Japan is one of the most aged societies in terms of longevity as well as the ratio of the elderly; however, the long-term care system based on German one was introduced only in 2000. The Japanese system has several uniqueness, especially the important role given to the family. This feature has been causing many issues, such as care fatigue of the family members, especially that of daughters, but more and more also that of sons.

Why an elderly care policy introduced in 2000 has been strongly relying on traditional family? The paper tries to analyse and explain this unique characteristic of Japanese long-term care system from historical, legal, and societal points of views.

The first two perspectives are strongly related each other. Japanese first modern civil law enacted in the Meiji period was based on its unique family system, in which the head of household had strong right and duty and was the basis of social security system (Motozawa, 1996; 2022). The paper first analyses the historical changes of family system in terms of legal background and societal tradition to understand the origin of today’s system, through literature review. Indeed, this societal tradition and legal setting at that time established that the wife of eldest son, daughter in law to take care of the parents of the son, but not her own parents, as she is not any more a member of the family where she came from. The new constitution enacted in 1946 after the Second World War changed completely the old traditional family system in legal term; however, the societal value of traditional family remained.

Second, the paper analyses the legal basis of social security and its development, which resulted in the long-term care insurance system, enacted in 1997, enforced in 2000. The Japanese long-term care insurance system is modelled after German system, but has many uniqueness. It is limited to the elderly and although the family structure and values are changing rapidly, it is still strongly base on traditional family system. Indeed, the Japanese long-term care insurance system relies on support of family caregivers. In 2017, a new measure was introduced to improve the existing long-term care insurance system: it is a combination of enhanced nursing care leave system and nursing care insurance benefits.

Third, the paper analyses the outcome and issues of the long-term insurance system in Japan. The system highlights the role and value of family, although they are rapidly changing, thus, causing many issues. Finally, it tries to analyse the system from financial point of view to identify the merit of the system.

Policy coordination has become a central and challenging issue in modern welfare states. One area where the need for coordination is particularly important is in the care of chronic and frail elderly patients. – This paper reviews the development in policy instruments to promote coordination/integration of care for this group using Denmark as the empirical example. We discuss the nature of the coordination issues and develop a classification of policy instruments that have been applied in Denmark since this issue was articulated as a critical problem in health and welfare services in the 1990s. We provide indications of effects using national, regional and local level indicators. – We use the concept of “wicked problems” and literature about “cross sector collaboration” to discuss reasons for the persistence of coordination as a policy issue despite continuous aspirations to address the problems through regulation, agreements and guidelines for policy actors and professionals at state, regional and local levels.

Abstract

In recent decades, reforms in European welfare states and public services have been strongly influenced by the ideas of New Public Management (NPM) and New Public Governance (NPG). Increasing efficiency through private sector methods has been a powerful driver behind many NPM reforms, while intentions to make the administration more user-friendly, holistic and cooperative reflect NPG ideas. Although the type and character of the reforms in welfare administrations differ per country, a common setting was the policy shift to 'activation' in the 1990s. The shift implied a change in focus from well-being to work, with the reduction of social expenditure and more flexibility of the labour market as important objectives. Given the common premise of 'activation', convergence of welfare administrations can be expected over time. But history, culture and national contexts can also influence reform trajectories and can lead to a (re)confirmation of differences between states.

In this paper, we aim to understand the convergence and/or divergence in welfare state governance across Europe. Unlike many studies with a shorter time horizon, we take a longitudinal approach, studying two countries over three decades. Our research question is if and how reform trajectories reflect NPM and NPG ideas in two welfare administrations since 1990, in particular with respect to the roles and relationships between the relevant public and private stakeholders.

Norway and the Netherlands are used as critical cases. Both countries are forerunners of "active" welfare reform; they significantly changed their welfare administrations, using elements of NPM and post-NPM models to improve service coordination, responsiveness to client needs, and efficiency in service delivery. Reforms for, e.g., a principal-agent model in Public Employment Services (PES), or one stop-shops and public-private networks reflect international trends visible in many OECD countries.

Data for this paper are derived from the longitudinal research of both authors in their respective countries. They include interviews with political and administrative leaders, trade unions, employers, and managers and professionals of organizations providing social and employment services. For both cases, we also studied a large range of public documents, laws, reports from public committees, organisational plans, and evaluation reports.

Findings point to increasing convergence of reform trajectories, but persistent divergence in current welfare administrations. Since 1990, Norway and the Netherlands have both changed their welfare administration twice in the first 15 years, and each time in different directions (divergence). Since about 2008, we have seen more convergence in a shared transition to NPM (2008-2014); in reform for NPG (2015), in line with the broader trend towards decentralization and collaborative services, and in current attempts at more recent standardization and efficiency (NPM). Yet, despite increasing convergence in reform trajectories, current welfare administrations in Norway and the Netherlands differ more than they are alike, with diverse roles of national and local government, social partners and other stakeholders. Our findings also indicate that both countries have developed more hybrid systems over time. Alternately NPM and post-NPM, the reforms criticized the previously dominant organization of the welfare state according to traditional hierarchy and functional differentiation. But despite the often far-reaching nature of change (e.g. NAV 2006; SUWI 2002), they did not fully replace earlier models.

Three important lessons about convergence and divergence can be drawn from this research. First, increasing convergence in reform trajectories does not necessarily imply convergence in outcomes (here: welfare administrations). Second, coexisting, overlapping and partly competing elements of NPM and NPG can be observed. Third, the paper contributes a long-term research perspective that is crucial to understanding the complex interplay between NPM and NPG ideas and institutional context factors as drivers of reform. A theory of public sector reform that aims to capture the role of NPM and NPG ideas in new welfare state arrangements should therefore go beyond the assumptions of public management models and leave more room for process-based, historical and institutional factors shaping reforms.