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The Netherlands: the struggle between universalism and cost containment
- Author:
- ROIT Barbara Da
- Journal article citation:
- Health and Social Care in the Community, 20(3), May 2012, pp.228-237.
- Publisher:
- Wiley
The tension between good-quality care and costs has been a key issue since the inception of the long-term care (LTC) scheme. This article addresses the question of how these two distinct objectives have been dealt with in policy in the past 20 years in the Netherlands. Based on existing studies, official statistics and policy documents, the article argues that the issue of cost containment is a theme in the development of home care that has been accompanied and legitimised over time by distinct normative views. On the one hand, budgetary controls have been predicated on the need to ensure the financial sustainability of the system and its universalistic features. On the other hand, the practice of cost containment has, since the early 1990s, also been accompanied by views that structurally challenge universalism through the introduction of new ideas about the responsibility for LTC risks, resource allocation and regulation of the system.
Strategies of care: changing elderly care in Italy and the Netherlands
- Author:
- ROIT Barbara Da
- Publisher:
- Amsterdam University Press
- Publication year:
- 2010
- Pagination:
- 220p.
- Place of publication:
- Amsterdam
This book traces the changes in the elderly care systems of Italy and the Netherlands since the early 1990s, drawing attention to the advantages and disadvantages of these two very different models. It examines the formal care system of the Dutch, and reveals how this system, despite strong policy pressures, has remained relatively stable, while the Italian system has undergone major transitions despite minimal policy intervention. Based on a wealth of data and extensive interviews with both caregivers and patients, this book is designed for anyone interested in the future of European health care debates. Contents include: changing care systems - an introduction; the context and policy trajectories; the challenge of dependence; changing care packages; care packages in practice; the creation of care packages and the transformations of care systems; and conclusions.
Relatives as paid care-givers: how family carers experience payments for care
- Authors:
- GROOTEGOED Ellen, KNIJN Trudie, ROIT Barbara Da
- Journal article citation:
- Ageing and Society, 30(3), April 2010, pp.467-489.
- Publisher:
- Cambridge University Press
In the Netherlands people in need of long term care are allowed to use payments for care to hire relatives to perform care tasks. This qualitative study explored paid relatives’ experiences of payments for care and how these affect their care-giving. Seventeen female care-givers who had been involved in paid home care for an intergenerational family member for at least 6 months underwent in-depth interviews in which they were asked to respond to three fictional vignettes of contrasting care trajectories. More than half of the respondents had provided care unpaid prior to the contract. It was found that the cash payment had mixed and partly contradictory implications for the care-givers. The care-givers considered that the payments recognised and raised their status as carers, and were seen as reward and reciprocation for their care work. Some carers reported that the contract helped manage strained relationships, by enabling a clearer differentiation of care tasks from affection. However some of the care-givers who regarded themselves as employees and saw their role as equivalent to formal carers felt a greater obligation to provide high-quality care, and found that they were thanked less often and received fewer tokens of gratitude. Implications for future social policy and payments are discussed.
Long term care policies in Italy, Australia and France: variations in cash-for-care schemes
- Author:
- Da ROIT Barbara
- Journal article citation:
- Social Policy and Administration, 41(6), December 2007, pp.653-671.
- Publisher:
- Wiley
Cash benefit provisions have been at the core of many recent reforms in the long-term care sector in Europe. The respective schemes, however, vary widely in terms of the definition of entitlements, the level of benefits, and the ways in which benefits can be used by recipients. This article investigates cash-for-care schemes in three European social insurance countries. It asks whether the diversity of these schemes indicates different paths or just differences in the pace with which the respective policies address the risk of dependency. A characterization of the three schemes and a discussion of the implications for care work arrangements lead to the conclusion that the context and timing of long-term care reform processes are in fact quite variegated. All three countries have histories of cash schemes and of applying the cash approach to support – and to some extent relieve – traditionally strong family obligations. Differences predominate in terms of linking cash to employment, although some convergence is apparent in the effects on qualifications, working conditions and wages in care work.
Migrant care work and care, migration and employment regimes: a fuzzy-set analysis
- Authors:
- Da ROIT Barbara, WEICHT Bernhard
- Journal article citation:
- Journal of European Social Policy, 23(5), 2013, pp.469-486.
- Publisher:
- Sage
Migrant care work has emerged as an increasingly important solution to the challenges of growing eldercare needs in both the private and the public sphere. Migrant workers are employed in domestic services in Southern European and in some continental European countries, and they are a significant part of the work force in the formal care sector in many national contexts. The article provides an exploratory cross-country analysis of the phenomenon. After assessing the extent of migrant care work based on individually contracted workers in the domestic sector vs. organization-based care workers in nine European welfare states, it investigates which conditions sustain specific national patterns. Using fuzzy-set analysis the article demonstrates how the intersection of care, migration and employment regimes shapes different patterns of migrant care work. (Publisher abstract)
Cash for long‐term care: policy debates, visions, and designs on the move
- Authors:
- Da ROIT Barbara, LE BIHAN Blanche
- Journal article citation:
- Social Policy and Administration, 53(4), 2019, pp.519-536.
- Publisher:
- Wiley
Cash‐for‐care (CfC) schemes have introduced a key transformation in long‐term care policies across Europe since the 1990s. The article explores the extent to which CfC policies have changed over time and into which directions, the ways in which change (if any) has occurred and the forces underlying it. By combining the literature on institutional change with ideational approaches, the article focuses on policy theories and policy designs, on modes of change and factors pushing for change within the CfC policy, and in the long‐term care and neighbouring policy fields. In doing so, we aim to contribute to understanding institutional change and the transformation of an increasingly important sector of the welfare state. (Edited publisher abstract)
Cash for care and care employment: (Missing) debates and realities
- Authors:
- Da ROIT Barbara, MORENO‐FUENTES Francisco Javier
- Journal article citation:
- Social Policy and Administration, 53(4), 2019, pp.596-611.
- Publisher:
- Wiley
The introduction of cash‐for‐care (CfC) schemes in different European countries over the last years has responded to a plurality of strategies aimed at attending the rising demand and increasing costs of the long‐term care needs of an ageing population. The specific system of care provision in each country shaped the response given to those challenges, as well as the room for manoeuvre for policymakers when trying to transform the domain of care into a sphere where markets may play a larger role, partly relieving families, and also the state, from these responsibilities. Policy debates and scholarly analyses largely overlooked the contribution of these schemes to the creation and shaping of employment. This article provides a comparative analysis of how CfC‐based policies entail—alongside the regulation of informal care—a(n implicit or explicit) connection with care employment and may contribute to structuring employment relations in this sector. It looks jointly at the specific features of CfC and at the institutional context—welfare regime—in which they are embedded in order to assess the extent to which these schemes contributed (generally unintendedly) to a transformation of the care employment size and features in seven European countries. (Edited publisher abstract)
Migrant care work going Dutch? The emergence of a live-in migrant care market and the restructuring of the Dutch long-term care system
- Authors:
- Da ROIT Barbara, BOCHOVE Marianne van
- Journal article citation:
- Social Policy and Administration, 51(1), 2017, pp.76-94.
- Publisher:
- Wiley
In recent years, a live-in migrant care (LIMC) market has emerged in European countries with specific care, migration, and employment regime features. In countries with relatively low levels of formal long-term care (LTC) provision, people in need of care and their families have started purchasing LTC directly from individual – mostly migrant – workers who live-in with the person in need of care. Previous research has shown that this arrangement is facilitated by the availability of cash-for-care benefits that can be freely used by the beneficiaries, and/or by low levels of regulation of employment and migration. The Netherlands traditionally features strong, universal and generous LTC policies. However, recently, the phenomenon of LIMC has also appeared there. Based on exploratory qualitative research, this article examines the features of Dutch LIMC and the factors that foster or hinder its development. The findings show that the ongoing restructuring of the Dutch LTC system – particularly the emphasis on informal care and decreasing accessibility of institutional care – are important factors pushing an LIMC market. At the same time, various institutional factors limit its growth, particularly the high levels of regulation of the Dutch care, migration and employment regimes. Further cutbacks in the care sector might push more families to this market in the near future, and change the character of the Dutch LTC sector. The Dutch case is relevant for other countries with longstanding traditions of generous LTC services which currently undergo retrenchment, and sheds light on routes to institutional change. (Edited publisher abstract)
Elasticity of care networks and the gendered division of care
- Authors:
- KRUIJSWIJK Wilco, Da ROIT Barbara, HOOGENBOOM Marcel
- Journal article citation:
- Ageing and Society, 35(4), 2015, pp.675-703.
- Publisher:
- Cambridge University Press
The gender gap in family care-giving is an established research finding: men dedicate less time to care-giving and provide specific gendered types of help. This article argues that in order to grasp men's contribution to care arrangements one should recognise the multifaceted nature of care and examine care networks beyond the 'care receiver-primary care-giver' dyad with a dynamic perspective. A qualitative analysis of the care networks of three large Dutch families with an older parent in need of care confirms the greater involvement of women in care-giving and men's tendency to provide specific types of care. However, men also contribute to the elasticity and stability of the care arrangement by filling temporary gaps and supporting the female care-givers. This article puts forward the idea that men's contribution is in turn a factor in the perpetuation of the gendered structure of care-giving. (Publisher abstract)
The turn to optional familialism through the market: long‐term care, cash‐for‐care, and caregiving policies in Europe
- Authors:
- LE BIHAN Blanche, Da ROIT Barbara, SOPADZHIYAN Alis
- Journal article citation:
- Social Policy and Administration, 53(4), 2019, pp.579-595.
- Publisher:
- Wiley
Cash‐for‐care (CfC) schemes are monetary transfers to people in need of care who can use them to organize their own care arrangements. Mostly introduced in the 1990s, these schemes combine different policy objectives, as they can aim at (implicitly or explicitly) supporting informal caregivers as well as increasing user choice in long‐term care or even foster the formalization of care relations and the creation of care markets. This article explores from a comparative perspective, how CfC schemes, within broader long‐term care policies, envision, frame, and aim to condition informal care, if different models of relationships between CfC and informal care exist and how these have persisted or changed over time and into which directions. Building on the scholarly debate on familialization vs. defamilialization policies, the paper proposes an analytical framework to investigate the trajectories of seven European countries over a period of 20 years. The results show that, far from being simply instruments of supported familialism, CfC schemes have contributed to a turn towards “optional familialism through the market,” according to which families are encouraged to provide family care and are (directly or indirectly) given alternatives through the provision of market care. (Edited publisher abstract)