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A number of researches have raised the concern of the affordability of long-term care in industrial countries. This paper seeks to explore these questions: how do the three care systems afford support for an increasing ageing population? What are the outcomes of the different welfare-mixes in long-term care? How are demand and supply balanced? It focuses on examining the way each country has contributed to the long-term care of older people. It argues that the approaches of different countries need to be located and understood within the context of broader welfare state models. This paper also point out the complexities and difficulties of welfare-mix comparisons. This study draws on an identical qualitative cross-national research method on three levels in each country: national, county and municipal. A total of 142 participants interviewed. This study found a precise comparison of mixed care systems remains problematic. The comparison of conditions in this paper, nevertheless, has yielded some findings and conclusions concerning affordability and responsibility. Both England and the Netherlands have experienced retrenchment in the statutory provision of long-term care. "Solidarity" is the core ideology in reshaping the responsibility between the state and society in the Netherlands, whereas in England the responsibility for care between care actors in the system remains unclear. In Taiwan, state intervention has increased, but it has focused more on stimulating the economy and employment, than on replacing the family as the central care agent.

The "Care Voucher for the Aged" program introduced in May, 2007 is the first demand-side subsidy policy that aims to extend user choice and formation of the social service market. The implementation of this voucher program acted as a catalyst that triggered the burning discourse on the privatization and commercialization of social services in Korea. However, there has been a lack of empirical research to identify the operation of market logic when introduced in the service field in Korea.    

As a case study in the field of policy implementation research, this study focuses on how the logic of consumer choice and provider competition operates on the front line of policy processing. To find the implementation process of the program, 39 interview data were analyzed, including voucher users, care workers, social workers in 4 agencies and local public officers in one of the district in Seoul, and relevant officials from the Ministry for Health, Welfare and Family affairs and the Center for Social Service Management.

The main results are as follows: In the level of policy implementation, user choice and competition, which was the main logic behind the implementation of the voucher program, did not occur as expected by policy makers. Instead of the user choosing his/her provider, it was found that the providers were choosing its users. Secondly, the case study found that providers have formed a caucus, called the 'providers cooperation committee' which allocated the local users equally amongst the providers. In this process, local public officers have supported the committee by providing them with a list of users. Such results may be interpreted as a habitual execution from the tradition of supply-side subsidy, rather than the way of implementation in the market system. Thirdly, although voucher users could not choose their preferred agency in the first stage of service, some other choices exists so that users may choose their preferred care-giver and time for service. Finally, the change of agency and care-giver in the way of delivering services were observed. Since the implementation of the provider support system, and the rules and routines accumulated from such practices, have been gradually affecting the characteristics of demand-side subsidy.  

This study opens a window for discussion focusing on the meaning of choice as policy implication and user practice, and the nature of the relationship between the government and private service agency in the social service market.  

Improving the provision of long-term care is one of the big challenges for the welfare system in many advanced economies including Germany and Japan. We have to face the fact of an aging population and financial problems in supporting the growing number of people in need of care. And we have to acknowledge that families particularly women can no longer be the main institutions responsible for taking care of their elderly, sick or disabled relatives. Therefore, new solutions for the allocation of resources and the provision of good quality care have to be developed.

In our presentation, we address the level of organisations providing care and show some innovative ways in dealing with the new demands on the provision of care. Even though different institutional frameworks and regulations have a strong impact on the development of care services and the quality of care in both countries, there are many similar ways in which care providers try to restructure their organisation and to improve the quality of care provided by their care workers.Using the empirical evidence of our case studies in both countries and the results of analysis of survey data for Japanese care workers, we address the following questions;

  • What are the organisational innovations the providers of elderly care services are developing to respond to new demands?
  • How can these innovations improve the provision of elderly care?
  • What knowledge is needed in improving the quality of care?
  • What management practices are effective for developing the knowledge base among care workers?

In spite of different institutional frameworks, we find many similarities in the direction of change in Germany and Japan which might be worth exploring for other counties to find effective solutions.

Presentation slides: Goldmann_Nishikawa_2009_elderly_care.pdf