Comparing the coordination of elderly care services in European welfare states: how organizational actors respond to marketization policies

老年人通常需要医疗保健和长期护理服务。面对人口老龄化，欧洲福利国家正在努力协调和整合两个系统接口的服务。近几十年来，医疗和长期护理系统的市场化政策进一步加剧了协调问题。协调不足导致费用增加和质量下降。虽然所有国家都采用了各种协调工具，但福利国家在这方面的系统性差异有多大以及为什么会有差异仍不清楚。我们预计，各国应对这些挑战的方式取决于医疗保健和LTC各自的机构设置以及该领域市场化政策和组织结构的轨迹。通过系统地考虑这些维度的跨国差异，我们能够为欧洲福利国家应对这一重大挑战的跨国差异提供新的证据和新的解释。在此过程中，该项目旨在1）确定医疗保健和长期护理系统之间联系的主要跨国机构差异（制度设置）; 2）分析市场化政策对两种制度界面协调问题的影响（政策和问题星座），（3）探讨组织在提供解决这些协调问题的工具方面的作用（组织行动）。该项目深入研究了五个体制不同的国家案例：瑞典、德国、波兰、荷兰和瑞士。我们主要依靠自己的主要数据，包括对所有五个国家的组织行为者的半结构化访谈，但也将使用国家和国际比较次要数据。

The elderly population is often in need of both healthcare and long-term care (LTC) services. Confronted with an ageing population, European welfare states are struggling with coordinating and integrating services at the interfaces of the two systems. In recent decades, marketization policies in both healthcare and LTC systems have further aggravated coordination problems. Inadequate coordination results in higher costs and lower quality. While various coordinative tools have been implemented in all countries, it is still unclear how far and why welfare states systematically vary in this respect. We expect that the way countries have responded to these challenges depends on the respective institutional settings in healthcare and LTC as well as on trajectories of marketization policies and organizational structures in the field. By systematically taking into account cross-national variations of these dimensions, we are able to provide new evidence and new explanations for cross-national differences in coping with this major challenge among European welfare states. In doing so, the project aims at 1) identifying the main cross-national institutional differences in the links between healthcare and LTC systems (institutional settings), 2) analysing the impact of marketization policies on coordination problems at the interfaces between the two systems (policies & problem constellations), and 3) exploring the role of organizations in providing tools for a solution of these coordination problems (organizational action). The project studies five institutionally diverse country cases in depth: Sweden, Germany, Poland, the Netherlands and Switzerland. We mainly rely on own primary data consisting of semi-structured interviews with organizational actors in all five countries, but will also use national and international comparative secondary data.