01.03 The Provision of Care: Decentralization and Cooperation

Aim of the project
This project examines the conditions under which decentralization of care provision can lead to forms of local care arrangements that are grounded in patterns of sustainable cooperation, that is, cooperation that is stable and valuable. It establishes how the stability of the cooperation required for local care provision depends on community cohesion and the civic sentiments (e.g. trust) and civic behaviour (e.g. volunteer work) pertaining to it. The value of the new arrangements will be assessed in terms of their effect on individual autonomy and on possible social inequalities deriving from local variations in care provision.

Theoretical background
Typically, family researchers examine the question of how meso-contexts (organizations, schools) and macro-contexts (policy, culture, economic circumstances) influence care arrangements in families. The reverse question, namely how what happens in families shapes solidarity relations at meso and macro levels, has received little attention. Taking the decentralization of care, i.e. the delegation of the delivery of health and care services to local authorities, as an exogenously given external policy change, this project combines in its empirical part both these questions. Decentralization in the public sector, provides a unique opportunity to empirically assess crucial explanations which go beyond the “crowding out” and “crowding in” hypotheses that dominate the research literature. We hypothesize that when there is more scope for help, caring for family members will foster a shared understanding of the hard realities of being frail, poor, or sick, which in turn reinforces civic sentiments and behavior (“shared fate” hypothesis); when possibilities are limited, e.g. because of more restricted public provisions, we expect that caring for family members will contribute to experiences of deprivation, which in turn weakens civic sentiments and behaviour (“detachment” hypothesis). The normative part of the project focuses on the assessment of the changes in the interrelations between family care arrangements, public care provisions, and community cohesion. The literature on autonomy and justice on the one hand, and care on the other, will form the relevant theoretic background. Whereas these two strands in the ethical literature are often seen as representing partially opposing ethical points of view, the project aims to bring them closer together.

Research design
The project requires data on care arrangements in families that are linked with the communities in which they live. The Netherlands Kinship Panel Study (NKPS), with its 6-digit postal codes of all family members, has linked geographic information to the survey data. Registry data at Statistics Netherlands allow for examinations at the individual level of the availability and use of publicly financed provisions such as daycare, home help, and youth care in connection with geographic distance to family members. Using state of the art data linkage facilities at ODISSEI (Open Data Infrastructure for Social Science and Economic Innovations, https://odissei-data.nl/en/), it will also be possible to see how care provision for individuals then affects local group dynamics by observing shifts in work patterns and living arrangements of their care providers and local community. Surveys which have been linked to registry data, such as the NKPS, the Longitudinal Ageing Study Amsterdam (LASA), and the Social Cohesion and Well-being survey (SocSam-Wmo) of Statistics Netherlands, provide an option for analyses at postal code level. Geo-coded data (e.g. verbal content such as reviews of services and amenities at a street level) enable sentiment analysis of communities. If feasible, analyses can be expanded to other countries where family surveys have been linked to registry data, such as Norway and Sweden. The empirical results will be normatively assessed, firstly, in terms of the effects of decentralization on personal autonomy (individual level). Rather than viewing care and autonomy as two distinct ethical values, we take them to be interrelated. Secondly, we discuss the implications that decentralization has for the access that individuals have to care, focusing on the issue of whether those differences create inequalities in access to care (social level).

Project initiators

 dr. Tom Emery (Sociology)