Different Nordic Welfare Systems? An alternative analysis of care services for older people

Transcription

1 Different Nordic Welfare Systems? An alternative analysis of care services for older people Viola Burau (Aarhus University) & Signy Irene Vabo (Oslo University College) Presentation prepared for the conference Reassessing the Nordic Welfare Model: Taking stock of the work so far Oslo, May 2009

2 (1) Our argument Overview (2) Review of the literature: towards micro dimensions of comparison (3) Our study: micro level analysis of care services 2

3 (1) Our argument Starting point Literature challenging idea of common Nordic model of care services for older people Variations in terms of degree of universalism and defamiliarisation [Rauch 2007] Differences regarding the balance between public services and informal care [Szebehely 2005b] Also increasing variations within countries [Wrede et al. 2008] Patterns of care arrangements are complex and contradictory, and therfore above all country specific [Kröger et al. 2003, Sipilä et al. 2003] 3

4 (1) Our argument Starting point, cont. Existing literature typically adopts top down approach, focusing on differences in the macro context Central government regulations of services [Rauch 2008] Extent to which New Public Management reforms have been implemented [Szebehely 2005b] Changes in the political ethos framing care, which has shifted from community orientation to efficiency [Wrede et al. 2008] Particular histories of individual services are key for explaining the evolution of care services [Antonnen et al. 2003] 4

5 (1) Our argument Aim of our research Exploring variations among Nordic care regimes from a bottom up perspective Analysis of factors shaping the local organisation of care services gives better insights into variations 5

6 (2) Review of the literature Why is the local level interesting? Historically Importance of welfare municipalities [Kröger 1997 a & b, more generally Burau & Kröger 2004] Empirically Decentralisation as part of New Public Management reforms [Kazepow in prep.] Methodologically Allows for thorough analysis of variations across countries (and what is typical of individual countries) [Kazepow in prep.] 6

7 (2) Review of the literature Focus on universalism Notion of universalism central to distinguishing between different welfare regimes [Esping Andersen 1990, Rauch and Vabo in prep] Existing analyses often look especially at coverage rates, as prerequisite for universalism [more generally Antonnen & Sipilä 1996] * Home help is most universal in Denmark and Iceland, and least universal in Sweden, with Norway in a middle position [Szebehely 2005b] * Universalism has fallen in Sweden, while it has retained its high level in Denmark, similar divergence in Finland and Norway [Rauch 2008] 7

8 (2) Review of the literatur Focus on the organisational prerequisites of universalism Rauch (2007) suggests broadening the definition of universalism and including the following indicators * Existence of service guarantees * Absence of certain admission tests * Share of client co payments Building on this, we look at organisational prerequisites fostering/constraining universalism specifically at the local level 8

9 (3) Our study Defining organisational prerequisites at the local level (i) The system of local authorities How autonomous are local authorities? What is their capacity for forming care services? (ii) Central level regulation of local authorities What are the relevant provisions in relation to regulation, quality standards, financing etc.? (iii) Local authorities room for manouevre How do local authorities fill this space in practice? 9

10 (3) Our study (iii) Local authorities room for manouevre indicators Procedures for allocation Service guarantees: the stronger the institutional embeddedness of guarantees, the more universialistic the service Guarantee relating to specific services or to generic, but undefined help? How is service delivery organised (in house/purchaser provider split)? How much discretion does the provider have? Admission tests: The more need based admission test, the more universialistic the service Who is making the decision (team/single person)? Formal/informal procedures in operation, decided by whom? How are the older person and/or her relatives involved? Are other factors than need part of the admission criteria? Co payments The less income based co payments, the more universialistic the service 10

11 (3) Our study Micro level, organisational data From the project Rescaling social welfare policies A comparative study on the path towards multi level governance in Europe (Finland), Norway, Sweden The institutional arrangements underlying the actual services given to three conceptualised older people (Vignettes) Two municipalities/regions within each country The preliminary analysis is restricted to Home help (social) and nursing homes Vignette interviews in 2006 with experts (researchers and high rank officers) and practitioners 11

12 Preliminary findings (3) Our study Service guarantees (the stronger, the more universialistic) National regulations somewhat stronger in NO than in SE Local governments are obliged to give help and some services are obligatory, but local discretion in deciding how much and what kind of help; Professional standards formulated in more detail in NO than SE Purchaser provide split in SE and in one of two NO cases Explicit contracts with providers, which are followed up regularly Provider discretion more specified purchases in NO than SE More open assessment from the purchaser in SE than in NO 12

13 (3) Our study Preliminary findings, cont. Admission tests (the more needs based, the more universalistic) Decision by a single welfare officer in SE and in one of two NO cases That is; a more extensive assesssment procedure in one NO case Recipient can choose between providers in the capital cities, but generally most focus on choice in SE Typical for SE is what she gets depends on what she wants... Services offered more dependent on family situation in SE than NO Partners count in SE, not in NO Local procedures defining admission referred to only in NO But they are all needs based... 13

14 (3) Our study Preliminary findings, cont. Co payments (the less income based, the more universialistic) Co payment primarily income based in both countries, but less so in SE (due to the max fee) than in NO Stricter regulated fees in SE than in NO Fees depend also on amount of help, housing costs and meals 14

15 To draw conclusions, the research needs to be continued... 15

16 Literature Antonnen, Anneli and Jorma Sipilä (1996) European social care service: is it possible identify models?, Journal of European Social Policy, 6: Antonnen, Anneli, Jorma Sipilä and John Baldock (2003) Patterns of social care in five industrial societies: explaining diversity, in Anneli Antonnen, John Baldock and Jorma Sipilä (eds) The young, the old and the state, social care systems in five industrial countries, Cheltenham: Edward Elgar. Burau, Viola and Teppo Kröger (2004) Towards local comparisons of community care governance: exploring the relationship between policy and politics, Social Policy & Administration, 38 (7), Kazepow, Yuri (in prep.) 'Rescaling social policies towards Multilevel Governance in Europe: Some reflections on Processes at stake and Actors involved', in Yuri Kazepov (ed): Rescaling Social Welfare Policies A comparative study on the path towards multi level governance in Europe. Aldershot: Ashgate. Kröger, Teppo (1997a) 'Local government in Scandinavia: autonomous or integrated into the welfare state?', in J. Sipilä (ed.) Social care services: the key to the Scandinavian welfare model, Aldershot: Avebury. Kröger, Teppo (1997b) 'The dilemma of municipalities: Scandinavian approaches to child day care provision', Journal of Social Policy, 26, 4: Kröger, Teppo, Anneli Antonnen and Jorma Sipilä (2003) Social care in Finland: stronger and weaker forms of universalism, in Anneli Antonnen, John Baldock and Jorma Sipilä (eds) The young, the old and the state, social care systems in five industrial countries, Cheltenham: Edward Elgar. 16

17 Literature Rauch, Dietmar (2007) Is there really a Scandinavian service model?: a comparison of childcare and elderlycare in six European countries, Acta Sociologica, 50 (3), Rauch, Dietmar (2008) Central versus local service regulation: accounting for diverging old age care developments in Sweden and Denmark, , Social Policy & Administration, 42 (3), Rauch, Dietmar and Signy Irene Vabo (in prep) Multi level governance in Europe exploring the relationship between universialism and the governing of social service Journal article to be submitted. Sipilå, Jorma, Anneli Antonnen and John Baldock (2003) The importance of social care, in Anneli Antonnen, John Baldock and Jorma Sipilä (eds) The young, the old and the state, social care systems in five industrial countries, Cheltenham: Edward Elgar. Szebehely, Marta (2005a) Äldreomsorger i Norden versamhet, forskning och statistik, in Marta Szebehely (ed) Äldreomsorgsforskning i Norden. En kunskabsöversikt, TemaNord 2005: 508, Köpenhamm: Nordiska ministerrådet. Szebehely, Marta (2005b) Nordisk äldreomsorgsforskning en sammanfattande diskussion, in Marta Szebehely (ed) Äldreomsorgsforskning i Norden. En kunskabsöversikt, TemaNord 2005: 508, Köpenhamm: Nordiska ministerrådet. Wrede, Sirpa, Lea Henriksson, Håkon Høst, Stina Johansson, Betina Dybbroe (eds) (2008) Care work in crisis. Reclaiming the Nordic ethos of care, Studentlitteratur. 17