The emergence of social policy in the field of long-term care. A comparative analysis of the introduction and types of long-term care systems in global perspective.

Abstract

While social protection measures against “old” social risks, such as sickness or work injury, have been introduced in large parts of the world since the late 19th century, social policies addressing “new” social risks are much less widespread. Long-term care (LTC), that is, the extended assistance with daily living resulting from impairments, constitutes one such novel risk that has, for a long time, not been recognized as a (distinct) field of social policy. However, this has increasingly changed in the last three decades, and many states throughout the world have introduced social protection measures for LTC. Against this backdrop, this cumulative dissertation examines LTC system introduction and variation globally, aiming to contribute an inter-regional and cross-temporal perspective on social policy in the field of elder care. More specifically, the research focuses on three phenomena, namely, (i) LTC systems under public responsibility, which entail the adoption of statutory entitlements to benefits, (ii) distinct LTC systems, which are additionally defined by a recognition of LTC as a specific social risk/policy field, and (iii) social long-term care insurance (SLTCI) systems as a specific type of distinct system that relies on social insurance principles, most notably compulsory social contribution funding. In doing so, four research questions stand in the center of the study: 1) Which countries have introduced LTC systems and at what time? 2) Which international interdependencies and domestic factors have influenced LTC system introduction? 3) How can a comprehensive and globally applicable typology for comparing LTC systems be configured? 4) How and to what extent do distinct LTC systems (generally) and social LTC insurance systems (in particular) vary?