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Not all that glitters is gold: long-term care reforms in the last two decades in Europe
- Authors:
- RANCI Costanzo, PAVOLINI Emmanuele
- Journal article citation:
- Journal of European Social Policy, 25(3), 2015, pp.270-285.
- Publisher:
- Sage
This article explores changes that took place in long-term care (LTC) policies during the last two decades in six European welfare states. It addresses three issues: (1) why reforms took place, (2) the main actors and coalitions driving this process and the institutional mechanisms at work and (3) the main outcomes of reform processes. In order to analyse the development of LTC policies, the article applies theoretical concepts of historical institutionalism. The interpretation is that institutional change in LTC policy has taken place through a protracted institutional dynamic in which continuity and discontinuity are inextricably linked and where tensions and contradictions have played a crucial role. With regard to outcomes, the article analyses coverage and citizens’ social rights, working conditions in the care sector and trajectories of de-/re-familization of care. The final impact is that the level of universalism has generally increased in Europe, but that in part it has adopted a new form of ‘restricted universalism’, characterized by universal entitlements to LTC benefits constrained by limitations in provision due to financial constraints and budget ceilings. (Edited publisher abstract)
Restructuring the welfare state: reforms in long-term care in Western European countries
- Authors:
- PAVOLINI Emmanuele, RANCI Costanzo
- Journal article citation:
- Journal of European Social Policy, 18(3), August 2008, pp.246-259.
- Publisher:
- Sage
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.