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AbstractThe article aims to contribute to understanding social inequalities resulting from familization (or de‐familization) tendencies among cash‐for‐care beneficiaries in a Conservative welfare state. It highlights justifications for choices in accessing and using care in a cash‐for‐care scheme from the perspective of care recipients aged 80 years and older in Vienna. Along key dimensions characterizing care recipients' experiences, we identify four different user groups, which reflect recipients' individual characteristics, particularly gender, socio‐economic status (SES), and care needs, and the respective care arrangement. The groups are dubbed: (1) the self‐confident; (2) the illiterate; (3) the dependent; and (4) the lonely. Narrative interviews with 15 frail older people were held in 2014 and analyzed using the framework analysis method. Results show that familiarity with support structures associates with higher SES, while those who depend on others for acquiring information or organizing care express ambivalence in choosing between formal and informal care. Engagement in deciding which care type to use is limited among people of lower SES or with complex care needs, but own experience as informal caregiver for a family member increases care recipients' long‐term care (LTC) system literacy. Gender differences among care recipients were limited, yet middle‐class female recipients often expressed normative claims for family care from female relatives. We conclude that unconditional care allowance schemes may reinforce existing gender relations, particularly among informal caregivers, as well as underpin socio‐economic differences among LTC users in old‐age. Results also partly question the assumptions of choice and empowerment implicit in many cash‐for‐care schemes.

Während im Zentrum der medialen Aufmerksamkeit vielfach das Thema Kosten für Langzeitpflege und -betreuung (LTC) steht, wird dem Thema der innerstaatlichen, bedarfsgerechten Verteilung öffentlicher Mittel für LTC üblicherweise wenig Aufmerksamkeit geschenkt. Vor dem Hintergrund eines internationalen Vergleichs werden zwei Kriterien der Bedarfsgerechtigkeit in Österreich in der LTC analysiert: regionale Anspruchsvoraussetzungen und faire Kriterien
für die regionale Umverteilung. Die Analyse veranschaulicht, dass in Österreich insbesondere im Bezug auf die Verteilung der Mittel für die Erbringung professioneller Pflege- und Betreuungsdienste Verbesserungsbedarf besteht. Sinnvoll wäre daher die Entwicklung eines nachhaltigen Finanzierungssystems sowie einer koordinierten Gesamtsteuerung und einer klaren Zuordnung der Verantwortungen über die Gesamtkosten der LTC unter Einbeziehung der Pflegebedürftigen.

The current proposals to update the European Union (EU) directive on professional qualifications will have potentially important implications for health professions. Yet those discussing it will struggle to find basic information on key issues such as licensing and registration of physicians in different countries. A survey was conducted among national experts in 14 EU member states, supplemented by literature and independent expert review. The questionnaire covered five components of licensing and registration: (1) definitions, (2) regulatory basis, (3) governance, (4) the process of registration and (5) flow and quantity of applications. We identify seven areas of concern: (1) the meaning of terminology, which is inconsistent; (2) the role of language assessments and the responsibility for them; (3) whether approval to practise should be lifelong or time limited, subject to periodic assessment; (4) the need for improved systems to identify those deemed no longer fit to practise in one member state; (5) the complexity of processes for graduates from non-EU/European Economic Area (EAA) countries; (6) public access to registers; and (7) transparency of systems of governance. The systems of licensing and registration of doctors in Europe have developed within specific national contexts and vary widely. This creates inevitable problems in the context of free movement of professionals and increasing mobility.

Countries with social health insurance (SHI) systems display some common defining characteristics - pluralism of actors and strong medical associations - that, in dealing with crisis times, may allow for common learnings. This paper analyses health system responses during the COVID-19 pandemic in eight countries representative of SHI systems in Europe (Austria, Belgium, France, Germany, Luxembourg, the Netherlands, Slovenia and Switzerland). Data collection and analysis builds on the methodology and content in the COVID-19 Health System Response Monitor (HSRM) up to November 2020. We find that SHI funds were, in general, neither foreseen as major stakeholders in crisis management, nor were they represented in crisis management teams. Further, responsibilities in some countries shifted from SHI funds to federal governments. The overall organisation and governance of SHI systems shaped how countries responded to the challenges of the pandemic. For instance, coordinated ambulatory care often helped avoid overburdening hospitals. Decentralisation among local authorities may however represent challenges with the coordination of policies, i.e. coordination costs. At the same time, bottom-up self-organisation of ambulatory care providers is supported by decentralised structures. Providers also increasingly used teleconsultations, which may remain part of standard practice. It is recommended to involve SHI funds actively in crisis management and in preparing for future crisis to increase health system resilience.

Introduction: Long-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to geographical equity of access to LTC, has received limited attention. We conceptualize that LTC systems promote DE when they are designed to set eligibility criteria nationally (vs. locally); and to distribute funds among PAs based on needs-formula (vs. past-budgets or government decisions). Objectives: This cross-country study highlights to what extent different LTC systems are designed to promote DE across PAs, and the parameters used in allocation formulae. Methods: Qualitative data were collected through a questionnaire filled by experts from 17 OECD countries. Results: 11 out of 25 LTC systems analyzed, fully meet DE as we defined. 5 systems which give high autonomy to PAs have designs with low levels of DE; while nine systems partially promote DE. Allocation formulae vary in their complexity as some systems use simple demographic parameters while others apply socio-economic status, disability, and LTC cost variations. Discussion and conclusions: A minority of LTC systems fully meet DE, which is only one of the criteria in allocation of LTC resources. Some systems prefer local priority-setting and governance over DE. Countries that value DE should harmonize the eligibility criteria at the national level and allocate funds according to needs across regions.

Introduction: Long-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to geographical equity of access to LTC, has received limited attention. We conceptualize that LTC systems promote DE when they are designed to set eligibility criteria nationally (vs. locally); and to distribute funds among PAs based on needs-formula (vs. past-budgets or government decisions). Objectives: This cross-country study highlights to what extent different LTC systems are designed to promote DE across PAs, and the parameters used in allocation formulae. Methods: Qualitative data were collected through a questionnaire filled by experts from 17 OECD countries. Results: 11 out of 25 LTC systems analyzed, fully meet DE as we defined. 5 systems which give high autonomy to PAs have designs with low levels of DE; while nine systems partially promote DE. Allocation formulae vary in their complexity as some systems use simple demographic parameters while others apply socio-economic status, disability, and LTC cost variations. Discussion and conclusions: A minority of LTC systems fully meet DE, which is only one of the criteria in allocation of LTC resources. Some systems prefer local priority-setting and governance over DE. Countries that value DE should harmonize the eligibility criteria at the national level and allocate funds according to needs across regions.