Beyond benevolence – solidarity and welfare state transition in Sweden

For many decades the Swedish welfare system has served as an archetype of the modern comprehensive welfare state. When economic recession hit Sweden in the beginning of the 1990s, a period of half a century of continuous expansion and reforms in the welfare sector came to an end. The economic downturn enforced rationing measures in most welfare programs and was accompanied by a move towards privatisation of local welfare services and an endeavour to initiate market incentives in the care-giving systems. The focus was increasingly directed on welfare as a financial burden, and the issue of how diminishing resources should be allocated ranked high on the political agenda. In this article we depart from the concept of solidarity and discuss the development of Swedish welfare and welfare opinion. First, we articulate various representations of the concept of solidarity – societal cohesion, individual support for comprehensive welfare and the amount of universality in the provision of care. Second, we describe some fundamental traits in the route taken by Swedish welfare during the 1990s, focusing especially on care of elderly and the demographic challenge of an ageing population. Third, we summarise the evolution of public opinion regarding welfare provision and discuss the determinants of its variations. The article concludes with a discussion of how the (once salient) features of universalism have been affected by the development during the past decade, and the role of popular support in the route ahead for Swedish welfare.     

Ageing and Family Dependency

The ‘graying’ of Australia's population has generated much debate within government, demographic, health and social service circles in recent times. Current and projected shifts in population structure towards greater numbers of ‘dependent’ populations raise a number of complex issues in regard to resource allocation in both income support and service provision. Service issues revolve around questions of whether public or private provision will resolve the care issues for dependent elderly people. It is argued that contrary to popular opinion, family care is well entrenched within the framework of social care, and that the solution of community care, posited in relation to the rising levels of chronic illness and dependency within the elderly population, is actually an attempt to place more responsibility of care on to the family. It is further suggested that family care is, in fact, care by women who themselves are in a state of dependency. Citing evidence from a study conducted by the authors, the paper argues that family care imposes heavy burdens upon women and families and suggests that social policy should, firstly, actively bolster family care through the provision of supportive and supplementary services; and secondly, broaden its intent by exploring other options of care for elderly people. The latter response is important because without it, family care will only help to reinforce and sustain the dependent status of women.     

A Comparative Case Study of Care Systems for Frail Elderly People: Germany, Spain, France, Italy, United Kingdom and Sweden

Comparative studies of European social policies towards frail elderly people typically focus on the systems and their implementation. The study presented in this article, conducted in 2001 in six European countries (Germany, Spain, Italy, France, the United Kingdom and Sweden) aims at comparing the rights of the individuals within the different care systems. The methodology used is a case study approach, which draws on a series of situations of dependent elderly people. Therefore, the analysis focuses on the public authorities’ responses – the care packages, which determine the type of care required and the financial contribution of the user – in each of the six countries, in relation to the concrete situations of frail elderly people. As local variations are important, in all the countries studied, local authorities have been chosen in each of the countries. This approach gives us interesting concrete elements on the services and financial help which can be given to frail elderly people, but it also enables us to understand precisely the national care systems organized in the different countries and the main difficulties encountered by public authorities in facing this problem of frail elderly people.     

Compulsory intergenerational family solidarity shaping choices between work and care: Perceptions of informal female carers and local policymakers in Estonia

Estonians are obliged by law to provide maintenance for family members who are unable to cope by themselves. As a result, 80% of fragile older people receive informal care. Whether this is because the carers themselves feel solidarity and choose informal caring or because they lack alternatives is the question. We applied the cultural approach for explaining the construction of compulsory family solidarity in care provision to older people through the perceptions of informal carers and policy actors. Our interest is in how filial norms framed by individual responsibilities of care provision required by law can influence (i) informal carers’ perceptions concerning their choices between work and care and (ii) impact policy actors’ perceptions concerning eldercare service provision. Analysing the empirical data produced during focus groups with female carers and interviews with policy actors, we demonstrate the triple‐fold pressure to informal caregiving as an expression of compulsory family solidarity. Key Practitioner Message: ? The article demonstrates how the national Family Law Act constitutes a compulsory requirement of family solidarity in society; ? The compulsory family solidarity norm influences local‐level policymaking and inhibits the development of formal care services for older people; ? Informal carers’ choices between work and care are shaped by their personal filial norms, familialistic policymaking, and pressure exerted by older people.     

Breaking the mould: new trajectories in the domiciliary care of older people in Ireland

This article reviews the development of domiciliary care services for older people in Ireland over the last decade. It reveals three central developments, namely (i) the first steps, in the Irish context, towards a quasi-market; (ii) the introduction of cash-for-care and the subsequent notable segmentation of care tasks among three provider groups; and (iii) a rapidly increasing reliance on for-profit private home care providers. The authors conclude that while the Irish social care regime is still anchored in important ways in the primacy of informal (family) care and the subsidiarity principle, it has broken path-dependency by evolving towards an increasingly complex mix of public, not-for-profit and for-profit provision and financing. The most policy-relevant aspect of this new constellation is the lack of a regulatory framework that would enable the State to monitor the multiple and diverse providers with the view to ensuring the quality of home care services.     

Class politics in the sandbox? An analysis of the socio‐economic determinants of preferences towards public spending and parental fees for childcare

This article analyses the socio‐economic determinants of public preferences towards public spending and parental fees for childcare and how they are conditioned by institutional contexts. Previous studies of childcare policy preferences have focused on attitudes regarding the provision of care. However, when it comes to questions of financing, we know astonishingly little about how supportive individuals actually are of expanding pre‐school early childhood education and care, and how support varies across different socio‐economic groups in society. This is an important research gap because childcare provision and how it is financed have redistributive implications, which vary depending on the institutional design of childcare policy. Using novel and unique survey data on childcare preferences from eight European countries, we argue and show that preferences towards expanding childcare are more contested than it is often assumed. The institutional structure of childcare shapes how income matters for preferences towards how much should be spent and how provision should be financed. Where access to childcare is socially stratified, the poor and the rich develop different preferences towards either increasing public spending or reducing parental fees in order to improve their access to childcare. The findings in this article suggest that expanding childcare in systems characterised by unequal access can be politically contested due to diverging policy priorities of individuals from different social backgrounds.     

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.     

The Probable Impact of Proposed Legislative and Budgetary Changes on the Lives of the Elderly and Their Families

The decade of the 1980s is characterized by economic uncertainty and political ambiguity regarding the direction of American public policy for the elderly. The purpose of this paper is to: (1) review demographic trends that particularly affect older adults; (2) summarize theReagan Administration's proposed cutbacks in programs and policies for the elderly; and (3) address the effects of these cuts on older individuals as well as on family systems across generations. It is our contention that the proposed budget cuts will seriously reduce a number of federal programs which have been developed to meet the needs of older adults. The impact of these cuts will be felt by all of the elderly and to a considerable extent, their families. However, the effects will be most severe for people who have poverty or near-poverty incomes, single women, and the "frail" elderly. The discussion suggests that these proposed budget cuts seem to reflect a lack of appreciation and recognition of both needs of the older individuals and those of their families. In addition, suggestions for program and policy directions, as well as further research are addressed.     

Social and Family Policies in Italy: Not Totally Frozen but Far from Structural Reforms

This article analyses the main shifts in the political and public discourse about families, children, elderly people, care needs and women‐friendly policies in Italy over the last two decades. It shows that while family and gender relationships have become an ideologically highly charged public issue, policies at the practical level have remained largely stagnant, marginal and fragmentary. At the same time, important institutional changes (such as the constitutional reform of 2001, which introduced a form of federalism) have created new problems of governance. The authors argue that in the face of inadequate policies, the recourse of individuals and families to old (family solidarity) and new (migrant labour) solutions may cause new tensions and inequalities.     

Commercial,non‐profit and governmental residential elderly care in Flanders: Differences in client selection and efficiency?

Verschuere B, Moray N, Decramer A. Commercial, non‐profit and governmental residential elderly care in Flanders: differences in client selection and efficiency? Inspired by New Public Management, governments have stimulated competition, outsourcing and privatisation in the public sector. Also, in care of the elderly, there has been a substantial increase in commercial provision. The present study explored the presumed differences in the performance of public (governmental), private non‐profit and private commercial elderly care organisations. We used quantitative indicators on the population of residential elderly care organisations in Flanders (Belgium). Although we found that commercial elderly care facilities tended to be more input‐efficient while non‐profit and public elderly care facilities tended to be more attentive to recruiting and housing residents with high care needs, these results need to be interpreted in light of the regulatory framework in which the different types of elderly care facilities operate.     

Comparing long-term care systems: A multi-dimensional,actor-centred typology

Like other fields of social policy, the organization of long-term care (LTC) varies temporally and geographically. The present article aims to advance the comparison of LTC systems worldwide by proposing a conceptual framework to analyse variation, putting a special focus on analysing the role of public and private actor types. In a precluding literature review of existing LTC typologies, we find that there are various promising classification approaches, but with an overwhelming concentration on European countries and often constructed in-transparently and superficially. Building on the concept of the care/welfare mix, we develop a multi-dimensional, actor-centred typology of LTC systems. In doing so, we employ the methodological procedure of theoretically constructing a typological attribute space. We argue that three dimensions, that is service provision, financing and regulation, are crucial for differentiating types. Furthermore, we chose an actor-centred approach, asking who bears the main responsibility in each dimension. Five relevant types of corporate actors are distinguished: state, societal actors, private for-profit actors, private individual actors, and global actors. Finally, we present and discuss the resulting attribute space and further illustrated the typology's use by exemplarily classifying three countries.     

Solidarity and tension between age-groups in the United States: challenge for an aging America in the 21st century

In this article, we argue that intergenerational tensions in the United States reflect a strategy for serving the aged that stresses the underlying values of individualism and self-reliance. Using national survey data, we examine the extent to which Americans' view of public responsibility for the aged has shifted between the mid-1980s and late-1990s, a period characterized by the intensification of "generational" politics, as well as a growing hostility toward "big government." We consider four factors that may be responsible for the escalation of intergenerational tensions as they are manifest in the erosion of public support for programs and policies serving the elderly: (1) Declining intergenerational solidarity with the aged ; (2) Increasing concerns over age-inequity in public programs ; (3) Increasing concerns over resource-inequity in public programs; and (4) Increasing opposition to big government . Results indicate that the public has generally grown more apprehensive about the value and costs of government programs serving both the elderly and the poor. Yet, the fact that Social Security enjoys far more support than social programs serving the poor suggests that the elderly are perceived as more deserving of their benefits than other dependent groups in society. The public also appears increasingly reluctant to redistribute old age benefits according to need. Age-group contrasts revealed little evidence of direct tension between the generations. The results suggest that growing distrust of government and reluctance to help the poor has indirectly fueled opposition to public spending on the older population. Proposed changes to programs and policies affecting the elderly will need to take into account the ambivalence felt by many Americans toward a government they expect to make good on its promise to care for all older citizens, but to use fewer resources in doing so.     

Beyond Rhetorical Differences: A Cohesive Account of Post‐devolution Developments in UK Health Policy

Health is perhaps the most significant policy area to be devolved to decision‐makers in Northern Ireland, Scotland and Wales. Consequently, there has been a great deal of interest in assessing the extent to which health policies (which already differed somewhat prior to devolution) have diverged since 1999. To date, analyses have tended to focus either on health care policies or on specific public health issues (e.g. health inequalities or tobacco control). The story that emerges from this body of work suggests health care policies have diverged significantly, whilst public health policies have remained remarkably similar. This article is one of the first to consider health care and public health policy alongside each other. It reassesses and updates previous analyses, incorporating developments relating to the 2010 general election and the 2007 and 2011 devolved administration elections. Drawing on a variety of textual sources (policy documents, research evidence and corporate literature), our findings differ from existing analyses in suggesting that, despite some noticeable differences in policy rhetoric, approaches to both health care provision and tackling public health problems remain similar. Looking to the future, the article concludes that the common economic challenges, combined with a tight fiscal policy (that remains excepted from devolution), means the similarities in health care provision across the UK are likely to remain more pronounced than the differences. However, current debate about the constitutional settlement, and in particular the prospect of greater fiscal freedoms for the devolved administrations, may provide opportunities for more meaningful divergence in health policy than has been possible hitherto.     

The Choice Revolution: Privatization of Swedish Welfare Services in the 1990s

During the 1990s, the Swedish welfare state was declared by some to be in a “crisis”, due to both financial strain and loss of political support. Others have argued that the spending cuts and reforms undertaken during this period did slow down the previous increase in social spending, but left the system basically intact. The main argument put forward in this article is that the Swedish welfare state has been and is still undergoing a transforming process whereby it risks losing one of its main characteristics, namely the belief in and institutional support for social egalitarianism. During the 1990s, the public welfare service sector opened up to competing private actors. As a result, the share of private provision grew, both within the health‐care and primary education systems as well as within social service provision. This resulted in a socially segregating dynamic, prompted by the introduction of “consumer choice”. As will be shown in the article, the gradual privatization and market‐orientation of the welfare services undermine previous Swedish notions of a “people's home”, where uniform, high‐quality services are provided by the state to all citizens, regardless of income, social background or cultural orientation.     

The performance of social security contributory and tax‐financed pensions in Central America,and the effects of the global crisis

Over the last 30 years, Latin America has pioneered structural pension reforms. This article focuses on a representative regional sample of seven Central American countries with diverse levels of development (Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama) studying contributory and tax‐financed pensions as well as recent pension reforms. It comparatively assesses system performance regarding five social security principles: unity; universal coverage; adequacy of benefits; equal treatment, solidarity and gender equality; and financial sustainability. It also evaluates the impact of the world crisis on these pension systems, highlighting the differences between public and private pensions, and extracts lessons and suggests policies for the future.     

Do cutbacks pay off? Perceived changes in the standard of municipal services and attitudes towards services among citizens and municipal decision makers in Finland

One common aim in the Nordic countries during the last decade has been to lessen state control over municipal affairs and to increase the local community's influence over the development of (welfare) services. These reforms happened to coincide with the economic depression of the 1990s, which especially hit Finland and Sweden, and enforced extensive cutbacks that negatively influenced the standard of services in a number of ways. However, according to some indicators the cutbacks also made public services more efficient. This article – utilizing Finnish data from 1995 – focuses on a comparison between how the general public on the one hand and leading municipal politicians and administrators on the other hand perceived the development of services and, further, whether these perceptions influence the groups' attitudes towards future changes in the system. Results show that decision makers, in contrast to a significant proportion of citizens, have a quite positive view on the development of services as well as on the continuation of cutbacks and a reduction of the municipalities' responsibilities for service provision. The study also indicates that citizens' views on the decline of various services are related to negative attitudes towards further decrease or changes in the municipalities' responsibilities. Among the decision makers, those politicians who think that (particularly efficiency aspects of) services have developed favourably also exhibit the weakest support for the prevailing system. The results raise questions concerning the role of citizens' attitudes in the development of services in the municipalities.     

Big Business in a Thin Market: Understanding the Privatization of Residential Care for Children and Youth in Sweden

This article analyzes the transformation of Swedish residential care for children from a regionally coordinated, public social service system into a thin, but highly profitable, national spot market in which large corporations have a growing presence. Marketization and privatization are theorized as complex processes, through which the institutional structure and logics of this small, but significant, social policy field changed profoundly. Using official documents, register data, media reports and existing research, three consecutive phases in the development of the children's home market are identified since the early 1980s. Change was driven on one hand by policies inspired by New Public Management, which shifted public authority horizontally to the private sector, and vertically to local authorities (funding) and to the state (regulation). On the other hand were the responses of local authorities and private actors to the changing incentives that policy shifts entailed. During the first two phases, both the proportion and size of for‐profit providers increased, and the model of family‐like care was replaced by a professional model. Cutting across the trend of privatization in the third phase was establishment of a parallel system of homes for unaccompanied refugee children – mostly in public ownership. Similarities with privatization in the English system of children's care homes are noted. By showing how the Swedish market for residential care has been created by policy and by actors’ responses to those reforms, the article provides a foundation for thinking through how the predictable, significant and well‐documented problems of such care markets might be addressed.     

Health Policy in the Asian NIEs

This paper compares the health policies of Hong Kong, South Korea, Singapore and Taiwan with the purpose of drawing policy lessons. The study finds two distinct policy clusters: Hong Kong and Singapore on the one hand, and Korea and Taiwan on the other. With respect to provision of health care, the former rely largely on public hospitals for delivering inpatient care while the latter rely on private hospitals. In matters of financing, they are similar in that out‐of‐pocket is a major source of financing in all four countries. However, they are also different because Korea and Taiwan have universal health insurance while the city states do not. The study concludes that public provision of hospital care, as in Hong Kong and Singapore, yields more favourable outcomes than many mainstream economists would have us believe. Conversely, private provision in combination with social insurance, as found in Korea and Taiwan, severely undermines efforts to contain health care costs.     

Caregiving in Transition in Southern Europe: Neither Complete Altruists nor Free-riders

In the framework of the SOCCARE Project, focusing on families dealing with a double front of care for children and frail elderly people, similarities can be found in Italy, France and Portugal beyond their different welfare regimes. The comparison of family histories and caregiving strategies, by the methodology of case‐matching, gives an interesting overview of the relationship between the debate on social care and that on the intergenerational contract. The paper aims to understand which are the available combinations of family, informal and institutional resources making a heavy burden of care “acceptable and still normal”: this focuses both typical situations of each country and common features through the countries. The results show how changes in the representations of obligation and duty in the intergenerational pact produce different outcomes and demands in welfare systems. The analysis of shifting boundaries between the public and private spheres in care provides useful policy recommendations, aimed at improving choices and “sustainable” responsibilities of individuals, families and social networks. Sustainable policies seem to be more dependent on family and structural types and resources of networks than on different welfare and services support.