Community care in England and France : reforms and the improvement of equity and efficiency / Bleddyn Davies, José Fernández, Robin Saunders.

Format:

Book

Author/Creator:

Davies, Bleddyn.

Contributor:

Fernández, José, 1971-

Saunders, Robin, 1944-

University of Kent at Canterbury. Personal Social Services Research Unit.

Language:

English

Subjects (All):

Community health services--England.

Community health services.

Community health services--France.

Medical policy--England.

Medical policy.

Medical policy--France.

Older people--Services for.

Older people--Long-term care.

Older people--Home care.

France.

Older people--Home care--England.

Older people.

Older people--Home care--France.

Older people--Long-term care--England.

Older people--Long-term care--France.

Older people--Services for--England.

Older people--Services for--France.

Community Health Services.

England.

Health Policy.

Medical Subjects:

Community Health Services.

England.

France.

Health Policy.

Physical Description:

xxiv, 228 pages : illustrations ; 23 cm

Place of Publication:

Aldershot ; Brookfield, Vt. : Ashgate, [1998]

Contents:

1 English and French policy goals and service systems: vivent les differences 3

1. Concentration of responsibility, authority and accountability 3

2. Balance between benefits in cash and kind 9

3. Focus of eligibility on the person 10

4. Proportions living in residential institutions and receiving home care 11

2 Home care in England 13

1. Main features pre-reform 13

1.1 Service provision 13

1.2. Access 14

1.3. Assessment: structures and incentives 15

2. The evolution of the policy 17

2.1. Confluence of policy-shaping influences, 1974-86 17

2.2. Model logic and implementation, 1986-1995 21

The Griffiths model 22

The White Paper version 26

Policy guidance 28

The policy logic in its context 28

Implementation 29

3. Post-reform features 29

3 Home care in France 35

1. Principal services 35

1.1. Home help 36

Financing 36

Supply 36

1.2. Other services 38

1.3. Access 38

1.4. Assessment: structures and incentives 40

2. Official critique and policy themes 41

2.1. Policy themes 44

Assessment 45

Financing 47

3. Reform proposals 49

3.1. Prestation experimentale dependance (PED) 49

The Ille et Vilaine Care Management Project 54

3.2. Prestation autonomie dependance (PAD) 56

Assessment and functional dependence 57

Income test and recuperation sur succession 59

Monitoring the use of the benefit 59

Cost to public funds 60

3.3. Prestation specifique dependance (PSD) 60

Role of the departements 63

Concerns 64

4 Study design 71

1. Collection of evidence 71

1.1. Research foci 71

1.2. Data collection 72

1.3. Study features 73

5 Users' need-related circumstances and the response of informal caregivers: a comparison for the English and French samples 77

1. Need-related circumstances 77

2. Informal care and needs 82

6 Formal agency response to needs and informal care 89

1. Comparison of matched areas 89

2. Do services in kind displace informal care? 93

2.1. Displacement, cost escalation, and the community care reform 93

2.2. Displacement, 'substitution', and related concepts 97

Within-mode substitution 97

Between-mode substitution 98

2.3. Displacement-related indicators 101

2.4. Results 103

2.5. Model form 106

2.6. Model results 108

Effects of need-related circumstances on levels of informal and formal help 110

Any tasks (Table 27) 110

Personal care tasks (Table 28) 110

Housework tasks (Table 29) 111

Interactions between informal and formal help 111

Any tasks (Table 27) 111

Personal care tasks (Table 28) 112

Housework tasks (Table 29) 112

La Manche: significantly different 112

7 Entry into institutions 117

1. Methods 118

1.1. Matching the English cases to the French sample to compare entry probabilities 118

1.2. Predictors and postulated effects 120

Policy variables: cash benefits 120

Policy variables: hours of agency services 124

1.3. Control and intervening variables 124

Impairment, disability and handicap 124

Income support network and living arrangements 125

Disease types 125

1.4. Methods and model form 125

1.5. Statistical techniques 126

2. Results 127

2.1. Average probability of entry 127

2.2. Model coefficients 127

3. Control variables 131

Disability 131

Informal care 131

Income 131

3.1. The principal results 132

Marginal productivities 133

Modal choice at the individual level 133

Cash and care 135

3.3. Effects of varying provision levels on entry 136

1. Summary of main findings 149

1.1. The evidence as a source 149

1.2. Comparisons between England and France 150

Need-related circumstances: users 150

Help from 'informal caregivers' 151

Formal agency response to need 151

Substitution between formal and informal inputs 151

The probabilities of entry into institutions for long-term care 152

1.3. Comparisons between the three French areas 153

Need-related circumstances of users 154

Informal help 154

Formal service response 155

Destinational outcomes for users 156

2.1. Contrasting foci: direct influence on supply versus subsidisation with regulation 156

2.2. Implications of the contrast 158

Mixed social insurance and social assistance financing 158

Targeting cash with brokerage 158

Marginal productivities of services 159

The displacement of informal care by services 161

3. Current reforms: sound foundations for the future? 162

3.1. England and Wales 162

3.2. France 164

Annex Need-related circumstances, caregiver and service responses and destinational outcomes during two years: the French sites compared 167

A.2. Destinational tables: proportions remaining in the community after the second and third assessments 167

A.3. Destination of the French sample by INSERM categories of disability 171

A.4. Destinations of French sample relative to the original level of disability measured by interval need 171

A.5. Informal response to needs 176

A.6. Informal care in relation to specific tasks 179

A.7. Mean number of hours of informal help 179

A.8. Formal response to needs 184

A.9. Synopsis 187

A.9.1. Attrition and user location (Tables A.1 to A.8) 189

A.9.2. Levels of help by informal caregivers (Tables A.9 to A.28) 189

A.9.3. Formal help (Tables A.29 to A.48) 189

G.1. An explanation of terms used in the text 199

G.1.1. France 199

G.1.2. England 201

G.2. List of variables used in modelling 205

G.2.1. The French data 205

G.2.2. The English data 206.

Notes:

"PSSRU, University of Kent at Canterbury"--Cover.

Includes bibliographical references (pages [209]-220) and indexes.

ISBN:

1840145846

OCLC:

39973859