Costanzo Ranci

Restructuring the welfare state: reforms in long-term care in Western European countries

Faced with the problems associated with an ageing society, many European countries have adopted innovative policies to achieve a better balance between the need to expand social care and the imperative to curb public spending. Although embedded within peculiar national traditions, these new policies share some characteristics: (a) a tendency to combine monetary transfers to families with the provision of in-kind services; (b) the establishment of a new social care market based on competition; (c) the empowerment of users through their increased purchasing power; and (d) the introduction of funding measures intended to foster care-giving through family networks. This article presents the most significant reforms recently introduced in six European countries (France, Germany, Italy, the Netherlands, Sweden and the UK) as regards long-term care. It analyses their impact at the macro- (institutional and quantitative), meso- (service delivery structures) and micro-level (families, caregivers and people in need). As a result the authors find a general trend towards convergence in social care among the countries, and the emergence of a new type of government regulation designed to restructure rather than to reduce welfare programmes.

Long-Term Care Systems in Comparative Perspective: Care Needs, Informal and Formal Coverage, and Social Impacts in European Countries

This chapter provides an overview of long term care (LTC) policies in Europe and other OECD countries in order to contextualize the findings presented in the other chapters of the book. While the individual country case studies outlined in subsequent chapters offer detailed accounts of LTC policies in various countries throughout Europe, this chapter develops a broad framework based on comparative statistical data, which in turn sets out the general background to transformations that have taken place in recent years with respect to both the demand for and the institutional responses to LTC. This chapter is organized around four themes central to the organization of LTC in Europe: the characteristics and the changing demands of LTC recipients; the organization of informal care; the organization of public (statutory) support; and the impacts of the various “care regimes” on users and their informal carers.

The third sector in welfare policies in Italy: the contradictions of a protected market

The paper describes how the involvement of non-profit organisations (NPOs) in welfare politics in Italy has historically developed in a mutual accommodation with the state, which has prevented the growth and the public recognition of an independent third sector. Using data from official statistics and recent research on non-profits, three analytical dimensions of the relationship between State and the third sector are considered: the resource exchange; the division of responsibility for delivering public services; and the dynamics of social policy making. The study indicates that distinctive features of the ‘welfare mix’ in Italy have been: the attribution of public status to many NPOs as a consequence of an arrangement between Church and state; the weakness of state guidance, in spite of the generous economic assistance provided to NPOs by the state; the substitutive role of NPOs in providing basic public services; and the emergence of informal arrangements between public authorities and NPOs mediated by political patronage.

Not all that glitters is gold: Long-term care reforms in the last two decades in Europe

This article explores changes that took place in long-term care (LTC) policies during the last two decades in six European welfare states. In this regard, it addresses three issues: (1) why reforms took place, (2) the main actors and coalitions driving this process and the institutional mechanisms at work and (3) the main outcomes of reform processes. In order to analyse the development of LTC policies, the article applies theoretical concepts of historical institutionalism. Our interpretation is that institutional change in LTC policy has taken place through a protracted institutional dynamic in which continuity and discontinuity are inextricably linked and where tensions and contradictions have played a crucial role. With regard to outcomes, the article analyses coverage and citizens’ social rights, working conditions in the care sector and trajectories of de-/re-familization of care. The final impact is that the level of universalism has generally increased in Europe, but that in part it has adopted a new form of ‘restricted universalism’, characterized by universal entitlements to LTC benefits constrained by limitations in provision due to financial constraints and budget ceilings.

The New Partnership: The Changing Relationship between State and the Third Sector in the Scenario of New Social Policies in Italy

The second half of the 1980s and the 1990s will be remembered in Italy as the period in which privatization assumed increasingly significant proportions as the dominant political strategy in the field of welfare policies (Pasquinelli, 1993). The move towards privatization has been drastic and generalized. It has radically reversed the tendency to extend government intervention that had characterized the growth of the Italian welfare system since the end of the World War II. Until the 1970s, politicians had not only acquiesced to the expansion of welfare spending but had encouraged it. Nevertheless, during the last decade the worsening of fiscal problems and growing political instability (the result of scandals caused by investigations into political corruption) weakened the social consensus surrounding the welfare state and gave room to proposals for radical change (Borzaga et al., 1996).

Institutional Change in Long-Term Care: Actors, Mechanisms and Impacts

This final chapter summarizes the main results of the national case studies and gives a general interpretation of the changes taking place in the long term care sector over the last 20 years in Europe. The discussion addresses all the theoretical and empirical questions which were introduced in the introductory chapter. More specifically, the chapter focuses on two general issues. The first relates to the mechanisms and institutional processes through which change has been made possible, notwithstanding financial pressures and strong institutional resistance against innovation. The form of change is analyzed by referring to recent theories of institutional change stressing also the relevance of incremental and implicit innovation. The role played by the main actors, both social and political, is also reviewed. Moreover, a comparative analysis is carried out in order to see if the most common typologies concerning care regimes can be satisfactorily used to better understand the main differences between the European countries considered in this book. The second issue concerns the general impact of the reform of long term care on potential beneficiaries and their families, as well as on workers and on the overall organization of the LTC delivery system. Finally, the conclusion offers a general overview and interpretation of the ongoing reform processes.

Long-term and Child Care Policies in Italy between Familism and Privatisation

Italy is unanimously considered a familistic country, where informal caregiving provided by household members is higher than in most other European countries (Chiatti et al., 2013). Welfare policy has long implicitly supported family networks in providing the most vulnerable people with care and services, with comparatively low public provision (Saraceno, 1994). This model has come under strain since recent demographic and social trends have increased the demand for greater provision of care services both for dependent people and young children. On one side, the ageing of population1 and the growth in the absolute number of dependent people, and especially of the heavily dependent, which increased by 35 per cent between 1994 and 2005 (Pavolini and Ranci, 2008), have made the care needs of families grow. On the other side, the increased propensity of women to participate to the labour market,2 together with rising retirement age, have radically changed the capacity of households to care for their dependent members. The combination of socio-demographic trends and of the restructuring of Italian families has thus provoked a growth of care needs. Faced with these challenges, the Italian care system did not see any radical change in the last two decades. Whereas other latecomer European countries have introduced relevant reforms in public care policies, institutional inertia has been the main characteristic in Italy (Costa, 2012; Da Roit and Sabatinelli, 2013; Ranci and Pavolini, 2012).

Reforms in Long-Term Care Policies in Europe: An Introduction

Long-term care (LTC) is one of the most rapidly developing policy areas in Europe, where significant institutional change and innovation have taken place over the last two decades throughout the continent. In contrast to mainstream policy fields (e.g., pensions, labor market policies, and health care), where attempts to reduce public intervention has been the most common trend (Castles, The Future of the Welfare State: Crisis Myths and Crisis Realities, 2004, Policy and Politics, 33(3), 411–430, 2005; Korpi and Palme, American Political Science Review, 97(3), 425–446, 2003; Pierson, The New Politics of the Welfare State, 2001), LTC has seen a broader scope of transformations, ranging from retrenchment and cost containment to a growth in public financing and an expansion of coverage. In many European countries, LTC policies over the last two decades have been characterized by a recognition of social rights on the one hand and yet increasing social responsibilities on the other (Morel, The Politics of Post-Industrial Welfare States, 2006). This book is aimed at describing these general trends, identifying the factors, which explain these broad developments, highlighting both the main differences between European countries and outlining the main consequences of the various policy developments that have taken place.

Is every country fit for social investment? Italy as an adverse case

The scientific debate on social investment (SI) is moving from an ideological and normative approach towards a more realistic one. Scholars are paying closer attention to the actual developments in social policy and to the contextual conditions and impacts of SI policies. Considering this, two main issues arise. First, that SI policies are politically feasible and likely to have positive impacts only if specific contextual conditions are met. Second, SI policies were supposed to have a positive impact on both inequalities and economic growth: a strong theoretical assumption that needs to be carefully tested. The Italian case will be used here to illustrate this new perspective and the consequences of the lack of contextual pre-conditions. For this reason, the article is divided into three parts. The first part will present our theoretical argument in the context of the most recent analytical accounts of SI policy in Europe. In particular we will argue that, given the lack of crucial structural pre-conditions, SI policies may have ambiguous and even unexpected negative impacts on both economic growth and equal opportunities. In the second and third parts, we will present empirical evidence of this ambiguity considering childcare and apprenticeship reforms in Italy. More specifically, based on empirical research carried out in Italy, we want to answer two questions: (1) Why is the Italian welfare state so ‘unfriendly’ to SI policies? What are the main factors explaining the limited room for SI policies? (2) When an SI approach is promoted in specific policy areas in Italy, what is its social and economic impact? Do these interventions achieve the positive results to be expected according to the SI approach? Finally, the last part synthesises the main arguments and aims to open a critical discussion on the structural pre-conditions of SI policies and the need for further analysis of the political economy contexts in which SI policy develops.

Legitimising the care market: the social recognition of migrant care workers in Italy

The sizeable presence of migrant care workers in the private care market in many European countries is confirmed by several studies that have explained the phenomenon through functional arguments, stressing the economic convenience of transnational markets and the crucial role played by public regulation. This paper focuses instead on the public and institutional discourses that have contributed to legitimising this private care market, characterised by the worsening of employment conditions and the decrease in care quality. The main argument of this paper is that the social recognition of these workers provides the public with the new concepts and rationales that determine the actual shape of the private care market. Migrant care workers are usually, compared to other migrant workers, more welcome in the host society and less targeted by xenophobic attitudes, especially where their labour helps to meet a lack of public provision as is happening in Southern European countries. Nevertheless, their rights are not fully granted either as citizens or as workers: basic requirements in this migrant care market include for instance reduced wages, great flexibility, and informal contracts. Our hypothesis is tested through the reconstruction of the public regulation and a content analysis of the public discourse that has accompanied this regulation for ten years (2002–2012) in Italy. The two main national newspapers have been taken into account. This analysis provides evidence on how market dynamics have been shaped by a deliberate political construction, which has relieved governments of the task of finding a public solution to care needs and has relegated migrant care workers to a subordinate social position, which is functional in making the care market work.