Patterns of Cash Payments for Care : Cross-National Comparative Study

장기요양 현금급여 정책의 국가간 비교 연구

  • Published : 2006.05.31

Abstract

The introduction of cash payments for care is a distinct trend that characterizes changes in care policies since the 1990s. Recently, many developed countries have newly introduced or extended cash payments for care that allow care users to be able to plan themselves for their cares instead of receiving direct care services from the state. Cash payments for care can be said to be one of the alternative policies by which user choices are extended, and it becomes possible to establish demand-cantered care delivery systems more economically and effectively, hence addressing the issue of the financial limitations and rigid systems that are common in modern welfare states, which make it difficult to response to various needs. However, the design and administration of cash for care vary across different countries. Such variations of cash for care policies influence on the combination of consumerism (based on liberal market values intrinsic in the care market) and citizenship based on social solidarity. Those variations eventually produce impacts on the balance of responsibilities and the roles of families, the state and market regarding care in other words, balancing of welfare pluralism. This paper has attempted to find general meanings and particularity of cash for care polices in modem welfare states by means of looking at the characteristics of cash for care policies of four different countries (Netherlands, France, Germany and Italy) and their impacts on their care market. If the four countries are ranked by the degree that they emphasize citizenship in light with social rights, the Netherlands, France, Germany and Italy could be placed in due order. From an economic point of view and in terms of cost containment, those countries will be placed in an inverse order, It is apparent that in the course of planting cash for care policies in the existing social systems involving different socio-cultural conditions and labour markets, sometimes more emphasis is placed on the citizenship of care users, family carers and care providers than on cost containment issue, and sometimes vice versa. Behind this lies the process of different social valuation on what care is about; who can better deliver care; who should be responsible for care; how responsibilities should be shared and so on.