Emmanuele Pavolini

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.

‘Social Investment’ or Back to ‘Familism’: The Impact of the Economic Crisis on Family and Care Policies in Italy and Spain

Family policies have traditionally been weak in Southern Europe. In the last two decades, however, and following a ‘catching up’ course, Spain has created new family programmes and expanded existing ones. Meanwhile, the picture for Italy during the years preceding the crisis is more of a ‘frozen landscape’. However, the diverging paths of the two countries in terms of policy reform in the years preceding the crisis do not place them in substantially different positions. The economic crisis and the austerity measures that followed have aggravated the weaknesses of family and care policies in both countries.

Is decentralization good for your health? Transformations in the Italian NHS

Decentralization is a cornerstone of health policy reforms across Europe and beyond. This article analyses some of the effects of decentralization using the Italian National Health System (NHS) as a case study. The authors evaluate the risks of welfare state retrenchment and the rise of territorial inequalities in accessing healthcare, using document analysis, secondary sources and micro-data elaboration. The analysis does not confirm an overall welfare state retrenchment, but reveals an increase in territorial inequalities. The results highlight a paradox: if decentralization is to be implemented in a country with strong territorial socioeconomic divides and a critical financial situation, it needs a strong central government in order to support and control local authorities. Otherwise, decentralization may cause a zero-sum game where the gains for the better-off regions counterbalance the losses in performance of the weaker ones; a situation which could lead to the growth of social inequalities, including gender inequalities.

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.

South European Healthcare Systems under Harsh Austerity: A Progress–Regression Mix?

This article addresses the question of whether the economic crisis provides a politically opportune time to drastically curtail public healthcare in South Europe or whether, instead, there are signs of longer-term reform strategies for potentially balancing fiscal targets with the quest for enhanced value and health outcomes, when eventually growth resumes. After a brief examination of the profile of healthcare systems in Greece, Italy, Portugal and Spain prior to the crisis, we comparatively assess the mix of retrenchment, restructuring and recalibration strategies. The effects of the austerity-driven reforms on current (and expected) health outcomes are also briefly analysed. We conclude with reflections on the future of public healthcare in South Europe.

Welfare Rescaling in Italy and Spain: Political Strategies to Deal with Harsh Austerity:

By looking at the main welfare state reforms undertaken by the Italian and Spanish governments since the outbreak of the financial crisis, this article explores changes resulting from the implementation of austerity policies. In light of the way in which unpopular fiscal adjustment measures have been introduced in both countries, especially since 2010, we call for a revision of the existing literature on welfare retrenchment and political strategies. We argue in this article that under conditions of ‘permanent strain’, bold retrenchment policies and cuts in social spending have been justified by the Italian and Spanish governments through a ‘there is no alternative’ or TINA legitimation strategy, which creates limited interaction space between social and political actors. We tentatively conclude that this political strategy does not entirely fit the notions of blame avoidance or credit claiming as currently formulated in the specialist literature. We call for further empirical testing of the arguments made in this paper.

Decentralisation at a Time of Harsh Austerity: Multilevel Governance and the Welfare State in Spain and Italy Facing the Crisis

Decentralisation was one of the most relevant trends in the institutional development of the Spanish and Italian welfare states up to the onset of the economic crisis. The present article tries to answer two questions. How have central government – subnational government relationships and models of welfare governance evolved? What has happened to territorial inequalities in access to welfare state provision before and after the onset of the crisis and the introduction of austerity policies?. Before the crisis, territorial differences in the operation of the welfare state across regions were more pronounced and intense in Italy than in Spain. With the onset of the crisis and austerity, the differences between territorial clusters in Spain have remained relatively stable or have decreased, whereas in Italy they have often increased. In both cases, regional governments have, in recent years, been more dependent on central government. In fact, to receive support or extra funding, regional governments have accepted the conditions imposed by central government. Sub-national governments have been forced to accept significant cuts and greater control or supervision of their budgets. As the largest part of the regional budget is spent on social policies, regional welfare systems have inevitably been affected both in scope and in the way in which decisions are made.

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).

Female employment and elderly care: the role of care policies and culture in 21 European countries

To what extent and in what ways do welfare state policies and cultural values affect the employment patterns of mid-life women with care responsibilities toward a frail parent? The study draws on Eurobarometer micro-data integrated with country-level information to respond to this question. Performing a multilevel analysis across 21 European countries, it considers macro factors that influence the decisions of mid-life women to give up or reduce paid work in order to care for a frail elderly parent. The results show that, while the overall level of expenditure on long-term care is not influential, settings characterized by limited formal care services, and strong norms with regard to intergenerational obligations, have a negative impact on women’s attachment to the labour market. Policies and cultural factors also influence the extent to which women are polarized: in more defamilialized countries, regardless of their level of education, female carers rarely reduce their level of employment.