Similar and yet so different: cash-for-care in six European countries' long-term care policies

Milbank Q. 2010 Sep;88(3):286-309. doi: 10.1111/j.1468-0009.2010.00601.x.


Context: In response to increasing care needs, the reform or development of long-term care (LTC) systems has become a prominent policy issue in all European countries. Cash-for-care schemes-allowances instead of services provided to dependents-represent a key policy aimed at ensuring choice, fostering family care, developing care markets, and containing costs.

Methods: A detailed analysis of policy documents and regulations, together with a systematic review of existing studies, was used to investigate the differences among six European countries (Austria, France, Germany, Italy, the Netherlands, and Sweden). The rationale and evolution of their various cash-for-care schemes within the framework of their LTC systems also were explored.

Findings: While most of the literature present cash-for-care schemes as a common trend in the reforms that began in the 1990s and often treat them separately from the overarching LTC policies, this article argues that the policy context, timing, and specific regulation of the new schemes have created different visions of care and care work that in turn have given rise to distinct LTC configurations.

Conclusions: A new typology of long-term care configurations is proposed based on the inclusiveness of the system, the role of cash-for-care schemes and their specific regulations, as well as the views of informal care and the care work that they require.

MeSH terms

  • Austria
  • Delivery of Health Care / economics*
  • Delivery of Health Care / organization & administration
  • France
  • Germany
  • Health Care Costs*
  • Health Expenditures
  • Health Policy / economics*
  • Humans
  • Italy
  • Long-Term Care / economics*
  • Netherlands
  • Sweden