Suchergebnisse

AbstractUnderstanding long‐term care (LTC) reform is at the core of the study of European social policy. Particularly important are the effects of regional devolution on the development of LTC services, being one of the few areas only subject to limited welfare retrenchment. One important question is the extent to which a devolved system of welfare governance influences the process of welfare reform as well as the degree of diversity in the provision and financing of LTC. The article draws upon evidence from Italy and Spain, two 'Latin Rim' countries, both of which have faced similar demands over the last twenty years for reform of systems with limited entitlement to long‐term care. It argues that when there is a latent demand for reform, welfare devolution does not inhibit reform when fiscal blame‐avoidance opportunities arise at the central government level. Furthermore, we examine the extent to which devolution leads to increasing fragmentation and diversity. The article's findings indicate that by diffusing policy responsibilities, devolution has enhanced LTC reform and reduced pre‐existing welfare fragmentation in Spain. In contrast, the lack of countrywide reform in Italy is explained by the absence of political opportunities for the diffusion of the fiscal blame that has frustrated attempts to reform the existing national cash allowance.

A recurrent objection to incipient processes of welfare-state devolution is that inducing diversity in welfare activity hampers public service uniformity and opens the door to regional inequalities. However, limited empirical evidence has been reported to back this claim from experiences of welfare-state devolution. I draw upon empirical evidence of three welfare services—namely, health care, education, and long-term care in Spain, 1998–2006. I aim to explore whether devolution has shifted the patterns of regional inequalities in welfare activity, and examine the impact of regional economic development and political and fiscal devolution on the observed patterns of inequality in welfare activity. My findings indicate a reduction in regional inequalities in welfare activity after the completion of regional devolution of all three welfare services examined. This was especially noticeable in education but also occurred (less markedly) in health and long-term care. Political devolution was found to be associated with 34% of (the declining of) inequalities in health care activity, 22% of those in education, and only 4% of disparities in long-term care activity where local authorities have continued to play a heavy role, and inequalities are largely explained by regional differences in tax responsibilities.

This paper examines the determinants of the demand for pharmaceuticals in the Spanish Autonomous Community of Catalonia using the latest available official survey data. Having accounted for the individual differences in cost-sharing among consumers, as well as the influence of self-medication, the paper builds a model of the (household) determinants of pharmaceutical expenditure and consumption. The econometric application deals with the infrequency of purchases and the non-distinction between out-of-pocket spending and drug cost sharing. The empirical evidence suggests that income and the variables accounting for cost sharing were significantly associated with drug use but not drug expenditure. Furthermore, gender, health status and having health insurance appear to be significant predictors. Access to pharmacies increases both drug use and expenditure; self-medication also increases drug expenditure as expected. These results are relevant for the entire Spanish case where current reform proposals have recommended the introduction of means-tested income-related rather than age related co-payments. The same applies to the need for controlling self-medication which results from individual behaviour of consuming medicines for minor ailments without a prescription and which can be acquired OTC and are priced cheaply.

This study considers the effects of globalization, in its economic and social dimensions, on obesity and caloric intake. In assessing these effects using longitudinal analysis, this study adopts an extensive list of controls to account for compositional changes and effects, as well as different specifications. The results suggest a robust association between globalization and both obesity and caloric intake. A one standard deviation increase in globalization is associated with a 20 percent increase in obese population and a 4 percent rise in calorie intake. The effect remains statistically significant even with an instrument variable strategy, a lagged structure, and corrections for panel standard errors. The primary driver is social globalization, and specifically the effects of changes in information flows and social proximity. A one standard deviation increase in social globalization increased the percentage of obese population by 14.5 percent and the consumption of calories by 2.8 percent, respectively.

This paper examines the heterogeneity in the public financing of long-term care (LTC), and the wide-ranging instruments in place to finance long-term care services. We distinguish and classify the institutional responses to the need for LTC financing as ex-ante (occurring prior to when the need arises, such as insurance) and ex-post (occurring after the need arises, such as public sector and family financing). Then we examine country-specific data to ascertain whether the two types of financing are complements or substitutes. Finally, we examine exploratory cross-national data on public expenditure determinants, specifically economic, demographic and social determinants. We show that although both ex-ante and ex-post mechanisms exist in all countries with advanced industrial economies and despite the fact that instruments are different across countries, ex-ante and ex-post instruments are largely substitutes for each other. Expenditure estimates to date indicate that the public financing of long-term care is highly sensitive to a country's income, ageing of the population, and the availability of informal caregiving.

Long-term care (LTC) is the largest insurable risk that old-age individuals face in most western societies. However, the demand for LTC insurance is still ostensibly small in comparison to the financial risk, which is reflected in the formation of expectations of insurance coverage. One explanation that has received limited support is that expectations of either "public sector funding" and "family bailout" crowd out individual incentives to seek insurance. This paper aims to investigate further the above mentioned motivational crowding out hypothesis by developing a theoretical model and by drawing on empirical analysis of representative survey data of fifteen European countries containing records on individual expectations of LTC funding sources (including private insurance, social insurance and the family). The theoretical model shows that, when informal care is treated as exogenously determined, expectations of both state support and informal care can potentially crowd out LTC insurance expectations, while this is not necessarily the case when informal care is endogenous to insurance, as is the case when intra-family moral hazard is integrated in the insurance decision. Evidence from expectations data suggest evidence consistent with the presence of family crowding out, but no evidence of public sector crowding out, and only weak evidence for cohorts of individuals older than 55.

The distribution of health inequalities appears to exhibit a different pattern when samples of developing countries are examined. One explanation is the existence of a health Kuznets ́curve. This paper sets out as an exploratory analysis to test the latter hypothesis of an inverse U shape pattern between both economic and health development and income inequalities in health. We draw upon two rich datasets and we use two measures of health, self -reported health and Body Mass Index (BMI). Our results are suggestive of a socioeconomic health Kuznets' curve on self-reported health but not on BMI. We find robust evidence of both cross country and time series heterogeneity which display a turning point of GDP per capita varying between US $26,000 -38,200.

Much of the theoretical literature on inequality assumes that the equalisand is a cardinal variable like income or wealth. However, health status is generally measured as a categorical variable expressing a qualitative order. Traditional solutions involve reclassifying the variable by means of qualitative models and relying on inequality measures that are mean independent. We argue that the way status is conceptualized has important theoretical implications for measurement as well as for policy analysis. We also bring to the data a recently proposed approach to measuring self-reported health inequality that meets both rigorous and practical considerations. We draw upon the World Health Survey data to examine alternative pragmatic methods for making health inequality comparisons. Findings suggest significant differences in health inequality measurement and that regional and country patterns of inequality orderings do not coincide with any reasonable categorization of countries by health system organization