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

Allen et al., 2011 Governance and Financing of LTC | European Overview
Contents
1 Background 3
1.1 Methods 5
1.2 Structure 6
2 Key concepts for the governance and finance of LTC 7
2.1 Key definitions and frameworks 7
2.2 Governance in emerging long-­‐term care systems 8
3 Key issues, contextual factors and the role of stakeholders 9
3.1 Different definitions of LTC 9
3.2 Different levels of resources spent 11
3.3 Different levels of service provision 12
3.4 Political structures and welfare regimes 15
3.5 The role of different stakeholders and welfare regimes 18
3.6 Selected indicators on values, user expectations and family ethics 21
4 Key governance mechanisms 23
4.1 Market mechanisms in LTC 25
4.1.1 Using competition in LTC 27
4.2 Decentralisation and recentralisation in LTC 30
4.2.1 Risks and benefits of decentralisation 30
4.2.2 De-­‐centralising LTC systems 32
4.2.3 Centralising LTC issues and systems 34
4.2.4 Centralising and de-­‐centralising quality management 35
4.3 The governance of informal care 36
4.3.1 Main issues and gaps in governance of informal carer support policies 37
4.3.2 Approaches to informal care and volunteering 40
4.3.3 A classification of measures to analyse informal carer governance policies 41
4.3.4 Main issues in the governance of volunteering 43
5 Finance and sustainability 44
5.1 Public expenditure and resources 44
5.2 Access and equity 46
5.3 Steering mechanisms 48
5.4 Sustainability and policy reforms 48
6 Conclusions 52
6.1 Towards a European agenda? Future research and policy 54
7 References 56
Appendix 1: EU literature quick scan 63
Appendix 2: National reports 74
Appendix 3: National practice examples 76
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