How does the introduction of ‘choice’ affect the pooling of risks in European welfare states? The case of long-term care

Schelkle, Waltraud. and van Wijnbergen, Christa and Costa-Font, Joan (2009) How does the introduction of ‘choice’ affect the pooling of risks in European welfare states? The case of long-term care. In: UNSPECIFIED. (Unpublished)

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Abstract

Ongoing reforms of European welfare states that aim at increasing ‘choice’ for patients, clients, and beneficiaries provide a unique opportunity to explore what exactly drives these reforms and how they reconstitute communities of economic risks. Traditionally, the solidaristic bargain underpinning European welfare states revolved around the twin objectives of a redistribution of resources and a pooling of risks (Baldwin, 1990). Much of the retrenchment literature to date has focused on the income distributive effects of dwindling resources to explain changes in European welfare states. We postulate that more profound changes in welfare arrangements are being driven by the introduction of ‘consumer choice’ which is compatible with welfare expansion of new welfare state pillars. Our case study on long term care explores in particular, what choices users get and whether this allow us to infer the thrust behind ‘choice’ reforms as well as the effects on the pooling of risks in European welfare states. We find that welfare state expansion in long-term care has responded to growing demand and that there is a great variety in the cost-sharing arrangements which cannot all be subsumed under the imperative of cost containment.

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