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 1.2 Structure After this brief introduction, Section 2 explores key concepts in more detail, while Section 3 examines the main issues, contextual factors and stakeholders influencing the delivery of LTC in different countries. After this, Section 4 investigates three main issues in governance identified by analysis of the national reports: • Using market mechanisms to stimulate greater choice and competition while at the same time ensuring sufficient collaboration and an ability to take a whole system approach. • The different tasks and functions that need to be performed at different national, regional and local levels. • The contributions made by both formal and informal spheres of care (including how best to support family carers, to develop an approach based on partnership or co-‐provision and to recognise the contribution made by migrant workers and volunteers). Section 5 explores issues of funding and financial sustainability, addressing the different financial mechanisms being used to steer and develop LTC. Section 6 then draws together key conclusions and lessons learned (including recommendations for future policy and research), with more detailed national examples provided in Appendix 3. 6
Allen et al., 2011 Governance and Financing of LTC | European Overview 2 Key concepts for the governance and finance of LTC 2.1 Key definitions and frameworks The primary working definition of LTC used in this report, in line with Hodges et al. (1996: 7), is outlined in Section 1. Stemming from the economic sector, governance as a term was adopted by social and political sciences in the 1970s and has since undergone a marked rise in usage: ‘Good governance’ was determined in 1992 by the World Bank as a criterion for the granting of loans to developing countries. In 2001, the European Commission defined in its ‘White Paper on European Governance’ that this refers to the rules, processes and behaviour affecting the way in which powers are exercised at European level, particularly as regards openness, participation, accountability, effectiveness and coherence. Generally speaking, governance comprises the processes and systems by which an organisation or a society operates, but the concept is not set univocally. Governance can rely on different tools: central planning for how to supply specific demand is based on hierarchy and is accomplished by the state or non-‐profit agencies and market competition is based on decentralized action and involves for-‐profit companies. In practice, in particular with respect to health and welfare systems, mixed approaches have entered the scene as governance in these sectors and imply “that private actors are involved in decision-‐ making in order to provide common goods and that non-‐hierarchical means of guidance are employed” (Héritier, 2002). Over the past decade the term governance has thus been used mainly to characterise non-‐hierarchical, non-‐centralised forms of coordination, which involve public and private, governmental and non-‐ governmental organisations in the production of publically provided goods. Some authors have coined the functioning of networks involving public-‐private partnerships and civil society as ‘co-‐governance’, while others have proposed to reserve the term ‘governance’ for horizontal forms of coordination in which the state is not involved at all (Schuppert, 2008: 19). In this report on governance in the realm of LTC for older people we assume a conception of governance in which the public, private and non-‐profit sectors, as well as households have shaped specific ‘welfare mixes’ according to national, political and cultural characteristics or ‘pathways’ (Esping-‐Andersen, 1990; Evers, 2005). However, as we shall see, governance of LTC has only partly been influenced by traditional welfare regime types, in particular when it comes to characterise the ‘familistic welfare systems’ of the Mediterranean countries (Strohmeier Navarro Smith, 2010: 279) or Central and Eastern European transition economies. Governance theory assumes that the state, market-‐oriented actors and civil society are working together in order to solve collective problems. It thus also assumes implicitly that the collaboration between the stakeholders serves the common interest (Mayntz, 2008: 54) to plan, provide and control public services. As a meta-‐actor, however, it is the state that provides the rules which determine the modes of collaboration between the various agents involved – with the ideal-‐type result that the traditional intervention state is being replaced by an ‘enabling’ state (Dingeldey, 2008: 318ff.). 7
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