Description Parallel Stream Session A.1

Description Parallel Stream Session A.1

Parallel Stream Session A (09:30-10:45)
Stream A.1: Justice in Cash and Care.

Rosanne Oomkens (Panteia) and Basak Akkan (Bogazici University, Istanbul).

All over Europe and due to aging, the costs of care emerge as a pressing policy issue for welfare states.  In the long-term care reforms, emphasis was placed on home-based care services; care services were increasingly targeted to those with the most severe needs; reimbursements for care providers were restricted in order to contain costs; co-payments with less severe care needs were increased (Pavolini and Ranci, 2008; Van den Broek et al. 2019). In many countries, long-term care is transferred to families as a result of recent reforms, a tendency called re-familiarization.

Dealing with these rising costs challenges solidarity and justice. Should the costs be paid by tax money and premiums in times of declining economic growth, or should these be paid by citizens from their own wallet? And if opted for the latter, what policy is the best; income related personal contributions and deductibles, supplementary insurance policies or direct non-insured care (Canoy, 2017)? Yet, many people cannot afford any longer the costs of care. In the Netherlands, people with low and middle incomes sometimes pay 20 to 25 per cent of their income on care. According to international OECD data, the Netherlands performs poorly when it comes to care avoidance (Van Loef, 2018).

Here, solidarity and justice are at stake. Justice implies recognizing the ‘deserved’ needs of the vulnerable elderly, while solidarity refers to the way society and individual citizens fulfil those needs based on mutually shared interests and human values. In health and social care, solidarity refers to redistributive mechanisms where collectively organised and contribution based compulsory insurance systems guarantee equal access to health and social care services. Thus, solidarity is not a just a matter of collective interests, but also refers to ‘relations of support and understanding between individuals engaged in cooperative practices’ (Ter Meulen, 2016: 525).  For a long time, collective solidarity has been referred to as the core value underpinning (health) and social care systems. However, a paradigm shift challenges collective solidarity by reframing it as ‘state dependency’, which should be substituted by individual freedom, autonomy and personal responsibility (Ter Meulen, 2016). This new paradigm hides that accentuating personal responsibility and individual freedom can only be materialized by way of family dependency for those vulnerable elderly that can’t afford commercialized care support. Yet, what does this mean in a context of persistent gender and class inequalities?

Therefore, social justice and just distribution of care resources is a fundamental issue in debates on the (cost) of care; not only its costs in financial terms but also in terms of time spent on care provision by family members. The perspectives on social justice shape the model of the (health) care system, which a particular country aims to establish. These perspectives also define, for example, the line between (health) care services freely available for the whole population though social insurance schemes and those which have to be purchased privately. The kind of health and social care resources distribution also provides the context for the interpretation of different dilemmas, such as the tension between autonomy and paternalism or providing and withdrawing certain forms of care (Gefenas, 2001).

This workshop focuses on the meaning and relevance of the concept of solidarity as compared to the concept of social justice. Taking on the capabilities approach (Nussbaum, 2011; Sen, 2009) social justice means being able to live a life that one values, in a context of freedom and dignity. It implies one is able to keep control over their own life, even if one needs care and support.  While liberal understanding of ‘justice’ refers to rights and duties, the concept of solidarity refers to relations of personal commitment and recognition. Both concepts are important for the arrangement of health and social care practices (Ter Meulen, 2015).

Questions on the balance between social justice, solidarity and the (cost) of care are at the core of this interactive workshop, in which the scholarly debate and implications for social policy come together. Emphasis on implications for social policy is highly valued.