Article Restructuring the welfare state: reforms in long-term care in Western European countries Emmanuele Pavolini, University of Macerata, Italy Costanzo Ranci*, Polytechnic of Milan, Italy Summary Faced with the problems associated with an ageing society, many European countries have adopted innovative policies to achieve a better balance between the need to expand social care and the imperative to curb public spending. Although embedded within peculiar national traditions, these new policies share some characteristics: (a) a tendency to combine monetary transfers to families with the provision of in-kind services; (b) the establishment of a new social care market based on competition; (c) the empowerment of users through their increased pur- chasing power; and (d) the introduction of funding measures intended to foster care-giving through family networks. This article presents the most significant reforms recently introduced in six European countries (France, Germany, Italy, the Netherlands, Sweden and the UK) as regards long-term care. It analyses their impact at the macro- (institutional and quantitative), meso- (service delivery structures) and micro-level (families, caregivers and people in need). As a result the authors find a general trend towards convergence in social care among the countries, and the emergence of a new type of government regulation designed to restructure rather than to reduce welfare programmes. Key words ageing, long-term care, privatization, social care, welfare state restructuring Current changes in long-term care The development of long-term care (LTC) services constitutes one of the main testing grounds for the innovative capacities of Western European welfare systems, which in their current state are in fact largely unable to satisfy the needs of an increasing number of care-dependent people (Martin, 2001). To date, dependence has been a social risk not adequately covered by welfare systems. Traditional forms of public protection provided care-dependent citizens with invalidity pensions and health and rehabilitation services. While government insurance schemes for chronically ill people are generally not sufficient to meet the huge costs of LTC, health serv- ices are still designed mainly to deal with the acute phases of disease, not to assist dependent people for long periods of time. The inadequate growth of LTC programmes has become increasingly apparent as the number of people who are dependent has grown. 1 These pro- grammes still receive very limited funding. At the same time there has been a progressive decrease in the ability of family networks to provide support owing to the increase in the old age dependency ratio and the female activity rate. Faced with the dilemma of these growing demands for services and the need to contain the costs of care provision, many Western European governments have reformed their LTC services over the last 15 years. The purpose of this article is to describe these changes and to provide a general interpretation of the direction *Author to whom correspondence should be sent: Costanzo Ranci, Polytechnic of Milan, via Bonardi, 3, 20133 Milano, Italy. [email: costanzo.ranci@polimi.it] Journal of European Social Policy 0958-9287; Vol 18(3): 246–259; 091058 Copyright © SAGE Publications 2008, Los Angeles, London, New Delhi and Singapore, DOI: 10.1177/0958928708091058 http://esp.sagepub.com at Biblioteca Scienze Politiche on November 10, 2015 esp.sagepub.com Downloaded from