A new age for older people? policy shifts in health and social care

This paper considers health and social policies for older persons from a cross-national perspective and attempts to uncover some of the factors influencing policy formulation and implementation. The focus is on community care, its meanings and practical implementation. Examples are drawn from Western Europe and the U.S.A. to illustrate and explain differences and similarities. Two sets of explanatory factors are considered crucial. First, the structure of health and social care systems create incentives for clients, care providers and planners in certain directions. The degree of organisational fragmentation and of public control are seen to be the most important structural factors. Second, it is argued that the political and ideological context within which health and social systems operate must be understood if one is to assess the likely directions of future policies.