Governance and finance of long-term care - University of Birmingham

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Allen et al., 2011 Governance and Financing of LTC | European Overview keeping older people in need of care at home as long as possible, particular features such as the role of families and informal carers show distinct differences (Bettio & Platenga, 2004). For instance, adult children in the Nordic countries have no legal obligation to provide care or financial support for their parents, which is in stark contrast to most other countries, especially the Mediterranean family-‐based welfare states. Issues of political regimes are discussed more fully with regards to centralisation and de-‐ centralisation in Section 4.2. Table 3.6 provides an overview of the main characteristics of selected countries with regard to their political systems, welfare regimes and level of administrative responsibility. It shows in particular the fragmented administrative responsibilities in nearly all countries. With the exception of the Nordic countries, Ministries of Health and those responsible for social affairs are split; in England the Department of Health is also responsible for social care. Furthermore, in most countries decentralized decision-‐making can be observed – with respective differences in supply and access regulations. Table 3.6 Political structures and welfare regimes Country Characteristics of political system Type of welfare regime CH Federal Republic Liberal Cantons UK Constitutional monarchy, parliamentary republic, decentralised DK Constitutional Monarchy, decentralised FI Semi-‐presidential parliamentary republic, decentralised SE Constitutional monarchy, decentralised AT Federal Republic, decentralised Administrative responsibilities Liberal Central government (Department of Health), NHS, Local authorities Northern social-‐ democratic Northern social-‐ democratic Northern social-‐ democratic Conservative/ corporatist DE Federal Republic Conservative/c orporatist FR Presidential Republic, centralised Conservative/ corporatist IT Parliamentary Republic Conservative/ corporatist, mediterranean EL Presidential parliamentary republic, centralised State, municipalities Central government (Ministry of Social Affairs and Health), municipalities Central government (Ministry of Social Affairs and Health), municipalities Regional governments, Federal government (LTC allowance) Federal State (Ministry of Health), LTC insurance fund (assessment, authorisation, contracting, quality control), Regional governments (quality control) Central State (Ministry of Health, framework legislation, Ministry of Work and Social Affairs), quality assurance Départements (Conseils généraux), care attendance regulation Regional governments, NHS Mediterranean Central government (Ministry of Health and Social Solidarity), municipalities ES Federal State with Mediterranean Federal State (framework legislation), 16
Allen et al., 2011 Governance and Financing of LTC | European Overview Autonomous Communities Autonomous Communities (impementation, co-‐ financing) NL Constitutional Monarchy, centralised SI Parliamentary Republic Emerging Central and Eastern European welfare state SK Parliamentary Republic Emerging Central and Eastern European welfare state Mixed Central state (Ministry of Health, Welfare and Sports), AWBZ (LTC Insurance), delegated agencies, municipalities for social Central government Central government (Ministry of Social Affairs), regions, municipalities The Esping-‐Andersen typology is arguably limited due to the breadth of provision it aims to cover and by political changes that have occurred over time (e.g. rise of more right-‐wing governments in parts of Scandinavia). More recent European work has addressed some political and welfare regimes with a specific focus on LTC. The European research consortium ANCIEN have developed a typology of LTC system models in EU countries, which are characterised by diverse arrangements for the provision of care/organisation and financing (Kraus et al., 2010). The specific and practical focus of the typology on long-‐term care organisation tries to provide further insight into national characteristics and clusters (see Table 3.7). This typology provides surprising results as, for instance, the German and Slovak LTC systems result as similar, while countries as different as Austria, England, Finland, France and Spain seem to show the same pattern of LTC service use and financing. As a corollary, these results may yet again underline that LTC as a system is just emerging in most European countries – and indicators for comparisons at an aggregate level currently remain vague. Table 3.7 Typology based on use and financing of long-‐term care Nature of the system Countries Characteristics Oriented towards informal care, low private financing Generous, accessible and formalised Oriented towards informal care, high private financing High private financing, informal care seems a necessity Belgium,* Czech Republic, Germany, Slovakia Denmark, The Netherlands, Sweden Austria, England, Finland, France, Spain Hungary, Italy Source: Kraus et al., 2010: 39.-‐ Note: *) medium spender. Low spending, low private funding, high IC use, high IC support, cash benefits modest High spending, low private funding, low IC use, high IC support, cash benefits modest Medium spending, high private funding, high IC use, high IC support, cash benefits high Low spending, high private funding, high IC use, low IC support, cash benefits medium 17
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