Between State, Local Government and Market
Edited by Hellmut Wollmann and Gérard Marcou
Chapter 5: Towards Marketization and Centralization? The Changing Role of Local Government in Long-term Care in England, France, Germany and Italy
Frank Bönker, Michael Hill and Anna Marzanati1 INTRODUCTION Long-term care emerged as a major policy issue in most OECD countries in the 1980s.2 A number of socioeconomic ‘megatrends’ have helped put the problem on the agenda and keep it there: the ageing of the population has increased the relative number of frail elderly people; rising female labour market participation and the weakening of family ties through less and less stable marriages, and the decline in multi-generation households have eroded the potential for informal care; the desperate attempts at cost containment in health care have increased the pressure to take care of frail people outside the health care system. Finally, personal social services have been widely perceived as one of the major expanding segments of the labour market, offering the prospect of employment growth, especially for less skilled people. Since the beginning of the 1990s, most OECD countries have seen major reforms and changes in the field of long-term care. This also applies to the countries covered in this volume. In the UK, the 1990 National Health Service and Community Care Act put the provision of services for the elderly on a new footing and substantially changed the welfare mix. Germany and France introduced comprehensive new benefit schemes for the frail elderly in the mid-1990s. In Italy, a much-awaited law on social services was adopted in 2000 that aimed at establishing a uniform framework for services and reducing regional and local disparities in service provision. Moreover, the spread of ‘grey’...
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