Public authority over home care.

Background: The ageing society, decreasing resources and financial constraints are putting governments under pressure. Across Europe, division of responsibilities for long-term care are being reconsidered. Under these pressures, the role of governments in home care could be changing. This paper will provide an insight into the current role of governments in home care and its position within the welfare mix. Methods: A systematic literature review & consultations with experts across Europe resulted in a set of consensus-based indicators for home care systems. In 2008–2010, data was collected in 31 countries. To enhance comparability, several key informants in each country additionally answered standard questions related to hypothetical case descriptions about people in need of home care. Results: Large cross-country differences in governmental control exist. Home care can be divided in home health care and home social care. In most countries both types of care governed differently. The predominant governance model is characterised by a central government being involved only in setting out visions and some minimum and general requirements for, for instance, home care provision and eligibility. Municipalities in that case further define regulations. Four different models of governmental interference in home care could be distinguished. Each model brings its own problems. Conclusions: The influence of local governments on publicly financed home care is generally strong. Local governments are often involved in ‘rowing’ the boat, rather than just steering it. National governments mainly steer. Whereas governance in the public sector is relatively clear, there is a lack of insight in the completely privately financed sector. (aut. ref.