Which European model for elderly care? Equity and cost-effectiveness in home based care in three European countries

Long term care for the elderly is growing apace in developed economies. As growth is forcing change in existing production and delivery systems of elderly care services, the question arises as to how different systems compare in terms of cost-effectiveness, equity or quality. Based on an in depth survey carried out in Denmark, Ireland and Italy – the GALCA survey – this articles compares prevailing arrangements of home based long-term care in these three countries, focussing on the overall cost-effectiveness of the provisions as well as on employment equity for the care workers. Comparison between alternative types of provisions within each country suggests that home based care is generally, although not consistently, more cost-effective than care within institutions. Comparison of home care provisions across the three countries suggests that the Italian and the Danish systems are the most cost effective, but the Danish system is more equitable, overall. These latter findings are partly explained by progressive replacement in Italy of unpaid family carers with low cost immigrant workers directly employed by the families and often cohabiting with the elderly, the migrant-in-the-family model of long term care. This new model has spread across Southern Europe and raises complex issues of equity and sustainability from an employment perspective.ederly care, cost-effectiveness, migration, welfare

Which European model for elderly care? Equity and cost-effectiveness in home based care in three European countries

Long term care for the elderly is growing apace in developed economies. As growth is forcing change in existing production and delivery systems of elderly care services, the question arises as to how different systems compare in terms of cost-effectiveness, equity or quality. Based on an in depth survey carried out in Denmark, Ireland and Italy – the GALCA survey – this articles compares prevailing arrangements of home based long-term care in these three countries, focussing on the overall cost-effectiveness of the provisions as well as on employment equity for the care workers. Comparison between alternative types of provisions within each country suggests that home based care is generally, although not consistently, more cost-effective than care within institutions. Comparison of home care provisions across the three countries suggests that the Italian and the Danish systems are the most cost effective, but the Danish system is more equitable, overall. These latter findings are partly explained by progressive replacement in Italy of unpaid family carers with low cost immigrant workers directly employed by the families and often cohabiting with the elderly, the migrant-in-the-family model of long term care. This new model has spread across Southern Europe and raises complex issues of equity and sustainability from an employment perspective.elderly care; long term care; cost-effectiveness; migration; welfare

Evidence on women trafficked for sexual exploitation: A rights based analysis

The aim of this paper is to investigate which factors influence the pattern of enforcement (violation) of basic rights among women trafficked for sexual exploitation. A conceptual frameworkis adopted where the degree of agency and the possibility to influence the terms of sex-based transactions are seen as conditional on the enforcement of some basic rights. Using IOM data on women assisted in exiting from trafficking for sexual exploitation, we investigate the enforcement (violation) of five uncompromisable rights, namely the right to physical integrity, to move freely, to have access to medical care, to use condoms, and to exercise choice over sexual services. By combining classification trees analysis and ordered probit estimation we find that working location and country of work are the main determinants of rights enforcement, while individual and family characteristics play a marginal role. Specifically, we find that (i) in lower market segments working on the street is comparatively less ‘at risk’ of rights violation; (ii) there is no consistently ‘good’ or ‘bad’ country of work, but public awareness on trafficking within the country is important; (iii) the strength of organized crime in the country of work matters only in conjunction with other local factors, and (iv) being trafficked within one’s country, as opposed to being trafficked internationally, is associated with higher risk of rights violationhuman trafficking, sexual exploitation, basic rights, classification and regression trees, ordered probit

Women, Men and the Financial Crisis. Seven Lessons from Europe

More than four years after its inception, the great European recession is still a work in progress. While this makes any stock-taking exercise a tentative affair, four full years are enough to draw some lessons from how women, men and gender equality fared in this crisis and on what may lie ahead. Seven such lessons are set out below focusing primarily on work – paid or unpaid – and welfare. The source material is the joint report on women, men and the crisis commissioned by the EC and available at http://ec.europa.eu/justice/gender-equality/tools/experts/index_en.ht

Costs and prospects for home based Long Term Care in Northern Italy: the Galca survey

An important issue in the design of sustainable Long Term Care policies is the relative social cost of community or home based care versus institutional care. Here we undertake this cost comparison making use of the findings from the GALCA surveys on Long Term Care in Denmark, Ireland and Italy but confining attention to Italy. The survey for Italy was conducted in the municipality of Modena that may be considered broadly representative of Long Term Care conditions in the North of the country. It offers detailed descriptions of the carers and the cared for ranging from demographic and epidemiological characteristics to labour market position. The survey also allows to accurately compile all the ‘inputs’ that go into home care, from ‘unpaid’ family labour and paid labour of immigrant minders to public and private services. Based on this information, we calculate the overall, per elderly social cost of home based care and find that home based care is more cost effective than institutional care even if the opportunity cost of ‘unpaid’ family carers is valued and included in the calculation. We discuss the reasons for cost effectiveness and identify some of the risk factors that threaten the long term sustainability of current home care arrangements in Italy. JEL classification: H51, I11, J14, J22. Keywords: Government Expenditure and Health; Analysis of Health Care Market, Economics of the Elderly; Time allocation and Labour Supply JEL classification: H51, I11, J14, J22. Keywords: Government Expenditure and Health; Analysis of Health Care Market, Economics of the Elderly; Time allocation and Labour Supply Acknowledgements This paper is drawn from the final report of the project Galca Gender Analysis and Long Term Care) financed by the European Commission and led by the Fondazione Giacomo Brodolini. Our thanks go the staff, the Secretary and the President of the Fondazione for support during the project and encouragement to circulate its findings

Sex Work and Trafficking: Moving Beyond Dichotomies

This contribution examines how feminist economists have conceptualized sex work and trafficking through the lens of agency and stigma. The ongoing debate about legalization has focused on sex workers’ agency and choice, and on the role of stigma in shaping the supply of and demand for sex work. Building on the analysis advanced by contributions to this special issue, this study contends that theoretical and policy debates about sex work are dominated by false dichotomies of agency and stigma. It argues that the relationship between stigma and agency operates along a continuum of contractual arrangements that underpins a high degree of segmentation in the industry. The higher the stigma, the lower tends to be the agency. Current policies toward sex work therefore need reconsideration–especially mounting support for criminalization of clients, which, by increasing stigma, is likely to detract from the agency and the well-being of sex workers, however unintentionally

Quashing demand or changing clients? Evidence of criminalization of sex work in the United Kingdom

The use of regulation of sex work is undergoing sweeping changes across Europe and client criminalization is becoming very widespread, with conflicting claims about the intended and actual consequences of this policy. We discuss changes in demand for paid sex accompanying the criminalization of prostitution in the United Kingdom, which moved from a relatively permissive regime under the Wolfenden Report of 1960, to a much harder line of aiming to crack down on prostitution with the Prostitution (Public Places) Scotland Act 2007 and the Policing and Crime Act of 2009 in England and Wales. We make use of two waves of the British National Survey of Sexual Attitudes and Lifestyles (NATSAL2, conducted in 2000–2001 and NATSAL3, conducted in 2010–2012) to document the changes in both the amount of demand for paid sex and in the type of clients that have taken place across the two waves, and their possible implications for policies that frame prostitution as a form of crime