Similar and Yet So Different: Cash-for-Care in Six European Countries’ Long-Term Care Policies

Abstract

Context:In response to increasing care needs, the reform or development of long-term care (LTC) systems has become a prominent policy issue in all European countries. Cash-for-care schemes-allowances instead of services provided to dependents-represent a key policy aimed at ensuring choice, fostering family care, developing care markets, and containing costs. Methods:A detailed analysis of policy documents and regulations, together with a systematic review of existing studies, was used to investigate the differences among six European countries (Austria, France, Germany, Italy, the Netherlands, and Sweden). The rationale and evolution of their various cash-for-care schemes within the framework of their LTC systems also were explored.Findings: While most of the literature present cash-for-care schemes as a common trend in the reforms that began in the 1990s and often treat them separately from the overarching LTC policies, this article argues that the policy context, timing, and specific regulation of the new schemes have created different visions of care and care work that in turn have given rise to distinct LTC configurations. Conclusions:A new typology of long-term care configurations is proposed based on the inclusiveness of the system, the role of cash-for-care schemes and their specific regulations, as well as the views of informal care and the care work that they require.Keywords: Long-term care, cash-for-care, care work, informal care. Address correspondence to: Since the 1990s, cash-for-care schemes have been a common trend in social policies, particularly in the field of longterm care (LTC). Instead of services, these schemes give people monetary benefits, which they can use to purchase care services.Most of the literature on this topic concerns the common objectives and possible implications of cash-for-care schemes. One of the main ideas behind cash-for-care is "free choice"; that is, disabled (older) people and/or their families may choose among different kinds of care and care providers, thereby giving them both autonomy and control, which disabled people's organizations have sought since the 1970s (Glendinning 2008). The resulting competition among care providers also has enhanced the quality and efficiency of care (Kremer 2006) in accordance with a "new public management" perspective (Ferlie, Lynn, and Pollitt 2007). Another objective is the recognition of (formerly unpaid) informal care, since many cash-for-care schemes allow beneficiaries to compensate or employ their relatives (Ungerson 1997). Finally, cash-for-care schemes can be seen as opportunities to offer LTC policies that are less expensive than traditional services.A closer inspection of cash-for-care schemes in various European countries also reveals some striking differences among them. First, the strict regulation of cash-for-care schemes has strongly influenced the "commodification of care" (Ungerson and Yeandle 2007), as well as the development of specific forms of care work and informal care (Da Roit, Le Bihan, andÖsterle 2008). ...

Long-term care hospitals in Turkey: a review

“…The LTC system in Europe differs from that in other nonEuropean countries and differences are also seen among European countries (15). Cash-for-care systems were first implemented in Europe in the 1970s and became widespread in the 1990s, and are programmers by which care services can be purchased according to the healthcare insurance premiums paid by an individual (16). The rationale behind cash-for-care systems was that alternative healthcare services could be freely selected by the individual (16).…”

“…The rationale behind cash-for-care systems was that alternative healthcare services could be freely selected by the individual (16). As the financial costs of the hospital and care institutions were met by the patient's insurance, competition to provide the best service started between care institutions (15,16).…”

“…In some European countries, LTCHs are integrated within the healthcare system for post-acute care (PAC) and located in healthcare institutions (15,16). The LTC system in Europe differs from that in other nonEuropean countries and differences are also seen among European countries (15).…”

“…Cash-for-care systems were first implemented in Europe in the 1970s and became widespread in the 1990s, and are programmers by which care services can be purchased according to the healthcare insurance premiums paid by an individual (16). The rationale behind cash-for-care systems was that alternative healthcare services could be freely selected by the individual (16). As the financial costs of the hospital and care institutions were met by the patient's insurance, competition to provide the best service started between care institutions (15,16).…”

Diversification of care policy measures supporting older people: towards greater flexibility for carers?

“…As in many other fields of comparative analysis of welfare states, long-term care and home-care policy have given rise to different typologies based on the welfare triad-welfare as the combination of state, market and family (Jamieson 1991;Burau et al 2007;Anttonen and Sipila 1996;Anttonen et al 2003;Martin and Le Bihan 2008;Da Roit and Le Bihan 2010). However, most of these attempts stress the difficulties of defining different groups of nations, since variations over time or at local level are more crucial than the characteristics which could be interpreted from a synchronic and national perspective.…”