Long-term care in Spain: a reform failure or the regulation of a development path?

Abstract

PurposeSpain departed from the Southern European tradition of residual long-term care services with the 2006 reform. The paper aims to present the main traits of the reform and its implementation, explores the reasons that may explain why the reform happened and to which extent and why it fell short of expectations.Design/methodology/approachThe article draws on available literature on the reform and on administrative data to present a complex and nuanced view of the reform process and its limits.FindingsThe reform was actually a measure to enhance and rationalize a preexisting process of social care services development, rather than the creation of a completely new care system. A rapid increase in female labor market participation since the 1990s and the looming demands of a late baby-boom and the subsequent fertility crash appear to be two key factors that explain both the previous development and its bolstering by the reform. The budgetary constraints of the Great Recession and governance problems, linked to a complex and sometimes dysfunctional multilevel governance arrangement, help to understand why the reform bogged down. Nevertheless, the overall balance is more nuanced, and significantly more services are provided 12 years after the reform.Originality/valueWhile many assessments of the reform have been negative, putting it into a larger context of social care development, the 2006 Dependency Act has contributed to a significant increase in expenditure and coverage. The impact of budgetary restrictions has been important, but other factors, such as governance arrangements, may explain more of the problems of the implementation.