Abstract

This paper draws on a comparative study of reforms to home care services in nine European countries; papers from the study will be published in a special issue of the journal This paper draws on a comparative study of reforms to home care services in nine European countries; papers from the study will be published in a special issue of the journal Health and Social Care in the Community during 2012.

The paper will argue that western European countries are subject to common pressures of population ageing, public expenditure constraints, changing public attitudes to the welfare state and workforce pressures within the care sector. Some common responses to these pressures can be discerned across countries, particularly the widespread introduction of market-oriented mechanisms and shifting divisions of work within the mixed welfare economy. However, policy responses also show considerable divergence between countries, with countries variously placing different reliance on strategies to reduce demand; narrowed eligibility through increased targeting; cost containment through the introduction of cash allowances; new technological and efficiency measures; and firmly embedding family and ‘grey’ care labour into the architecture of home care provision.

The paper argues that these differences have their foundations in the historical traditions, values and structures of each country. In addition, shifting patterns of governance in home care services, particularly the tensions between local state, national state and market modes of governance, will be argued to shape the reforms of individual countries in distinctive ways.

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