Same same but different? Comparing institutional performance in the long-term care systems of Japan and South Korea

Responding to a rapidly aging population, Japan and South Korea introduced social insurance-based long-term care systems (LTCSs) in 2000 and 2008, respectively. Korea studied and took up key features of Japan's system while evolving along its own trajectory in line with its healthcare system. The aim of the present study is to unpack the broad category of ‘social insurance’ to explore how distinct system inputs and designs in Korea and Japan related to outcomes in performance measured in terms of coverage, quality of care, and sustainability. In doing so, the study serves as an important starting point for advancing a new stream of social policy research on the comparative performance of LTCSs. Our findings demonstrate that despite adopting a common system type, differences in implementation of the social insurance model (particularly in terms of financing and governance) contributed to divergent performance, with Japan outperforming Korea on most indicators during the observed period. This bears contrary implications for policymaking in the two countries: Whereas Japanese policymakers are faced with the challenge of promoting quality while containing spending, in Korea greater investment is required to strengthen the workforce and build up community care.     

Migrant Care Work Going Dutch? The Emergence of a Live‐in Migrant Care Market and the Restructuring of the Dutch Long‐term Care System

In recent years, a live‐in migrant care (LIMC) market has emerged in European countries with specific care, migration, and employment regime features. In countries with relatively low levels of formal long‐term care (LTC) provision, people in need of care and their families have started purchasing LTC directly from individual – mostly migrant – workers who live‐in with the person in need of care. Previous research has shown that this arrangement is facilitated by the availability of cash‐for‐care benefits that can be freely used by the beneficiaries, and/or by low levels of regulation of employment and migration. The Netherlands traditionally features strong, universal and generous LTC policies. However, recently, the phenomenon of LIMC has also appeared there. Based on exploratory qualitative research, this article examines the features of Dutch LIMC and the factors that foster or hinder its development. Our findings show that the ongoing restructuring of the Dutch LTC system – particularly the emphasis on informal care and decreasing accessibility of institutional care – are important factors pushing an LIMC market. At the same time, various institutional factors limit its growth, particularly the high levels of regulation of the Dutch care, migration and employment regimes. Further cutbacks in the care sector might push more families to this market in the near future, and change the character of the Dutch LTC sector. The Dutch case is relevant for other countries with longstanding traditions of generous LTC services which currently undergo retrenchment, and sheds light on routes to institutional change.     

Is Personalization the Right Plan at the Wrong Time? Re‐thinking Cash‐for‐Care in an Age of Austerity

As personalization has dominated the policy agenda for reform in social care, its roll‐out as a mainstream option has coincided with global programmes of austerity which have targeted services for disabled people. Was this simply bad timing or was its implementation always part of the agenda for reform? Whilst the principle of cash‐for‐care schemes drew strongly on promoting the independence and autonomy of disabled people, early incarnations of direct payments policy in the UK were initially at least in part rolled out in light of potential cost savings to social care budgets. This article explores these and other issues in light of evaluations of the Scottish government's self‐directed support (SDS) test sites (2009–11) and implementation of subsequent legislation enforcing models of SDS in Scotland from April 2014. Discussion draws on the authors’ recent book (Pearson et al. 2014) to reflect on what the evidence can tell us about radically transforming social care at a time of global austerity.     

Does the unification of health financing affect the distribution pattern of out‐of‐pocket health expenses in Turkey?

Turkey has implemented health reforms for over a decade and has taken significant steps toward unifying health financing. This study investigated the financial burden associated with out‐of‐pocket (OOP) expenditures under universal health coverage, using national 2003–2015 household budget data from the Turkish Statistical Institute. Progress was evaluated using Kakwani–Suits indices and Lorenz concentration curves. The results indicate that overall, more than a decade after its unification, redistribution of wealth in the Turkish health financing system has benefitted the wealthy but not the poor. Both curve and index approaches (Kakwani index 2003 = ?0.50; 2015 = ?0.44) reveal an increasingly regressive pattern of OOP health expenditures. The effective use of fiscal space and good political leadership are essential for the successful continuation of reforms to combat poverty in Turkey.     

The marketisation of education in Australia: Does investment in private schooling improve post‐school outcomes?

The distribution of school funding has been a controversial topic for decades particularly since the Australian Government introduced a new funding model for private schools in the late 1990s. Recent research shows that changes in the funding of private schools have encouraged growth in the number of private schools allowing parents with the financial means to select from an increasing range of options for their children. For this article, I conduct analyses of data from the 2003 cohort of the Longitudinal Surveys of Australian Youth project to examine differences in the outcomes of students according to the type of school attended. The results presented in this article show that students with highly educated parents were more likely than other students to attend independent schools. After controlling for the level of economic, social and cultural status of the school population, type of school attended was not associated with academic achievement, as measured by the Programme for International Student Assessment tests. Furthermore, there was no statistically significant association between type of school attended and employment status, occupation or earnings at age 24, net of level of educational attainment.     

What is a person‐centred approach? Familiarity and understanding of individualised funding amongst carers in New South Wales

Person‐centred approaches place individuals with a disability at the centre of decision making, with their carers and family invited to be partners in the process. Rather than being required to fit within existing service programs, person‐centred approaches enable individuals to choose the support options that best meet their needs. In order to facilitate this, person‐centred approaches will be accompanied by the introduction of individualised funding. This means the individual will be provided with funding to purchase services of their choosing. Given these significant changes occurring in the disability sector, Carers NSW surveyed informal carers of people with a disability to identify what they knew about person‐centred approaches and how they felt about their introduction. Survey results indicate that there is a need to increase the capacity and willingness of carers significantly in order to engage with person‐centred approaches and individualised funding. Carers require targeted and comprehensive information about these concepts in order to understand fully the changes occurring within the disability sector. These findings also indicate specific areas that need to be addressed in order to increase carers' awareness of these concepts and also to address existing negativity and confusion.     

Does It Matter if Preschool Children and Mothers Discuss Positive vs. Negative Events During Reminiscing? Links with Mother‐reported Attachment,Family Emotional Climate,and Socioemotional Development

The purpose of the study was to examine the differential relations between mother–child reminiscing about a positive emotional event vs. a negative emotional event and attachment security, family climate, and young children's socioemotional development. Fifty preschool children (M age = 50.69 months, SD = 4.64) and their mothers completed two reminiscing conversations at the laboratory, which were coded for emotion‐laden discourse, affect, and elaboration, and children completed measures of emotional understanding and representations of relationships. At their homes, mothers completed the attachment Q‐sort and the self‐report family inventory. Both attachment security and family climate were related to the quality of mother–child affect and maternal elaboration during both positive and negative reminiscing conversations. Attachment security and family climate, however, were principally related to discussion of emotion during the negative event discussions. In addition, it was mother–child reminiscing about the negative emotional event that was associated with high levels of children's socioemotional development.