse selection’.