Performance of long-term care systems in Europe. ENEPRI Policy Brief No. 13, December 2012

The evaluation of long-term care (LTC) systems carried out in Work Package 7 of the ANCIEN project shows which performance criteria are important and – based on the available information – how European countries score on those criteria. This paper summarises the results and discusses the policy implications. An overall evaluation was carried out for four representative countries: Germany, the Netherlands, Spain and Poland. Of the four countries, the Dutch system has the highest scores on quality of life of LTC users, quality of care and equity of the LTC system, and it performs the secondbest after Poland in terms of the total burden of care (consisting of the financial burden and the burden of informal caregiving). The German system has somewhat lower scores than the Dutch on all four dimensions. The Polish system excels in having a low total burden of care, but it scores the lowest on quality of care and equity. The Spanish system has few extreme scores. Some important lessons are the following. The performance of a LTC system is a complex concept where many dimensions have to be included. Specifically, the impact of informal caregiving on the caregivers and on society should not be forgotten. The role of the state in funding and organising LTC versus individual responsibilities is one of the most important differences among countries. Choices concerning private funding and the role of informal care have a large effect not only on the public expenditures but also on the fairness of the system. International research into the relative preferences for the different performance criteria could produce a sound basis for the weights used in the overall evaluation.

No need for a master plan from Brussels. CEPS Commentary, 7 January 2013

Taking exception with the often-heard bromide that Europe needs more integration to save its social model, Daniel Gros reiterates his position in this new CEPS Commentary that faster economic and population growth are key to ensuring the future of Europe’s social security systems.

Social politics in a transoceanic world in the early Cold War years

This article argues that those termed 'liberals' in the United States had the opportunity in the late 1940's to use overseas case studies to reshape the ramshackle political agenda of the New Deal along more specifically social democratic lines, but hat they found it impossible to match interest in the wider world with a concrete programme to overcome tension between left-wing politics and the emerging anti-totalitarianism of the Cold War. The American right, by contrast, conducted a highly organised publicity drive to provide new meaning for their anti-statist ideology in a post-New Deal, post-isolationist United States by using perceived failures of welfare states overseas as domestic propaganda. The examples of Labour Britain after 1945 and Labour New Zealand both provided important case studies for American liberals and conservatives, but in the Cold War it was the American right who would benefit most from an ideologically driven repackaging of overseas social policy for an American audience.

Leisure, consumerism and active citizenship in the UK

Since the first election victory of the Thatcher administration in 1979, Britain has witnessed a cultural transformation from the municipal socialism enshrined in the post-World War 2 development of the Welfare State to a form of post-industrial entrepreneurialism based largely on market rationality. This has had a profound effect on all aspects of civil life, not least the redefinition of the role of active leisure. Since the late 1950s the dominant policy for active leisure has been 'Sport For All', an assertion of a social right too important to be left to the market. The transformation has, therefore, signalled a shift from government support for active leisure as an element of citizen rights to the use of leisure to promote the government's interest in legitimating a new social order based not on rights but on means. Thus access to active living is no longer a societal goal for all, but a discretionary consumer good, the consumption of which signifies 'active' citizenship. It furthermore signifies differentiation from the growing mass of 'deviants' who are unwilling or unable to embrace this new construction of citizenship and are, therefore, increasingly denied access to active living and, hence, active citizenship.

The politics of fiscal policy during economic downturns, 1981-2010

This article investigates fiscal policy responses to the Great Recession in historical perspective. We explore general trends in the frequency, size and composition of fiscal stimulus as well as the impact of government partisanship on fiscal policy outputs during the four international recessions of 1980-81, 1990-91, 2001-02 and 2008-09. Encompassing 17-23 OECD countries, our analysis calls into question the idea of a general retreat from fiscal policy activism since the early 1980s. The propensity of governments to respond to economic downturns by engaging in fiscal stimulus has increased over time and we do not observe any secular trend in the size of stimulus measures. At the same time, OECD governments have relied more on tax cuts to stimulate demand in the two recessions of the 2000s than they did in the early 1980s or early 1990s. Regarding government partisanship, we do not find any significant direct partisan effects on either the size or the composition of fiscal stimulus for any of the four recession episodes. However, the size of the welfare state conditioned the impact of government partisanship in the two recessions of the 2000s, with Left-leaning governments distinctly more prone to engage in discretionary fiscal stimulus and/or spending increases in large welfare states, but not in small welfare states.

Om trångboddhet : Hur storleken på våra bostäder blev ett välfärdsproblem

About crowding – How the size of our dwellings became a welfare problem Housing policy documents have traditionally been studied by political scientists, resulting in a lack of interest in the private aspects of housing policy. Hence, this paper uses the example of crowding standards to examine how a previously private matter, the size of our dwelling, became a concern of the state. Official governmental documents are analyzed with the help of discourse theory, working on the supposition that the need of the population and the framing of a problem changes over time. The first official standard of crowding, formulated in 1946 argue for larger dwelling size in order to increase the size and quality of the Swedish population. The second standard, formulated in 1965, is based on the assumption that the population, defined as consumers, demands larger sized homes. The final standard, formulated in 1975, claims that larger sized homes is a social right.

The Emerging Civil Society in China and Its Impact on Democratization

Recent years have seen an emerging civil society in an authoritarian China. The authoritarian embrace of civil society challenges the conventional wisdom that civil society is closely linked to democracy. In Beijing, the rhetoric of civil society linked less to democracy than to modernization. However, does civil society development have any impact on democratization in authoritarian regimes? The thesis tries to provide a tentative answer by studying civil society and democratization in post-Mao China. As a result of economic development and political reforms, gradual political liberalization has marked a shift of state-society relations that gives rise to a certain degree of democratization and a growing civil society. The thesis uses a statistical correlation study to examine the relations between grassroots democratization and civil society development. The study concludes that civil society development may have contributed to democratization at the grassroots level but not on the national level. The impact of civil society on democratization depends on the political structure of the state and will remain limited unless the government allows for further state-led democratic openings.

Social welfare analysis in a simple financial economy with risk regulation

In the last years, regulating agencies of rnany countries in the world, following recommendations of the Basel Committee, have compelled financiaI institutions to maintain minimum capital requirements to cover market risk. This paper investigates the consequences of such kind of regulation to social welfare and soundness of financiaI institutions through an equilibrium model. We show that the optimum level of regulation for each financiaI institution (the level that maximizes its utility) depends on its appetite for risk and some of them can perform better in a regulated economy. In addition, another important result asserts that under certain market conditions the financiaI fragility of an institution can be greater in a regulated econolny than in an unregulated one

Organizações comunitárias de provisão social nos Estados Unidos e França

Documento de pesquisa que aborda o perfil, a dimensão e a magnitude das organizações comunitárias de provisão social na França e nos Estados Unidos, relacionando suas formas de vinculação, dinâmicas e identidades em face da esfera governamental e da esfera privada capitalista, apontando: (i) tipos dominantes de atores e como funcionam seus quadros em relação ao Estado e aos interesses capitalistas no mercado; (ii) recursos mobilizados na interação com o poder político e poder econômico (Estado e empresas capitalistas) quando recebem doações: significado do trabalho voluntariado e das iniciativas de geração de ocupação e renda (associativismo/cooperativismo) e (iii) fins visados e valores expressos. São discutidas as formas de atuação de base, participação local em cada país e é analisada, comparativamente, a questão do significado desses agentes no quadro atual dos atuais sistemas de bem-estar (Welfare State) na sociedade civil norte-americana e francesa.

A superação da pobreza através da distribuição justa das riquezas sociais: uma análise da consistência teórica do Programa Bolsa Família e das perspectivas dos beneficiários de saída autosustentada do programa

Bolsa Família is the major brazilian conditional cash transfer program. It provides money to poor families contingent on investments in human capital, such as sending children to school or bringing them to health centers. This work aims to investigate if this program, in its normative structure, can be considered an appropriate policy of income redistribution and if it is able, appliances of the Welfare State model in the brazilian society and to approach the program in two different ways: as an alternative to more traditional social assistance programs and as a demand-side complement to the supply of other social needs. We will work on the thesis that the program by itself can not provide vulnerable populations with enough means to overcome poverty and to participate effectively on the market. According to this assumption, this paper is going to consider the reasons why tackling income necessary, along with the program, that the Government - in both federal and local spheres shall place major investments in critical areas like education and health.

Desafios para a formação de parcerias no serviço creche da secretaria da assistência social da PMSP

Analisa os vínculos estabelecidos entre a Secretaria de Assistência Social da PMSP e algumas Entidades Sociais para a prestação do serviço creche. Investigou-se o campo da Assistência Social e o da relação entre a esfera pública estatal e a esfera privada, sem fins lucrativos, na provisão de serviços públicos. A partir de revisão bibliográfica, de pesquisa documental e de estudo de casos, dando voz a todos que se relacionam no convênio, definiu-se parcerias como sendo relações substantivas que implicam corresponsabilidades, compartilhamento de valores e comprometimentos. Analisou-se duas creches diretas, duas conveniadas e duas indiretas, (e as respectivas Entidades Sociais), além da SAS Regional de IQ/G e SAS Central. Foram escolhidas as creches que obtiveram avaliação positiva quanto ao seu desempenho e alcance de resultados. Considerou-se que tanto os serviços prestados de forma direta quanto os conveniados podem ter qualidade e sucesso no alcance de seus objetivos, sendo necessário, em qualquer das modalidades, ter presente aspectos como: transparência nas ações, diálogos permanentes, clarificação de papéis e competências, responsabilização e compromissos com causas e com acordos. Justificam-se os serviços conveniados em razão das questões conjunturais hoje postas, e da responsabilização por parte de toda uma sociedade no enfrentamento da questão social. Justificam-se os serviços diretos pela necessidade vital da afirmação do papel do Estado na provisão de serviços públicos para garantia de serviços de forma continuada com vistas à universalização. Indicou-se, como desafio a necessidade de rever a forma como estão se dando os vínculos entre os agentes estudados, na direção do estabelecimento de parcerias, bem como o desafio da apropriação da condução da política pública pelos órgãos de assistência social, consolidando como esfera pública não-estatal a ação das Entidades Sociais.

Federalismo cooperativo no Brasil: da Constituição de 1988 aos sistemas de políticas públicas

A tese se dedica à discussão da relação de reciprocidade entre federalismo e políticas sociais no Brasil, analisando os sistemas de políticas públicas nas áreas da saúde, assistência social e educação. A tese se apóia na literatura internacional sobre federalismo e Estado de Bem-Estar Social para construir um referencial teórico que analisa os sistemas de políticas públicas como uma matriz, que aprofunda o compartilhamento federativo, com base na negociação intergovernamental. Argumenta-se que esse modelo resulta da interação entre o desenho institucional produzido pela Constituição de 1988 e as diretrizes de universalização de políticas sociais implementadas, por meio de ações federais, a partir da segunda metade da década de 1990. Com esse estudo,pretende-se propor uma nova abordagem sobre o federalismo brasileiro, alternativa à dicotomia entre centralização e descentralização que predomina na literatura nacional; além de chamar atenção para a figura dos sistemas de políticas públicas enquanto arranjos institucionais que permitem a combinação de nacionalização de políticas sociais, com fortalecimento da negociação federativa.

Corporação médica e reforma sanitária

o presente trabalho analisa a trajetória da Corporação Médica no processo de formulação da política da Reforma Sanitária brasileira, a partir de estudo de caso das entidades médicas do Estado do Rio de Janeiro, no período de 1977 a 1989. Partindo-se da análise da representação de interesses no processo de fonnulação de políticas públicas, identificam-se as características diferenciais das políticas sociais. Procura-se demonstrar que a Refonna Sanitária, enquanto política social, sofreria os conflitos inerentes à implantação dessas políticas no contexto pós Welfare, estando sua efetivação dependente de uma concertação dada no plano da dinâmica societária, onde são determinantes os interesses dos diferentes atores que dela participam. O processo de fonnulação da política da Refonna Sanitária brasileira alcança a Corporação Médica em uma crise de seu ideário, cuja orientação é disputada por distintos projetos. A análise do período demonstra a prevalência dos interesses privados nas demandas da Corporação e como esses interesses se conflitavam com a concepção e propostas da Refonna, comprometendo sua efetivação. Os limites de adesão da Corporação à política da Refonna contudo, não são atribuídos ao corporativismo e conservadorismo médicos. Procura-se demontrar, diferentemente das análises correntes, que essses limites explicam-se pelas características intrínsecas à prática médica e à modalidade atualmente prevalente de organização da prática médica. Enquanto ator crucial ao interior do setor saúde, os conflitos enfrentados pela Corporação Médica revelariam as contradições da própria Refonna Sanitária.

After the demise of neoliberalism but not of conservatism, a third developmentalism?

Neoliberalism and developmentalism are the two alternative forms of economic and political organization of capitalism. Since the 2008 global financial crisis we see the demise of neoliberalism in rich countries, as state intervention and regulation increased, opening room for a third historical developmentalism (the first was mercantilism, the second, Fordism). Not only because of major market failures, not only because the market is definitely unable to assure financial stability and full employment, an active macroeconomic policy is being required. Modern economies are divided into a competitive and a non-competitive sector; for the coordination of the competitive sector the market is irreplaceable and regulation as well as strategic industrial policy will be pragmatically adopted following the subsidiarity principle, whereas for the non-competitive sector, state coordination and some state ownership are usually more efficient. Besides, the fact that capitalist economies are increasingly diversified and complex is an argument against the two extremes – against statism as well as neoliberalism – in so far that they require market coordination combined with increased regulation. But the third developmentalism probably will not be progressive as was the second, because the social-democratic political parties are disoriented. They won the battle for the welfare state, which neoliberalism was unable to dismantle, but the competition of low wage developing countries and immigration continue to offer arguments to conservative political parties that defend the reduction of the cost of labor contracts or the or precarization of labor.