Abstract

Long term care has been one of the welfare policy fields in which the most significant institutional changes and policy innovation have taken place over the last two decades, both in Western and Central-Eastern Europe. The national case studies presented in this study show that very different trends have taken place throughout Europe: from a general growth in public financing, an expansion of beneficiaries, and, more generally, an attempt to define larger social responsibilities and related social rights in some countries, to cuts in public expenditure, targeting of services and a general reduction in social rights in others.

This paper aims to describe these general trends; identify the factors which explain them; summarize the main differences between European countries; and consider the most important consequences of the various developments. We also look at institutional conditions and the gaps between “problem pressures” and existing solutions which require policy innovation; at the political and institutional processes through which subsequent changes have taken place; and at the general impact of such changes on the structure of the care systems.

The paper is organized in the following way. The first section describes the state of affairs in the individual countries at the beginning of the 1990s, just before major reforms were introduced in several different countries. Two fundamental care regimes will be identified which explain the developments which subsequently took place in the countries included in our analysis. The next section discusses the main drivers which led to reform and also the constraints which hindered it. The subsequent section will be dedicated to identifying the problems requiring a change: how the gaps between problem pressures and available solutions were perceived in the countries considered, preparing the stage for innovation. The following section then outlines the main thrust of the reforms introduced in the last two decades in the countries considered.

After describing the politics of LTC reform (who have been the main actors and coalitions who push for change or stability, which are their values, interests and resources), the paper will outline the institutional and political mechanisms through which change has taken place. Finally, the impacts of the reforms on potential beneficiaries and their families, as well as on workers and on the overall organization of the LTC delivery system, will be examined. The conclusion draws a general overview and interpretation of the on going reform processes.

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