To Make or to Buy Long-term Care? Part I: Learning from Theory (original) (raw)
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To Make or to Buy Long-term Care II: Lessons from quasi-markets in Europe
This Policy Brief is the second part of a trilogy dedicated to the reliance on markets for the delivery of long-term care, or in other words to the ‘make or buy’ decision in long-term care. It is focusing on evidence from four selected European countries on existing experiences with competition and choice in long-term care systems to provide policy lessons on the ‘make or buy’ decision and its impact on outcomes for users, on quality of care, and the organisation of care markets.
Article Restructuring the welfare state: reforms in long-term care in Western European countries
Faced with the problems associated with an ageing society, many European countries have adopted innovative policies to achieve a better balance between the need to expand social care and the imperative to curb public spending. Although embedded within peculiar national traditions, these new policies share some characteristics: (a) a tendency to combine monetary transfers to families with the provision of in-kind services; (b) the establishment of a new social care market based on competition; (c) the empowerment of users through their increased purchasing power; and (d) the introduction of funding measures intended to foster care-giving through family networks. This article presents the most significant reforms recently introduced in six European countries (France, Germany, Italy, the Netherlands, Sweden and the UK) as regards long-term care. It analyses their impact at the macro-(institutional and quantitative), meso-(service delivery structures) and micro-level (families, caregivers and people in need). As a result the authors find a general trend towards convergence in social care among the countries, and the emergence of a new type of government regulation designed to restructure rather than to reduce welfare programmes.
Restructuring the welfare state: reforms in long-term care in Western European countries
Journal of European Social Policy, 2008
Faced with the problems associated with an ageing society, many European countries have adopted innovative policies to achieve a better balance between the need to expand social care and the imperative to curb public spending. Although embedded within peculiar national traditions, these new policies share some characteristics: (a) a tendency to combine monetary transfers to families with the provision of in-kind services; (b) the establishment of a new social care market based on competition; (c) the empowerment of users through their increased purchasing power; and (d) the introduction of funding measures intended to foster care-giving through family networks. This article presents the most significant reforms recently introduced in six European countries (France, Germany, Italy, the Netherlands, Sweden and the UK) as regards long-term care. It analyses their impact at the macro-(institutional and quantitative), meso-(service delivery structures) and micro-level (families, caregivers and people in need). As a result the authors find a general trend towards convergence in social care among the countries, and the emergence of a new type of government regulation designed to restructure rather than to reduce welfare programmes.
Social Policy & Administration, 2013
Readers will have high expectations of this book: Mark Blyth's endorsement on the back cover heralds it as the 2010's answer to Esping-Andersen (1990) and Hall and Soskice (2001). The authors' aim is to reexamine some key ideas and assumptions (or perhaps 'myths') about the development of welfare states in order to test the 'conventional narrative' (p. 2) that romanticizes the 1940s, privileges 'crisis' as the catalyst for change and assumes a race to neoliberalism at least, if not the bottom. To undertake their task of reassessment, the book is divided into seven chapters, covering historical development, the varieties of capitalism/welfare regimes framework, globalization, competitiveness, European integration, the question of welfare state convergence and, lastly, the impact of the 2007-08 financial crisis. In addressing these themes, each chapter presents a highly engaging and clearly written mix of summary, possibility, data and analysis, such that even those most well versed in the chapter specialisms remain likely to learn something new. The subjects of interrogation in the individual chapters may not be novel, and likewise the conclusions drawn, but as the authors stress, the empirical basis of what we think we know about the life and times of the welfare state is often shakier than we presume. Discussion of the reality and numerical accuracy of 'three worlds of welfare' (Chapter 2) for example, is a familiar enterprise, generative of a wealth of cross-national insight. Hay's and Wincott's contribution here: that what exist are 'clusters' rather than 'worlds', formed according to (two) dimensions rather than distinct models of welfare, suggests that the shared qualities of modern welfare states are more preponderant than the factors of difference. Interestingly, although the representation of the two-dimensional clustering for the 2000s throws up some thought-provoking (Belgium), though perhaps not entirely surprising (Denmark) movement (p. 61), by the time convergence is discussed in Chapter 6, the clusters have reverted to divisions of European geography. Having concluded Chapter 2 with a preference for clusters not types, the following two chapters examine the threat to welfare state viability posed by its representation as an economic burden. First, by assessing evidence for the more general capital-repellent qualities of taxation in the context of globalised markets (Chapter 3), and then in more detail (Chapter 4) the evidence of retrenchment that has already taken place and the arguments that support it.
Policy Dilemmas in Financing Long-term Care in Europe
Global Policy, 2016
Long-term care (LTC) is the largest insurable risk facing the elderly in most western societies. Paradoxically, institutional responses to the need to insure ex-ante (before the contingency occurs) the financial risks of needing LTC (by means of social and private insurance and selfinsurance) exhibit limited development. In contrast, mechanisms to finance LTC ex-post continue to develop, primarily those supported by the public sector (by means of subsidies or tax deductions) and the family (by means of intergenerational transfers). Both ex-ante and expost types of financing mechanisms are found to be subject to shortcomings which give rise to dilemmas for public policy. Governments confront these dilemmas in different ways, causing a great deal of heterogeneity in the financing and provision of LTC services across Europe.
The marketisation of care: Rationales and consequences in Nordic and liberal care regimes
Journal of European Social Policy, 2012
The use of markets and market mechanisms to deliver care services is growing in both liberal and social democratic welfare states. This article examines debates and policies concerning the marketisation of eldercare and childcare in Sweden, England and Australia. It shows how market discourses and practices intersect with, reinforce or challenge traditions and existing policies and examines whether care markets deliver user empowerment and greater efficiency. Markets for eldercare and childcare have developed in uneven and context specific ways with varying consequences. Both politics and policy history help to shape market outcomes.