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 3.5 The role of different stakeholders and welfare regimes An additional factor that contributes to the fragmentation of LTC systems is the increasing number of stakeholders involved in service delivery. While in central European countries the role of private non-‐ profit organisations as providers of care has a long tradition, private for-‐profit organisations are on the rise everywhere. This development includes the Nordic countries where, however, a majority of services are still publicly provided. Table 3.7 shows an overview of the specific ‘welfare mixes’ in the provision of services in terms of market-‐shares of public, private non-‐profit and private for-‐profit providers. It should be underlined that the emergence of private for-‐profit providers has been a phenomenon of the past 20 years only. However, the type of privatization depends a lot on the regulatory framework. While, for instance, the care home sector in the UK has become an ‘LTC industry’ with the usual market-‐ mechanisms of mergers and acquisitions of large investment firms, the German for-‐profit home care agencies are to a large extent small enterprises with 5 to 10 employees. Table 3.7 Different welfare mixes in the provision of LTC services (estimated market shares of different providers by type of service in percent, around 2010) Country Public providers Private non-‐profit providers Private for-‐profit providers Residential Home care Residential Home care Residential Home care CH (1) 30% 30% 40% DK DE 5% 2% 55% 37% 40% 62% EL n/a ES (1) (2) 23% 24% 53% FR 23% 15% 55% 65% 22% 20% IT (1) 30% 50% 20% NL (1) -‐ 80% 20% AT 55% 8% 24% 91% 21% 1% SK (1) 75% 23% 2% FI 56% 93% -‐ -‐ 44% 7% SE 75% 84% 10% -‐ 15% 16% UK 7% 14% 13% 11% 80% 75% Sources: Huber et al. 2008; Leichsenring et al. 2011; IMSERSO (ES); Statistisches Bundesamt (DE); Office fédéral de la statistique (CH); National reports. Notes: (1) only aggregate data for residential and home care available; (2) No clear distinction can be made between private providers in Spain – in this table non-‐profit providers thus include all those with a formal contract with the Autonomous Communities; private for-‐profit providers include those with an authorization only, i.e. all costs have to be covered by the individual resident. Table 3.8 synthesizes the above data in relation to the provider mix in the selected countries by outlining the share of services provided by the public, non-‐profit and private sectors, as well as the informal care contribution to LTC. The information given does not reflect the level of provision in each country, i.e. whether services meet LTC needs/demand, rather it aims to demonstrate who is providing LTC in each country. However, this data should be interpreted with the caveat that different countries may define different stakeholders in different ways. As one example, participating countries have often 18
Allen et al., 2011 Governance and Financing of LTC | European Overview placed growing emphasis on the role of volunteers, yet may have a spectrum of approaches between formal and informal care (from paid carers to migrant carers in the grey economy, to volunteers who might be remunerated for their contribution in some way, to unpaid volunteers, to friends and neighbours, to family). Different countries might also see volunteers as a way of replacing paid care/professionals or of complementing/adding value to current services and workers. Table 3.8 LTC provider mix and level of provision, by country Country Public Non-‐profit sector Private Expectations of Informal carers to provide care Slovakia High Medium (Church) Medium High Finland High Low (NGOs) Medium Medium Switzerland Medium Medium High Medium Austria Medium High (charities and other non-‐profit organisations – traditionally affiliated to churches and political parties) Netherlands Low High (non-‐profit organisations, mutuals) France Low High/medium (non-‐profit organisations) Sweden High Medium (trusts, co-‐ operatives) Medium Medium Low Medium Medium High Medium Low Greece Low Low (NGOs, church) High (migrant care workers) Low (residential care) UK (England) Low Medium (social enterprise, voluntary, non-‐profit organisations) High High Medium Denmark High Low Medium Low Germany Low (in-‐patient and out-‐patient services) High (in-‐patient) and medium (out-‐patient services) Medium (in-‐ patient services) High (out-‐ patient services) Medium Some additional features provided by national reports may help to get further insight into specific characteristics of regional backgrounds: • In Slovakia LTC is provided to a large degree informally within the home or through public services. There are 443 public social service care facilities (governed by municipalities and regions) compared to 67 church facilities and 168 private facilities (SOSR, 2008 in: Bednárik et al., 2010). LTC is funded 19
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