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

The project investigated the coordination of healthcare (HC) and long-term care (LTC) services for the elderly in four European welfare states with different HC and LTC systems: Germany, the Netherlands, Sweden, and Switzerland. The coordination of these services is a challenge in all mature welfare states due to demographic ageing and staff shortages in health and social services. Building on institutional and organizational theories, we assumed that the country-specific institutional, professional, and organizational structures positively or negatively affect coordination between the two sectors. At the same time, we expected the problems to be similar in all countries due to a general lack of staff and financing.

To identify the main coordination problems and possible solutions at the systemic, professional, and organizational level, we conducted 10–15 expert interviews per country with major stakeholder organizations in HC and LTC, each lasting about 45–60 minutes. Most interviews were held in person, but due to the Corona-pandemic, some were held digitally. The interviews were transcribed and analysed by qualitative content analysis with MaxQDA software.

The results show that most coordination problems occur at the system level. Deficits at this level cannot be fully compensated at the professional or organizational level, which is due to general staff shortages, a mismatch between professional education and work competencies, a lack of communication, and high competition between the service providers. We also identified a set of institutional features that facilitate coordination in different institutional contexts: local organization, academically trained nurses, earmarked financing, effective electronic communication tools, gatekeeping in HC, and a limited competition in LTC. Sweden and the Netherlands were found to provide overall better institutional conditions for effective coordination. However, these tools could also be implemented in the other institutional contexts.