The Marketization of Welfare: Changing Nonprofit and For-Profit Roles in the American Welfare State

Recent changes in government spending coupled with demographic and other pressures have produced a significant change in the basic structure of the American social welfare system. The widespread pattern of government-nonprofit partnership that characterized the system in the 1960s and 1970s seems to have given way in the 1980s to a system whose principal characteristic is the dominance of markettype relationships. One facet of this change has been the emergence of fees and sales as the principal source of nonprofit growth, not only among hospitals and universities, but also among social service and civic organizations. Equally important has been an accelerated growth in the provision of welfare services by for-profit firms, especially in such fields as short-term specialty hospital care, outpatient and clinic care, and a broad range of social services. Although these trends may have positive results, they raise serious questions about the future of the nonprofit sector and about access to care on the part of the disadvantaged.