Governance on home care in Europe.

Abstract

Introduction: Demand for health and social care services in the community will grow as a result of the ageing of populations across Europe. At present, however, very little is known about the preparedness of national home care systems for changing demand, which is not just quantitative but also qualitative in kind. There is a need for insight into the state of home care, including policy and regulation and aspects of financing, organisation and provision of services. Methods and Materials: EURHOMAP study has developed an extensive set of indicators to map home care systems that focus on: policy and regulation; financing; organisation & service delivery; and clients & informal carers. Data were collected in 31 European countries. We also used the answers of key informants on questions related to four ‘vignettes’ (hypothetical case descriptions of home living people in need of care). Results: Home care systems widely vary in their degree of development and that the structures of governance, regulation and models of provision are very heterogeneous. An aspect of home care that creates challenges at all levels is the mix of social, nursing and health services, which are supposed to be delivered in an integrated way to clients and patients. Cost control in community care is a common issue of most countries, but budgetary and efficiency measures taken and mechanisms developed are very different. Maintaining and improving home care services is a priority in many countries which does not always match with needs to increase efficiency. Conclusion: Although home care is a major point of policy in many countries, it is not heavily regulated. In many countries home care governance is split between different types of care and, consequently, not well integrated. Despite the dominance of public provision, tendencies towards more privatisation, contracting and competition can be identified. (aut. ref.