‘Replacement Care’ for Working Carers? A Longitudinal Study in England, 2013–15

In the context of rising need for long‐term care, reconciling unpaid care and carers’ employment is becoming an important social issue. In England, there is increasing policy emphasis on paid services for the person cared for, sometimes known as ‘replacement care’, to support working carers. Previous research has found an association between ‘replacement care’ and carers’ employment. However, more information is needed on potential causal connections between services and carers’ employment. This mixed methods study draws on new longitudinal data to examine service receipt and carers’ employment in England. Data were collected from carers who were employed in the public sector, using self‐completion questionnaires in 2013 and 2015, and qualitative interviews were conducted with a sub‐sample of respondents to the 2015 questionnaire. We find that, where the person cared for did not receive at least one ‘key service’ (home care, personal assistant, day care, meals, short‐term breaks), the carer was subsequently more likely to leave employment because of caring, suggesting that the absence of services contributed to the carer leaving work. In the interviews, carers identified specific ways in which services helped them to remain in employment. We conclude that, if a policy objective is to reduce the number of carers leaving employment because of caring, there needs to be greater access to publicly‐funded services for disabled and older people who are looked after by unpaid carers.     

Explaining subnational variations in early childhood education and care. A fuzzy‐set analysis of the Italian case

Although cross‐country differences in the development of early childhood education and care (ECEC) services have been widely researched, the pronounced subnational variation that characterizes many countries is little researched. This article aims to contribute filling this gap by investigating the factors underlying ECEC development in Italian regions, where take‐up rates of public and subsidized daycare centers, behind a national average of 12%, range from 2% in some Southern regions to 25% in Emilia Romagna (North‐East). The article explores the configurations of economic, socio‐demographic, political, institutional, and cultural factors possibly responsible for high and low ECEC development through Fuzzy‐set/Qualitative Comparative Analysis. Results show that economic development and female employment are necessary but not sufficient conditions for ECEC development; similarly, familistic values, the lack of early ECEC development and of social capital are necessary but not sufficient conditions for limited expansion. The analysis identifies multifaceted patterns of (non)expansion, thus demonstrating the complexity of social policy development processes and preventing determinism based on need, cultural, or economic factors.     

An Enhanced Macroeconomic Approach to Long-Range Projections of Health Care and Social Security Expenditures as a Share of GDP

An enhanced two-sector economic growth model is created to project health care and Social Security expenditures as a share of GDP in the United States. Parameters used in the economic simulation model are based largely on consensus views in the literature. The main advantages of an economic model over the more commonly used actuarial models are: (1) explicit specification of underlying fundamental structures, (2) ability to investigate relationships in the entire economy, and (3) a fuller scope provided for policy analysis. Under the base model assumptions, that is, a continuation of current conditions for the production of, demand for, and financing of health care services, the economic model projects that the health care sector consumes 15.8 percent of national output by the year 2000 and 27.1 percent by the year 2040. The annual rate of increase in per capita consumption (less health spending) (“adjusted consumption”) falls from 1 percent in 2000 to 0.6 percent in 2025, and then increases to 0.8 percent in 2040, as the rate of increase in spending on health care for the elderly, and the capital investment required to support such spending, flow and ebb with the passing of the baby boom generation. Over the whole projection horizon, government spending on the health care of the elderly increases from a projected 3.8 percent of GDP in 2000 to 9.2 percent in 2040. Social Security expenditures for the elderly are projected to increase from 3.9 percent to 6.3 percent over the same period. More widespread HMO coverage is shown to lead to some small improvements in adjusted consumption. Over the long horizon, improved efficiency and productivity in the health sector and lower Social Security benefits assumed to cause an increased rate of savings and investment, however, actually cause the rate of growth in health spending to increase and adjusted consumption to decline, ceteris paribus. By contrast, an increase in sensitivity to health care prices leads to dramatically improved results, both in higher adjusted consumption and better finances for government programs of health care for the elderly.     

Return of the Nanny: Public Policy towards In‐home Childcare in the UK,Canada and Australia

Research on early childhood education and care (ECEC) policy focuses overwhelmingly on formal, centre‐based provision and, to a lesser extent, on family day care (or childminding) provided in the homes of registered carers. Comparatively little research addresses the policy treatment of care provided in the child's home by nannies and au pairs. This article examines the position of in‐home childcare in Australia, the UK and Canada, and the varied nature and extent of public funding and regulation. Introducing a new dimension into comparative studies of ECEC, it also explores how shifts in migration policy in each country have intersected with ECEC funding and regulation to reshape the recruitment and employment of in‐home child carers. Australia, the UK and Canada are all liberal, market‐oriented countries, but there is considerable diversity in the way governments support and regulate in‐home childcare, their rationales for so doing, and in the connections between childcare and migration. We argue that connecting the analysis of in‐home childcare to migration policies raises new questions about the classification and comparison of ECEC policies.     

Can we declare military Keynesianism dead?

This paper empirically tests the Keynesian hypothesis that government defence spending positively impacts on aggregate output, by using a long-run equilibrium model for the US and the UK.Our contribution, with respect to previous works, is twofold. First, our inferences are adjusted for structural breaks exhibited by the data concerning fiscal and monetary variables. Second, we take into account different dynamics between defence spending on aggregate output, showing that the results are sensitive to sub-sample choices. Though the estimated elasticities in both countries show a lack of significance in the more recent years of the sample, defence-spending priorities addressed to international security may revitalize pro-cyclical effects in the UK, by an industrial policy of defence shared with the EU members.     

An Agenda for Social Security in the Years Ahead

This paper focuses on recent debates on social welfare spending in Australia, and on social security in particular. Its starting point is the current economic climate and the perceived imperative for continued fiscal restraint. Its central argument is that the welfare debate must be placed firmly in the context of the role of the public sector as a whole. In the social welfare context, government interventions through direct expenditures and tax expenditures must be assessed together, along with the impact of the tax structure on revenue raising potential. The paper questions the virtue of increased reliance on selectivity and presents the case for a more universalist approach.     

Empirical Analysis of Fiscal Soundness and Public Social Expenditure: A Lesson for the Future Direction of the Korean Welfare State

The aim of this paper is to investigate the relations between fiscal soundness and public social expenditure in advanced welfare states so as to reconsider the conventional wisdom that welfare expenditure aggravates national finances. Through this, I propose the clues of building the sustainable Korean welfare state. I focus on the interdependent relationship between fiscal soundness and public social expenditure based on fiscal sociology. Considering this interaction, I form two sets of simultaneous equations models and employ a special statistical method, three‐stage least squares (3SLS). The results regarding the causal relationship between fiscal soundness and public social spending indicate that, if public welfare spending is increased, fiscal health is damaged. However, as many comparative social policy researchers have pointed out, outcomes of welfare states differ from country to country according to the composition of public welfare spending. Specifically, some welfare states with priority given to social services such as vocational training or childcare services have maintained the stability of public finance. By extension, we can say that public social expenditures have a positive influence on fiscal soundness based on the composition of social expenditures. Finally, it is possible to create financially sustainable welfare states.     

Reducing unemployment? Examining the interplay between active labour market policies

Active labour market policies (ALMP) are important tools that welfare states utilize to influence the labour market. This study analyses the macroeconomic effects of different types of ALMP spending on aggregate unemployment rates, and especially if there is evidence of interdependencies between policies. The types of policies scrutinized are public employment services (PES), training programs, public job creation and subsidized employment, where the PES is singled out as a crucial factor that moderates the effects of other types of labour market programs. The study examines 19 welfare states between 1985 and 2013, using error correction modelling to separate between short‐ and long‐term effects. The results indicate that PES, training and subsidized employment reduce unemployment in the short‐run, whereas PES and wage subsidies are associated with reduced unemployment when considering long‐term effects. However, PES is found to have indirect effects on other policy types and increased spending on PES is shown to reinforce long‐term effects of training programs.     

Trade in services: Impact on employment in India

India's services sector has been growing rapidly and so also the trade in services. This paper attempts to assess if trade is able to generate employment in the services sector. Based on the time series macro data the direct and indirect effects of exports and imports on employment after deciphering their effects included in the overall growth, are seen to be mostly negligible. This holds both in the case of formal and informal services. Also, as per the company-level data international trade is not found to be an important determinant of employment in the services sector. On the whole, trade in services sector may enhance growth but this pattern of growth is less likely to be inclusive. Finally, the paper brings out the policy implications.     

Accommodation for Elderly People With Special Needs: 1971–1981

The first five years of the decade under review was marked by an expansion in the provision of public sector residential care for the elderly, spurred on by the government's guidelines for a growth in capital spending. After 1973 attention focused on ideas concerning welfare pluralism and the forms it might take. Any major restructuring would include two major factors: an examination by the state of priorities on provision of professional and technical skills, a clarification of the goals of those services on offer and an assessment of changes in the circumstances of clients and the character of services. A regulatory jole would require tapping in resources in the voluntary and private sectors and taking adequate care on responsibility and public accountability, monitoring procedures and evaluating results.     

Getting low educated and older people into work: The role of fiscal policy

Raising employment, in particular employment among older individuals and low educated individuals, stands high on the agenda of policy makers in many OECD countries. Increased sensitivity in recent years to rising inequality has made the challenge only larger. In this paper we evaluate alternative fiscal policy scenarios to face this challenge. We construct and use an overlapping generations model for an open economy where individuals differ not only by age, but also by innate ability and human capital. The model allows us to study effects on aggregate employment, per capita income and welfare, as well as effects for specific age and ability groups. We show that well-considered fiscal policy changes can significantly improve macroeconomic productive efficiency, without increasing intergenerational or intragenerational welfare inequality. Our results strongly prefer a reduction in the labor tax rate on older workers and on all low-wage earners, financed by an overall reduction in non-employment benefits. An alternative financing option is to raise the consumption tax rate. These results are to be seen as long-run effects for economies at potential output.     

Center‐Based Early Childhood Education and Care in China: Policies,Trends, and Implications

The development of early childhood education and care (ECEC) policies and programs in China has been closely intertwined with social, economic, and demographic changes. This article systematically reviews center‐based ECEC policies and programs in China and presents the major trends and implications for future research and policy. The focus of China’s ECEC policy has shifted from health and custodial care to nurturing and child‐centered education since the economic reforms and the one‐child policy were launched in the late 1970s. Empirical data show that the costs of ECEC services have been continuously increasing. Both the number of children enrolled and the overall enrolment rates have declined during the late 1990s but they have increased slightly since 2001. The ECEC programs vary substantially in every regard by urban or rural residence, type of organization, and region. The quality of center‐based ECEC programs in China is still quite low, indicated by their high child–teacher ratios and low levels of education among principals and teachers relative to developed countries. Children living in rural areas or less developed regions and those from low‐income families suffer from fewer resources and lower quality ECEC as compared to their peers. These problems must be addressed by future policy interventions.     

Free,free, set them free? Are programmes effective that allow job centres considerable freedom to choose the exact design?

Active labour market programmes are expected to be quite effective if job centres have a substantial degree of freedom to deliver tailor‐made individual services. For Germany, we studied the effectiveness of Schemes for Activation and Integration (SAI), which were introduced in 2009 to grant such freedoms to implement short training and private placement services. We estimated SAI participation effects on welfare recipients’ earnings and employment rate using propensity score matching and rich administrative data. We distinguished between participation in in‐firm training or training in other settings, and considered effect heterogeneity by gender, region and non‐employment duration. Participation substantially improved the participants’ earnings and employment rate, in‐firm training more so than training in other settings. Our employment effect estimates were not considerably larger than those previously found for comparable pre‐reform programmes. A lack of experience with SAI and a still inadequate client focus in the period studied might explain this.     

After the tax revolt: Why Medicare matters more to middle Australia than lower taxes

The Australian Survey of Social Attitudes 2003 gives new insights into the public's increasing preference for more social spending and their willingness to pay more taxes to fund services. This paper profiles the new electorate and discusses factors driving this trend in public opinion. Multivariate analysis allows us to identify the key demographic, political and policy variables that predict support for spending. All the usual factors matter: being older and more educated, and identifying as Labor, Green or Democrat all predict support for higher spending. But we find that policy perceptions matter as well: believing that health and Medicare and/or public education have declined in the past two years brings major support for increased spending. We also find that the Australian public supports modest tax increases to fund spending on health and education and that the Australian electorate is more open minded about tax rises than conventional wisdom holds. Our main conclusions are that support for social spending over reduced taxes has increased over the past two decades, and especially after the election of the Howard Government, and that dissatisfaction with health and Medicare, and public education, are reshaping the fiscal preferences of the Australian electorate.     

A Bourdieusian analysis of employment services workers in an era of Workfirst

This article draws on qualitative research which focused on worker experiences of Workfirst activation during the Job Services Australia (JSA) contract of employment services. The Workfirst orientation of Australian labour market programmes created imperatives for activation workers to monitor job seeker compliance with activity tests. As part of the broader cohort interviewed in the study, activation workers were interviewed about the way sanctions were used to discipline job seekers in street‐level exchanges. These workers had experienced the transition from the Job Network to JSA and had observed how a shift to Workfirst became institutionalised in organisational practices and culture. Concepts from Bourdieu's field theory are used to situate activation workers in the employment services field that became more managerial during the transition to Workfirst and where sanction‐based practice was mainstreamed. Drawing also on Peillon's sociology of welfare, employment services are described as part of the welfare field in which the activation workers experienced the misrecognition associated with Workfirst, which is described as a structure of domination. The analysis employs the concept of intersubjective recognition to draw attention to the subjective and objective co‐construction of street‐level interactions. This study has implications for understanding how welfare reforms affect activation workers, the contributors to the erosion of employment services capability, and the need for investment in workforce development in the employment services sector.     

Stabilise,balance and adjust—Framing the early years transitions of children whose parents work non-standard hours

This study examined talk by parents about the early years transitions of their children (n = 7) in the context of parental non-standard working hours and Finnish early childhood education and care (ECEC) services. Parents were interviewed at three time points: when their child was aged one, four, five or six years (a total of 21 interviews). The third interview was conducted during the COVID-19 pandemic. This article focuses on the children's ECEC transitions and the interpretative frames used by parents when talking about their work and childcare. The frames used by the parents to discuss the children's transitions were stabilising the children's lives, balancing between staying at home and attending ECEC and adjusting to norms and rules. The diversity of families' experiences and their children's transitions during the early years should be considered when developing family policy and ECEC services.     

The government spending multiplier: Evidence from county level data

The passage of the American Recovery and Reinvestment Act (ARRA) of 2009 has brought fiscal policy to the forefront once again. The size of the “multiplier” of government spending becomes of critical importance for determining the effect of stimulus programs. Yet there is considerable controversy about this issue. This study adds to the discussion on the size of the multiplier by using earnings data by county. This allows the creation of a panel data that includes 3141 counties for the time period 2001–2012. We estimate the federal government spending multiplier to be approximate 1.5. Our estimate for state and local spending multipliers are considerably smaller. Our results have implication for policy in that federal programs will be more effective for stabilization county economies than state or local spending.     

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.     

Choices, Policy Logics and Problems in the Design of Long–term Care Systems

Establishing a public, comprehensive, independent, mainly community–based long–term care system, separate from medical care and social services, can lead to the provision of more effective and consumer–oriented services, and also to a more appropriate mix of public/private financing. Of the two main approaches to financing long–term care (LTC), a tax–based model is more flexible in providing benefits according to the individual's need, since income levels and the family's ability to provide care will be taken into consideration, while a social insurance model is more rigid because the individual's rights are more explicitly defined. The latter system is likely to provide more opportunities for choice, including decisions about the mix of health and social services. Policy–makers must decide which approach to take after weighing the positive and negative aspects of each, and the existing organizational infrastructure. Decisions must also be made on the practical issues of coverage, fairness, form of benefits, service delivery patterns, relationship with medical and social services, and controlling costs. With increasing pressure to contain public sector expenditures and improve efficiency, the focus of care will gradually shift from medical care to LTC, and within LTC, from institutions to housing. How to make this process proactive and planned, instead of ad hoc and reactive, is the challenge for public policy.     

Links between social environment and health care utilization and costs

The social environment influences health outcomes for older adults and could be an important target for interventions to reduce costly medical care. We sought to understand which elements of the social environment distinguish communities that achieve lower health care utilization and costs from communities that experience higher health care utilization and costs for older adults with complex needs. We used a sequential explanatory mixed methods approach. We classified community performance based on three outcomes: rate of hospitalizations for ambulatory care sensitive conditions, all-cause risk-standardized hospital readmission rates, and Medicare spending per beneficiary. We conducted in-depth interviews with key informants (N = 245) from organizations providing health or social services. Higher performing communities were distinguished by several aspects of social environment, and these features were lacking in lower performing communities: 1) strong informal support networks; 2) partnerships between faith-based organizations and health care and social service organizations; and 3) grassroots organizing and advocacy efforts. Higher performing communities share similar social environmental features that complement the work of health care and social service organizations. Many of the supportive features and programs identified in the higher performing communities were developed locally and with limited governmental funding, providing opportunities for improvement.