Political Institutions and Elderly Care Policy: Comparative Politics of Long-Term Care in Advanced Democracies

244 Pages·2012·6.149 MB·English

by  Takeshi Hieda (auth.)

Political Institutions and Elderly Care Policy

Political Institutions and
Elderly Care Policy
Comparative Politics of Long-Term Care
in Advanced Democracies
Takeshi Hieda
Associate Professor, Graduate School of Law, Osaka City University
© Takeshi Hieda 2012
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First published 2012 by
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ISBN 978-1-349-34846-6 ISBN 978-1-137-03105-1 (eBook)
DOI 10.1057/9781137031051
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21 20 19 18 17 16 15 14 13 12
Contents
List of Tables vii
List of Figures viii
L ist of Abbreviations ix
Acknowledgements xi
1 Introduction 1
1.1 Outline of the argument 3
1.2 Methodology 5
1.3 Contributions of the book 7
1.4 Plan of the book 9
2 Understanding the Politics of Universalistic Social
Care Services: A Theoretical Framework 12
2.1 Rationality and historical contingency:
analytical framework 14
2.2 Political competition and universalistic welfare
programs: theoretical model 16
3 Political Institutional Conditions for the Development of
Elderly Care Programs: Quantitative Evidence 28
3.1 Hypotheses 28
3.2 Data and variables 29
3.3 Analytical method 34
3.4 Results 37
3.5 Discussion 45
4 Sweden: The Manipulative State 49
4.1 The characteristics of political institutions in Sweden 51
4.2 Elderly care programs in Sweden 62
4.3 The development of elderly care in Sweden 64
4.4 The transformation of elderly care system in Sweden I:
Ädel reform 73
4.5 The transformation of elderly care system in Sweden II:
privatization and decentralization 83
4.6 Conclusion 89
v
vi Contents
5 Japan: ‘MHW and the Japanese Miracle’, in a Sense 91
5.1 The characteristics of the constitution,
the electoral system, and party organizations in Japan 93
5.2 Elderly care in Japan 104
5.3 The politics of elderly care policy in Japan 110
5.4 Conclusion 136
6 The United States of America: Evolution without Revolution 140
6.1 The characteristics of political institutions in
the United States 142
6.2 Elderly care programs in the United States 151
6.3 The legislative history of long-term care policy
in the United States 159
6.4 Conclusion 177
7 C onclusion: Political Institutions, Voter–Politician Linkage,
and Universalistic Social Policy 182
7.1 Overview 182
7.2 Alternative explanations 187
7.3 Implications 193
Notes 196
Bibliography 209
Index 227
Tables
2.1 Typology of social protection programs 19
3.1 The strength of personal vote 32
3.2 Mean value of dependent and independent
variables, by country 35
3.3 Regression of public elderly care spending as a per cent
of GDP on explanatory variables with pooled-OLS
models, 1980–2001 38
3.4 R egression of other public spending programs on
explanatory variables with pooled-OLS models, 1980–2001 46
4.1 S wedish electoral systems of the second chamber
(((Andra Kammaren) 53
4.2 The percentage of seats in the second chamber and
the formal governing coalitions, 1921–2006 56
4.3 T he social democrats’ parliamentary bases in
the two chambers, 1932–1970 57
4.4 Bed blockers in acute-care hospitals in Sweden, 1989–1992 7 5
4.5 T he list of members in Ädel Committee 79
5.1 Japanese electoral systems 96
5.2 Long-term care system before and after 2000 106
5.3 Contents of ‘Gold Plan’ 129
6.1 The U.S. electoral systems 145
6.2 N ursing home care expenditures in millions by
source of funds, 1970–2005 152
6.3 Coverage of institutional and home care services for
aged 65 and over 155
6.4 Legislative history of Medicaid long-term care
coverage, 1965–2005 179
7.1 Public attitudes towards expected and preferred care
forms in selected European countries in 2007 191
7.2 Desirable form of care at home in Japan, 1995 and 2003 192
vii
Figures
2.1 S catter plot between aged population rates and public
in-kind benefits for the aged as a per cent of GDP,
17 countries, in 2005 13
3.1 T ime-series changes in public spending for elderly care
as a per cent of GDP, by country, 1980–2001 31
3.2 P redicted effects of population aging, interacted with
the degree of personal vote and the degree of federalism,
with 95 per cent confidence interval, in Model A2 41
4.1 Demographic trend in Sweden, 1900–2008 64
4.2 Nursing homes and old people’s homes,
the number of residents 70
4.3 T he number of recipients of elderly care services
in Sweden, 1960–2000 72
4.4 P ublic expenditures for elderly care and
health care programs in Sweden, 1980–2003 74
4.5 Personnel employed in the private sector of
state-subsidized care for elderly people 84
5.1 Coordination problems under SNTV in a four-seat district 98
5.2 Time trend of elderly care expenditures in Japan,
1980–2006 108
5.3 Percentage of old age people in care institutions 109
5.4 T ime trend of home helpers in Japan, 1965–2009 116
5.5 Time trend of health care for the aged 118
5.6 Time trend of social expenditures by items 121
viii
Abbreviations
Sweden
C Centre Party
FP Liberal Party
KD Christian Democrats
M Conservative Party
MP Green Party
SAP Social Democratic Party
VPK L eft Party Communists
Japan
DSP Democratic Socialist Party
JCP Japan Communist Party
JMA Japan Medical Association
JSP Japan Socialist Party
LDP Liberal Democratic Party
LTCI Long-Term Care Insurance
MHW Ministry of Health and Welfare
MMD Multi-Member District
MOF Ministry of Finance
PARC Policy Affairs Research Council
SNTV Single Non-Transferable Vote
United States
AARP American Association of Retired Persons
ADA Americans with Disabilities Act
AHA American Hospital Association
AMA American Medical Association
ANHA American Nursing Home Association
HCBC home and community-based care
HEW Department of Health, Education and Welfare
HHS Department of Health and Human Services
HIPAA Health Insurance Portability and Accountability Act
ICF intermediate care facility
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