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Long-Term Care Reforms in OECD Countries$
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Cristiano Gori, Jose-Luis Fernandez, and Raphael Wittenberg

Print publication date: 2015

Print ISBN-13: 9781447305057

Published to Policy Press Scholarship Online: January 2017

DOI: 10.1332/policypress/9781447305057.001.0001

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Multilevel governance and its effects on long-term care support

Multilevel governance and its effects on long-term care support

(p.271) Twelve Multilevel governance and its effects on long-term care support
Long-Term Care Reforms in OECD Countries

Hildegard Theobald

Elizabeth Ozanne

Policy Press

The chapter discusses the changes occurred in multi-level governance in recent decades, with the introduction of more universal LTC policies. These changes have resulted in a greater involvement by central tiers of government, in contrast to previous policies which were generally administered at local or regional government levels. This means that LTC policies have experienced a shift towards greater national uniformity. The central government has set up common rules that – to various degrees and in different forms – apply to the whole country, including rules on eligibility, levels of care, funding, assessment procedures, and quality regulation. This process has positively increased the territorial equity of LTC systems. The chapter shows that introduction of more territorial uniformity was generally part of broader policies aimed at developing and enlarging LTC systems, but over time has changed. In several countries, the recent trend is for greater national uniformity to be accompanied by decreasing public support for LTC provision. A challenge for the future, therefore, will be to monitor the effects of this combination of greater national uniformity with reduced public expenditure on LTC.

Keywords:   multi level governance, central government, regional governments, local governments

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