This chapter focuses on two important processes of institutional change in formal, publicly subsidized social care for older people: marketization and privatization. The chapter defines marketization and privatization, examines their drivers, and sets out the main policy instruments through which market logics and private actors are brought into social care systems. The chapter also explores the impacts of marketization and privatization on the ownership structure of formal eldercare systems, the distribution of care, the quality of care, and the politics of the welfare state. Based on a broad survey of international research, with empirical illustrations, this chapter stresses the role of both political and market actors in shaping the size and organization of social care markets. The chapter concludes that, despite differences between countries, marketization and privatization create new challenges for quality regulation and increase the risk of inequalities in access to high quality social care.