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Quasi-markets Targets and the Evaluation of Nursing-home Funding in the Valencian Region


  • Amadeo Fuenmayor

    () (Universidad de Valencia)

  • Rafael Granell

    () (Universidad de Valencia)

  • María Angeles Tortosa

    () (Universidad de Valencia)


Spanish long term care is in danger, therefore we propose a change in the nursing home funding sys¬tem. We use as an example the extremely complex nursing home financing system of Valencian Region. In this region, there are many funding mechanisms: two types of public subsidies, two different acces¬sibility plans, a voucher scheme and a cash benefit approach related to residential service. We evaluate these methods through the quasi-market theory. We find that these approaches have negative impact on equity, efficiency and freedom of choice and we propose a new, homogeneous financing method for all nursing homes through voucher.

Suggested Citation

  • Amadeo Fuenmayor & Rafael Granell & María Angeles Tortosa, 2016. "Quasi-markets Targets and the Evaluation of Nursing-home Funding in the Valencian Region," Hacienda Pública Española, IEF, vol. 216(1), pages 13-38, March.
  • Handle: RePEc:hpe:journl:y:2016:v:216:i:1:p:13-38

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    References listed on IDEAS

    1. García-Gómez, Pilar & Hernández-Quevedo, Cristina & Jiménez-Rubio, Dolores & Oliva-Moreno, Juan, 2015. "Inequity in long-term care use and unmet need: Two sides of the same coin," Journal of Health Economics, Elsevier, vol. 39(C), pages 147-158.
    2. Martin Cave, 2001. "Voucher Programmes and their Role in Distributing Public Services," OECD Journal on Budgeting, OECD Publishing, vol. 1(1), pages 59-88.
    3. Abelson, Julia & Gold, Sara Tedford & Woodward, Christel & O'Connor, Denise & Hutchison, Brian, 2004. "Managing under managed community care: the experiences of clients, providers and managers in Ontario's competitive home care sector," Health Policy, Elsevier, vol. 68(3), pages 359-372, June.
    4. Levin, Henry M., 1992. "Market approaches to education: Vouchers and school choice," Economics of Education Review, Elsevier, vol. 11(4), pages 279-285, December.
    5. Rafael Granell, 2002. "Education Vouchers in Spain: The Valencian Experience," Education Economics, Taylor & Francis Journals, vol. 10(2), pages 119-132.
    6. Marianna Fotaki & Alan Boyd, 2005. "From Plan to Market: A Comparison of Health and Old Age Care Policies in the UK and Sweden," Public Money & Management, Chartered Institute of Public Finance and Accountancy, vol. 25(4), pages 237-243, August.
    7. Giulia Garavaglia & Emanuele Lettieri & Tommaso Agasisti & Silvano Lopez, 2011. "Efficiency and quality of care in nursing homes: an Italian case study," Health Care Management Science, Springer, vol. 14(1), pages 22-35, March.
    8. Randall, Glen E. & Williams, A. Paul, 2006. "Exploring limits to market-based reform: Managed competition and rehabilitation home care services in Ontario," Social Science & Medicine, Elsevier, vol. 62(7), pages 1594-1604, April.
    9. Meinow, Bettina & Parker, Marti G. & Thorslund, Mats, 2011. "Consumers of eldercare in Sweden: The semblance of choice," Social Science & Medicine, Elsevier, vol. 73(9), pages 1285-1289.
    10. Forder, Julien & Allan, Stephen, 2014. "The impact of competition on quality and prices in the English care homes market," Journal of Health Economics, Elsevier, vol. 34(C), pages 73-83.
    11. Chalkley, Martin & Malcomson, James M, 1996. "Competition in NHS Quasi-markets," Oxford Review of Economic Policy, Oxford University Press, vol. 12(4), pages 89-99, Winter.
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    More about this item


    Long term care; nursing homes; quasi-markets; vouchers;

    JEL classification:

    • H44 - Public Economics - - Publicly Provided Goods - - - Publicly Provided Goods: Mixed Markets
    • H53 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Welfare Programs
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs


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