Comparing the Coordination of Elderly Care Services in European Welfare States: How Organizational Actors Respond to Marketization Policies

Research question/goal: 

The elderly population is often in need of both healthcare and long-term care (LTC) services. Confronted with an ageing population, European welfare states are struggling with coordinating and integrating services at the interfaces of the two systems. In recent decades, marketization policies in both healthcare and LTC systems have further aggravated coordination problems. Inadequate coordination results in higher costs and lower quality. While various coordinative tools have been implemented in all countries, it is still unclear how far and why welfare states vary systematically in this respect. We expect that the way countries have responded to these challenges depends on the respective institutional settings in healthcare and LTC as well as on trajectories of marketization policies and organizational structures in the field. By systematically taking into account cross-national variations of these dimensions, we are able to provide new evidence and new explanations for cross-national differences in coping with this major challenge among European welfare states. In doing so, the project aims to 1) identify the main cross-national institutional differences in the links between healthcare and LTC systems (institutional settings), 2) analyse the impact of marketization policies on coordination problems at the interfaces between the two systems (policies & problem constellations), and 3) explore the role of organizations in providing tools for a solution of these coordination problems (organizational action). The project studies five institutionally diverse country cases in depth: Sweden, Germany, Poland, the Netherlands, and Switzerland. We mainly rely on own primary data consisting of semi-structured interviews with organizational actors in all five countries, but we will also use national and international comparative secondary data.

Current stage: 

Despite a delay due to the pandemic, most of the interviews with stakeholders in long-term and health-care services for elderly people were completed in 2021. For most countries, data were coded and analysed. First drafts of the Dutch and Swedish country chapters and of the theory and methods chapters for the project monograph have been prepared. Furthermore, we published a new long-term care typology, which includes most OECD countries.

Fact sheet

2015 to 2022
Data Sources: 
various international and national data sets
Geographic Space: 
Germany and other European countries