Neoliberalism and human services: threat and innovation.
Market-style services fail people with ID because they cannot act like typical shoppers.
01Research in Context
What this study did
Swenson (2008) wrote a theory paper. It asked: what happens when human services for people with intellectual disability copy business models?
The author looked at market rules like choice, price, and competition. He argued these rules break down when the user cannot shop around.
What they found
The paper says market-based care fails for ID clients. People with ID often cannot compare prices or switch providers.
Their needs are too complex for one-size products. So the market cannot fix poor care; it hides it.
How this fits with other research
Van der Molen et al. (2010) extends the same worry. After showing markets flop, they offer a fix: plan services around relationships, not sales.
Storch et al. (2012) seems to contradict Swenson (2008). They tell BCBAs to chase new markets like dementia care. Read side-by-side, the clash is real: one says markets harm, the other says expand.
Parchomiuk et al. (2025) backs Swenson (2008) with lived data. Adults with ID name family, staff, and policy rules that block choice. The barriers S guessed are now visible.
Why it matters
If you write behavior plans, do not assume families can shop for the best clinic. Offer one-page fee sheets and plain-language summaries. Build in flexibility so clients can change parts without losing the whole plan.
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02At a glance
03Original abstract
BACKGROUND: The turn to neoliberalism in welfare policy suggests that human services need to be based on a market approach. The problem with this suggestion is that it presupposes marketing information such that service providers can market their services for identified client needs. In the field of intellectual disability (ID) services this type of information is not available. METHOD: The method is a reflective analysis of the key presupposition of a market-orientated approach to disability services, namely that service providers know who needs what. Using insights from marketing theory the paper engages in a reflective thought experiment to lay out the intricacies of this presupposition. RESULTS: The analysis results in an argument regarding the validation of a market-based approach to disability services. First, this approach has its limits in view of the question of whether the specific and atypical needs of people with ID, as well as their financial position as potential consumers constitute a market. Second, the approach has limited validity both in view of the ability of people with ID to act as consumers, and of the restrictions imposed upon them by the eligibility criteria for welfare and support programmes. CONCLUSIONS: A market-based approach to disability services and supports can be helpful to spur innovation and further political and philosophical inquiry in human services, but the neoliberal optimism about the market as the only successful mechanism for service distribution is misplaced.
Journal of intellectual disability research : JIDR, 2008 · doi:10.1111/j.1365-2788.2008.01076.x