Like other fields of social policy, the organization of longterm care (LTC) varies temporally and geographically. The present article aims to advance the comparison of LTC systems worldwide by proposing a conceptual framework to analyse variation, putting a special focus on analysing the role of public and private actor types. In a precluding literature review of existing LTC typologies, we find that there are various promising classification approaches, but with an overwhelming concentration on European countries and often constructed in-transparently and superficially. Building on the concept of the care/welfare mix, we develop a multi-dimensional, actor-centred typology of LTC systems. In doing so, we employ the methodological procedure of theoretically constructing a typological attribute space. We argue that three dimensions, that is service provision, financing and regulation, are crucial for differentiating types. Furthermore, we chose an actor-centred approach, asking who bears the main responsibility in each dimension. Five relevant types of corporate actors are distinguished: state, societal actors, private for-profit actors, private individual actors, and global actors. Finally, we present and discuss the resulting attribute space and further illustrated the typology's use by exemplarily classifying three countries.
Typologies are a useful and widely employed instrument in comparative research, including the study of health care systems. This study analyses the effectiveness of extant classifications in representing health care systems globally, examining whether existing literature adequately helps to understand health care systems of the Global South. To this end, the study highlights key elements of health care systems in the Global South, in particular limited resources, segmentation and the involvement of non-domestic/international actors. In a further step, we conduct a systematic literature review of typological scholarship on health care systems, in which 42 classifications are identified and analysed regarding regional coverage, methods, as well as the criteria and categories they include. The results point to major limitations: First, there is a general lack of representation and systematic classification of health care systems of the Global South. Second, there is a bias as criteria for classification are developed inductively based upon health care systems of the Global North. Consequently, existing typologies mostly fail to take into account the particularities of the countries beyond high-income economies. The study concludes by putting forth recommendations for developing a more comprehensive, globally applicable typological framework.
To date, social long-term care insurance (SLTCI) systems have been introduced in six countries globally: the Netherlands, Israel, Germany, Japan, Luxembourg and South Korea. Applying an actor-centred, multi-dimensional framework and fuzzy-set analysis, the present article investigates the typical characteristics and variations of these SLTCI schemes at introduction and today. In short, we find that the SLTCI model features dominant social contribution financing, a mix of for- and non-profit providers, and state regulation. In light of the relevance of corporate self-regulation often associated with social insurance systems, the dominance of state regulation is unexpected. The analysis also reveals considerable variance between cases, most notably concerning the extent of private individual actors’ involvement. While geographical proximity of countries does not explain differences between SLTCI systems, “temporal clusters” seem to partly drive the variation of SLTCI actor configurations.
The introduction of social protection schemes for long-term cares that is assistance with daily living activities in case of extended impairments, constitutes a comparably recent development. Taking a birds-eye perspective, this chapter explores which international interdependencies and national constellations contributed to the establishment of long-term case systems from 1945 to 2010. In particular, we investigate the relevance of channels of horizontal diffusion, that is, geographic proximity, cultural similarity, and colonial ties, the influence of the European Union as well as domestic factors such as problem pressure and women’s political empowerment.
Few countries have, to date, introduced distinct social insurance systems that explicitly address the risk of long-term care (LTC) dependency. Germany, Japan, and South Korea all established such long-term care insurance schemes in the 1990s/2000s. While domestic factors and discourses were important for these adoptions, transnational expert exchange accompanied the introduction, too. This chapter aims to investigate the role of LTC policy transfer and learning in Japan and South Korea: What indications exist for transnational—“positive” as well as “negative”—transfer? We compare the (dis)similarities in the design of the LTC systems and consider the evidence on foreign influences provided in the literature. While we find potential instances of transfer, our analysis shows that evidence on transnational learning remains thin for both cases.
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