National Intentions and Local Welfare Markets: A Comparative Analysis of Market Tools to Support Older Adults in France and Québec

Abstract

This homecare policy study compares the creation and enactment of a managed market (Quebec) and a consumer-driven market (France) in urban and rural areas. Market tools are ill-suited for rural environments, as policymakers have an urban setting in mind. Consequently, market tool preferences have modest relevance in rural settings, with implementers facing multiple hurdles to develop and sustain markets. This comparative study demonstrates that the deployment of market tools actually results in heightened pressures on not-for-profit organizations to fill a growing number of service gaps and to adapt market instruments and mechanisms.

Keywords:

• welfare markets
• homecare
• rural
• urban
• cash-for-care
• managed market

Acknowledgements

The authors would like to thank Daniel Béland, Martin Seeleib-Kaiser, and the other participants of the JCPA workshop – Territorial Governance and Comparative Policy Analysis at the Subnational Level – 22–23 June 2023 in Montreal, as well as participants in the joint PASOLO/FICOPSAD seminars, for their generous comments and suggestions.

Disclosure Statement

No potential conflict of interest was reported by the authors.

Notes

1. Figures obtained via a request to information access in 2021.

2. Net expenditure for APA in 2020: 6.3Mds (billions of euros). Total net expenditure for French social protection in 2021: 834Mds.

3. Full-time equivalence per month is 133.33 hours.

Additional information

Funding

FRQSC-ANR – Personnes âgées et solidarités locales (PASOLO) Project. [ANR # ANR-16-FRQC-0005-0 PASOLO. FRQSC # 148130].

Notes on contributors

Patrik Marier

Patrik Marier is professor of Political Science at Concordia University and Scientific Director of the Centre de recherche et d’expertise en gérontologie sociale (CREGÉS) in Montréal. He specialises in aging policy.

Loïc Trabut

Loïc Trabut is a researcher at the Institut national d’études démographiques. He specialises in the territorial analysis of public policies, and in particular their development in relation to the articulation of family and public solidarity around seniors.

Alexandra Garabige

Alexandra Garabige is a sociologist specializing in public political autonomy policies in France. After several years in research, in recent years at the Institut national d’études démographiques, she joined the national solidarity fund for autonomy (CNSA).