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2012 Conference Presentation

Domiciliary care BelgiumGermanyItaly

6 September 2012

Governance levels and the performance of care systems

Jef Breda, University of Antwerp, Belgium


The care policy for dependent elderly at home is in all countries a mix of financial benefits and services: benefits in order to pay for care activities or extra care costs and services for personal care and household chores. Yet these instruments are implemented at different levels.

There is a strong tendency to use the financial instrument at the national level and the services at the regional level. This mixture can create coordination problems but some authors see in the decentralization of these competencies a kind of conscious strategy to limit the development of the care infrastructure. Only regions with a high income are maybe in a position to install a high supply of services. In an empirical assessment we are able to confirm the fact that there are everywhere huge regional differences in the take up not only of services but also of the (uniform, national) benefits. But none of these differences are related to differential income levels of the regions, but to other phenomena. Except for Italy where the huge income differentials of the autonomous regions are positively related to the uptake of all kind of services and indirectly of the national cash benefits. The institutional differentiation at distinct governance levels of policy competences in the home care leads towards a complex policy structure and implementation but seems to have no decisive influence on the level of innovation and on the level of supply of benefits and services (not in Belgium and Germany, but yes in Italy). The chosen type of the long term care system and the type of welfare state seem to have a more decisive impact than the choice of the geographical level.


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