The 'Consumer Principle' in the Care of Elderly People: Free Choice and Actual Choice in the German Welfare State

In the mid-1990s, together with new long-term care legislation, the German welfare state introduced care markets and consumer choice between family care and different types of formal care. However, instead of using the new option to choose publicly funded care by long-term care agencies, the majority of elderly people in need of care continued to decide in favour of care exclusively provided by family members. The article examines how the persistence of family care in spite of the new options of consumer choice can be explained, using data from representative surveys on the care of elderly people in Germany and the results of guided interviews by the authors with family members involved in care. The findings indicate that there are two main reasons. The first is that elderly people and their families orient their behaviour towards traditional care values in which the first priority is given to mutual support between spouses and generations. The second reason is that elderly people on the one hand and care agencies on the other have substantially different definitions of a good quality of care.     

On Granger causality and the effect of interventions in time series

We combine two approaches to causal reasoning. Granger causality, on the one hand, is popular in fields like econometrics, where randomised experiments are not very common. Instead information about the dynamic development of a system is explicitly modelled and used to define potentially causal relations. On the other hand, the notion of causality as effect of interventions is predominant in fields like medical statistics or computer science. In this paper, we consider the effect of external, possibly multiple and sequential, interventions in a system of multivariate time series, the Granger causal structure of which is taken to be known. We address the following questions: under what assumptions about the system and the interventions does Granger causality inform us about the effectiveness of interventions, and when does the possibly smaller system of observable times series allow us to estimate this effect? For the latter we derive criteria that can be checked graphically and are in the same spirit as Pearl’s back-door and front-door criteria (Pearl 1995).     

THE DISABLED BODY,GENEALOGY AND UNDECIDABILITY

The received history of the disabled body is deeply problematized by a genealogy – inspired initially by Foucault – that disrupts the notion of a continuous development of ideas and images, and shifts the focus to competing, fractured and discontinuous discourses culturally embedded in particular historical periods. Following Foucault's explication of the emergence of modernist normativities and the operation of power/knowledge, disability scholarship has charted a break between early religiously-inspired models concerned with a god-given nature, a medical model that pathologizes the disabled body and, more recently, the social model of disability that effects a politicization of the problematic. Yet consistent with a Foucauldian analytic, even the latter resistant discourse gives rise to its own normativities and generates new resistances. Alongside the return of the disabled body to challenge the hegemony of socio-cultural determinations, I offer, then, a further complication. Where previous approaches speak to external discursive power – albeit embedded in the individual consciousness – as the motor of change, I seek to supplement and reconfigure the problematic by engaging with the operation of psychic elements. Within the historically contextualized transformations in the meaning of disability, there is, I argue, another current of interior and less accessible responses, which not only challenge the privileging of periodization in historical thought, but also disorder the alternative Foucauldian approach. Where his analysis is concerned with the multifarious mobilizations of the binary of self and other, a more specifically deconstructive approach seeks to uncover the other as an interior attribute of the embodied self. This essay plays over some historical moments and brings them together with postmodernist and psychoanalytic theory to show how binary differences are constantly undone by the irreducible différance of the disabled body.