August Österle

Home care in Austria: the interplay of family orientation, cash‐for‐care and migrant care

This article discusses the development of the home care sector in Austria. It analyses what impacts the interplay of the traditional family orientation to care, a universal cash-for-care scheme (reaching about 5% of the population) and a growing migrant care sector have on formal home care in Austria. The article is based on an analysis of research papers, policy documents and statistical data covering the period from the introduction of the cash-for-care scheme in 1993 up to 2011. Some authors have argued that generous cash benefits with no direct link to service use – as in the case of Austria – limit the development of home care, particularly in countries with a traditionally strong family orientation towards long-term care. Additionally, a tradition of family care and an emphasis on cash benefits may be conducive to the employment of migrant carers in private households, as a potential substitute for both family care and formal care. Despite this context, Austria has seen a substantial increase in formal home care over the past two decades. This has been driven by clients using their increased purchasing power and by policy priorities emphasising the extension of home care. Migrant care work was regularised in 2007, and the analysis suggests that while migrant care has usually worked as a substitute for other care arrangements, migrant care can also become a more integral element of care schemes. The article concludes that family orientation, unconditional cash benefits and the use of migrant carers do not necessarily preclude the development of a strong social service sector. However, there is a risk that budgetary limitations will primarily affect social service development.This article discusses the development of the home care sector in Austria. It analyses what impacts the interplay of the traditional family orientation to care, a universal cash-for-care scheme (reaching about 5% of the population) and a growing migrant care sector have on formal home care in Austria. The article is based on an analysis of research papers, policy documents and statistical data covering the period from the introduction of the cash-for-care scheme in 1993 up to 2011. Some authors have argued that generous cash benefits with no direct link to service use - as in the case of Austria - limit the development of home care, particularly in countries with a traditionally strong family orientation towards long-term care. Additionally, a tradition of family care and an emphasis on cash benefits may be conducive to the employment of migrant carers in private households, as a potential substitute for both family care and formal care. Despite this context, Austria has seen a substantial increase in formal home care over the past two decades. This has been driven by clients using their increased purchasing power and by policy priorities emphasising the extension of home care. Migrant care work was regularised in 2007, and the analysis suggests that while migrant care has usually worked as a substitute for other care arrangements, migrant care can also become a more integral element of care schemes. The article concludes that family orientation, unconditional cash benefits and the use of migrant carers do not necessarily preclude the development of a strong social service sector. However, there is a risk that budgetary limitations will primarily affect social service development.

Travelling for teeth: characteristics and perspectives of dental care tourism in Hungary

Background and aim Despite quite lively debates about dental care tourism, scientific studies into the size and the characteristics of the phenomenon remain widely lacking. The present study is the first to measure the phenomenon in one of the most prominent destination countries, Hungary, with a particular focus on the Western Hungarian region and the capital Budapest.Method A questionnaire has been sent to dentists in these regions. The response rate is 25.3% in Western Hungary and 20.7% in Budapest.Results According to the survey, patients from neighbouring countries dominate dental care tourism in the border regions of Western Hungary, while Budapest attracts more patients from countries further away. In terms of motivation, dentists regard relative price levels but also service considerations as being of major importance for patients coming to Hungary for dental care.Conclusion The study confirms Hungary as a centre for dental care tourism, attracting patients from bordering countries but also patients travelling longer distances. Price levels have been a major factor making Hungary an international treatment destination. With price differences narrowing down, broader service quality is increasingly emphasised as a selling strategy.

Migrant Care Labour: The Commodification and Redistribution of Care and Emotional Work

Many European countries are experiencing a redistribution of care work from family members to paid migrant workers in private households. This involves not only a commodification of the practical tasks of care work, but also a redistribution of the emotional element of care. This study explores the emotional experiences of migrant care workers from Central Eastern Europe providing care work in private households in Austria. Based on a literature review and qualitative interviews with migrant care workers, the article investigates the emotional dimensions of migrant care work and the ways in which the regulatory context impacts on these dimensions.

Evaluating Equity in Social Policy: A Framework for Comparative Analysis

This article proposes a framework for the systematic comparative analysis of equity in social policy design. Equity research concentrates on theories of justice, on empirical studies on equity beliefs or on testing specific equity interpretations. Less attention is paid to the range of equity objectives and how equity concerns are translated into social policy practice. This article, therefore, starts from three dimensions that constitute equity. Focusing on these dimensions — resources, recipients and principles — recognizes the complexity of equity and allows an identification and clarification of explicit and implicit equity interpretations. The approach contributes to goal-focused evaluation and helps in various evaluation approaches to investigate the range of equity concerns in social policy design. Long-term care policies are used to illustrate the concept and to discuss the potential of the approach in social policy evaluation.

Socioeconomic determinants of prescribed and non-prescribed medicine consumption in Austria.

BACKGROUND Equitable access to health care is a goal subscribed to in many European economies. But while a growing body of literature studies socioeconomic inequalities in health service use, relatively little is still known about inequalities in medicine consumption. Against this background, this study investigates the (socioeconomic) determinants of medicine use in the Austrian context. METHODS Multivariate logistic regressions were estimated based on the European Health Interview Survey, including representative information of the Austrian population above age 25 (n = 13 291) for 2006/2007. As dependent variables, we used prescribed and non-prescribed medicine consumption as well as prescribed polypharmacy. Socioeconomic status was operationalized by employment status, education and net equivalent income. Health indicators (self-assessed health, chronic conditions), demographic characteristics (age, sex) and outpatient visits were included as control variables. RESULTS Socioeconomic status revealed opposing utilization patterns: while individuals with higher education and income were more likely to consume non-prescribed medicines, the less educated were more likely to take prescribed medicines. Lower socioeconomic groups also showed a higher likelihood for prescribed polypharmacy. For the consumption of both medicine types, the main socioeconomic determinant was high income. In an additional analysis, lower socioeconomic groups were found to more likely report prescription purposes as the main reason for consulting a practitioner. CONCLUSION These results point to different behavioural responses to ill health, not least determined by institutional incentives in the Austrian health care system.

Long-Term Care Reform in Central–Eastern Europe: The Case of the Czech Republic

This chapter provides an overview of long-term care policies in CEE. The central–eastern European region has seen major social policy reforms over the past 2 decades. Yet, in contrast with major policy reform in other welfare areas, long-term care did not play any prominent role in social policy debates in CEE in the 1990s and into the 2000s. Policy debates and reform efforts toward a more comprehensive public response to long-term care needs only intensified in the new millennium. This chapter investigates the changes to long-care systems in CEE, with a particular focus on the situation in the Czech Republic, the first CEE country to see the establishment of a novel long-term care system in 2006. The analysis covers a time span of more than 2 decades, starting with the transition from communism to market-oriented democratic systems up until today. It outlines the context for long-term care reform in CEE and identifies commonalities and diversities in the development and the status quo of long-term care in this European region. Apart from describing how the long-term care system has developed over that period, the particular focus of the analysis is on identifying the drivers of reform (or nonreform), in studying the importance of key actors involved in reform processes and in analyzing the impact of the reforms.

A unifying framework of the demand for transnational medical travel.

Transnational medical travel has gained attention recently as a strategy for patients to obtain care that is higher quality, costs less, or offers improved access relative to care provided within their home countries. This article examines institutional environments in the European Union and United States that influence transnational medical travel, describes the conceptual model of demand for medical travel, and illustrates individual dimensions in the conceptual model of medical travel using a series of case studies. The conceptual model of medical travel is predicated on Andersens behavioral model of health services. Transnational medical travel is a heterogeneous phenomenon that is influenced by a number of patient-related factors and by the institutional environment in which the patient resides. While cost, access, and quality are commonly cited factors that influence a patients decision regarding where to seek care, multiple factors may simultaneously influence the decision about the destination for care, including culture, social factors, and the institutional environment. The conceptual framework addresses the patient-related factors that influence where a patient seeks care. This framework can help researchers and regulatory bodies to evaluate the opportunities and the risks of transnational medical travel and help providers and governments to develop international patient programs.

Lange Traditionen und neue Herausforderungen: Das österreichische Wohlfahrtssystem

Die europaischen Wohlfahrtsstaaten stehen vor gro\en sozialen, okonomischen und politischen Herausforderungen. osterreich stellt dabei keine Ausnahme dar. Im Hinblick auf das Ausgabenvolumen ist der osterreichische Wohlfahrtsstaat vergleichsweise gro\zugig dimensioniert. osterreich rangiert bei den Sozialausgaben als Anteil am Bruttoinlandsprodukt an sechster Stelle innerhalb der EU-25 (29,5% des BIP im Jahr 2003), in absoluten Zahlen gemessen sogar an vierter Stelle (7700 Kaufkraftparitaten pro Kopf). Neben den soziodemographischen Entwicklungen und einem veranderten polit-okonomischen Umfeld, ist nicht zuletzt dieses hohe Ausgabenniveau Ausloser und Kern vielfaltiger Debatten zur Zukunft des osterreichischen Wohlfahrtsstaates. In diesem Beitrag sollen die historischen Entwicklungen, die wesentlichen Charakteristika des osterreichischen Wohlfahrtsstaates sowie aktuelle Trends aufgezeigt und analysiert werden. Kapitel 1 widmet sich zunachst der Entstehungsgeschichte des osterreichischen Wohlfahrtsstaates, der dann im Rahmen der vergleichenden Wohlfahrtsstaatsliteratur verortet wird. Zudem wird die Rolle und Bedeutung von offentlichen und privaten Tragern in der Wohlfahrtsproduktion verdeutlicht. Nach einer kurzen Charakterisierung von aus quantitativen Informationen ablesbaren Prioritaten des osterreichischen Wohlfahrtsstaates, werden die zentralen Sozialpolitikbereiche in Kapitel 2 im Detail prasentiert. In der Folge werden in Kapitel 3 dann ausgewahlte Gestaltungsprinzipien und Ergebnisse der Wohlfahrtspolitik politikfeldubergreifend untersucht. Abschlie\end wird in Kapitel 4 ein kurzer Ausblick auf die Entwicklungsperspektiven des osterreichischen Wohlfahrtsstaates gegeben.

Three Domains of Migrant Domestic Care Work: The Interplay of Care, Employment and Migration Policies in Austria

An important feature of care regimes in many European countries is the provision of care by migrant workers in private households, be it domestic work, childcare or care for older and disabled people. However, the arrangements for migrant domestic care work and the status of workers vary largely across countries and even within countries across different care sectors. They can vary in terms of regular or irregular migration of workers, in terms of documented or undocumented employment, in terms of pay, social security coverage or living arrangements.

Long-Term Care Reform in Austria: Emergence and Development of a New Welfare State Pillar

This chapter analyses the reform developments that took place in Austria in the long-term care (LTC) sector over the last two decades. The first section provides a brief overview of the history of LTC policies (culture, values, actors, policies) and a description of the field of LTC as it has been institutionally defined in Austria. In the second section, the 1993 “cash for care” reform is presented and discussed, looking in particular at the content of the reform, at the concrete mechanisms that have facilitated institutional change, and at the coalitions of actors who have pushed for change. This is followed by an analysis of the developments after 1993, characterised by only gradual changes. In the next section, the chapter examines a new major reform, which has been introduced in the last few years, focusing exclusively on the regularization of migrant care in the private household. In studying the developments from the establishment of long-term care as a separate social policy field in 1993 up to the present, this chapter focuses on two major aspects: (1) it analyzes the aims, tools, and effects of the major reforms and gradual changes in that period; and (2) it studies the driving forces behind the changes, including the role of the various actors involved and the specific reform mechanisms. The final section provides a broad interpretation of such innovation.