Care Policy in Slovenia: Divergent Trends and Convergent Attitudes

Slovenia makes a compelling case for care policy analysis since it is marked by extreme dichotomy in care. Therefore, placing Slovenia on a continuum of care regimes ranging from defamilialised to familialised with respect to care is difficult, with care for children being highly defamilialised, and care for older people highly familialised. The country’s childcare policies build on a historically well-developed system of public childcare provision and generous leave policies, together with a well-developed social protection system targeting families. These have been retained and, in some cases, were expanded, still following the 2009 economic crisis, certain austerity measures were introduced. On the other hand, care policies for older people started to develop later and after the initial growth they relatively stagnated (especially the social homecare system). A comprehensive long-term care system has yet to be developed and become a subject of ongoing political debates. Further, unlike in childcare, the increasing role of private actors can be observed in this sector. In the article, we discuss these care policy developments in Slovenia in terms of the role of relevant actors (state, family, private actors) with an emphasis on the views of people regarding care, based on data gathered within an innovative method of democratic forums. The article reveals that the dichotomy of care policies, as well as the differing recent trends in family policies for children and care for older people, is not present in people’s attitudes and their preferences for the arrangement of such policies. Key words: care, social policy, Slovenia, older people, childcare, democratic forum, attitudes.

An Exploration of Person-Centred Approach in End-of-Life Care Policies in England and Japan

Background: Increasing evidence has suggested that a person-centred approach is beneficial not only for improving care outcomes but also for mitigating the pressure on public health systems. However, policy implementation gaps have prevented the translation of this complex framework into useful practical, ethical and moral stances for end-of-life care. This article aims to explore the meaning and implications of person-centredness in end-of-life care policy discourses.Methods: By perceiving policy documents as a medium embodied with socio-political and cultural norms, we analysed how person-centred approach in end-of-life care is constructed within specific socio-cultural contexts and the implications of these contexts on resultant care. Focusing on England and Japan, we conducted a critical policy analysis to examine and compare key policy and legal documents collected between 2007 and 2019 in these two post-industrial and socio-culturally distinctive countries. Results: Our analysis found that the person-centred approach is mobilised in policy discourses primarily through three interconnected dimensions: individual, relational and existential. While acknowledging that both countries have developed varied policy and legal mechanisms to emphasise holistic and integrated care with respect to these three dimensions, we also identified significant gaps in the policies both within and between England and Japan. They include ambiguity in defining patients’ best interests, fragmented support for social and family care and the neglect of existential needs. Conclusions: This cross-cultural analysis has revealed the complex nature of discourses around person-centred approach in English and Japanese end-of-life care policies, which often concentrate on the multifaceted aspects of experiences as one approaches the end of life. Despite this, we argue that a more holistic construction of person-centred approach is needed in end-of-life care policies not only in England and Japan but also more broadly, to encapsulate the richness of end-of-life experiences.

The Economic Value of Non-Professional: A Europe-Wide Analysis

Background: This paper had two aims. Firstly, to provide a broader view of the profile of non-professional caregivers in Europe, and secondly, to estimate the economic value of the non-professional caregiving. Methods: The European Quality of Life Survey 2016/17, carried out by Eurofound, was used. The target population of the survey was adults who care for a relative or friend in a total of 33 European countries. The opportunity cost method was used to estimate the economic value of caregiving, in which two of the activities forgone were analysed: paid activities (restricted to caregivers who were employed), for which the average gross wage of each country was used; and unpaid activities, for which the minimum gross wage of each country was used. Results: There were more than 76 million non-professional caregivers in Europe that provides care for a relative or friend. This figure represents 12.7% of the population in Europe. The estimated time devoted to non-professional care in Europe reached 72,301.5 million hours in 2016. Sharp differences were found among countries. The economic value of that time is estimated at 576,000 million of euros, which represented about 3.63% of Europe’s GDP. Conclusions: This study show the very important number of resources dedicated to the non-professional care of dependent people and their economic valuation. These results may be helpful in prospective analyzes estimating future needs on professional and non-professional and for designing of long-term care policies in Europe.

Antenatal care policy in high-income countries with a universal health system: a scoping review

The availability, effectiveness, and access to antenatal care are directly linked with good maternal and neonatal outcomes, making antenatal care an important determinant in health. But to be effective, care must always be appropriate, not excessive, not insufficient. Perinatal outcomes vary within and between countries, raising questions about practices, the use of best evidence in clinical decisions and the existence of clear and updated guidance.Through a scoping review methodology, this study aimed to map the available antenatal care policies for low-risk pregnant women in high-income countries with a universal health system founded on the Beveridge Model.Following searches on the main databases and grey literature, the authors identified and analysed ten antenatal care policies: Australia, Denmark, Finland, Iceland, Italy, Norway, Portugal, Spain, Sweden and the United Kingdom. Some policies were over 10 years old, some recommendations did not present a rationale or context, others were outdated, or were simply different approaches in the absence of strong evidence. Whilst some recommendations were ubiquitous, others differed either in the recommendation provided, the timing, or the frequency. Similarly, we found wide variation in the methods/strategy used to support the recommendations provided. These results confirms that best evidence is not always assimilated into policies and clinical guidance. Further research crossing these differences with perinatal outcomes and evaluation of cost could be valuable to optimise guidance on antenatal care. Similarly, some aspects of care need further rigorous studies to obtain evidence of higher quality to inform recommendations.

Euthanasia and Withdrawal of Treatment in People with Disabilities and Intractable Diseases: Comparison Between Japan and Western Countries

"Background: In Japan, groups advocating for people with disabilities and intractable diseases (hereafter “PWDs”) have recently voiced serious concerns regarding end-of-life care policies. For example, when non-partisan MPs announced a draft bill on allowing forgoing life-sustaining treatments (LSTs) in 2012, these groups protested. One group in particular strongly protested against a TV documentary by the Japanese public broadcasting corporation in 2019, in which a patient with a serious neurologic intractable disease died by physician-assisted suicide in Switzerland. Objective: To present the specific concerns voiced by PWDs regarding end-of-life care policies and to compare debates between Japan and Western countries on the topic. Method: Comprehensive literature review. Results: Several important points emerged. In Japan, PWDs felt that those living with LSTs would consider it a life without dignity. In Western countries, the following issues surfaced: negative images of people with disabilities have deep roots in society due to the long and tragic history of discrimination; people with disabilities might become victims of society’s value judgment, such as “life with a severe disability is not worth living”; and laws and safeguard policies cannot eliminate the concerns of a slippery slope. Conclusion: Western countries have recently discussed the risks of legalising euthanasia, while discussions in Japan have focused more on the risks of legislation on forgoing LSTs. Future literature review studies and interviews with advocacy groups aimed at identifying similar situations in other East Asian countries are warranted. "

Policy in palliative care

This chapter describes all aspects of policy, including definitions, who is it that sets policy, how policy is made, how policy is implemented, the elements of effective policies, the differences between policies and regulations, the policies that are important for palliative care, global versus national policy differences, and barriers to the creation and implementation of palliative care policies. Understanding policy is important, as it is one of the fundamental building blocks of palliative care under the World Health Organization’s public health model. This model underscores the pre-eminence of policy, as it makes possible all the other elements. Palliative care professionals should understand the complexity inherent in policy and embrace it as an important area to master.

Priorities and Instruments of Local Elderly Care Policies in China: Text Mining and Comparative Analysis

Health care for the elderly is one of the key issues in the field of public health. In the context of global aging, the government's policy framework for elderly care affects the development of local elderly care. The priorities and instruments of the elderly care policy are important windows for understanding the local development planning system. This paper uses a quantitative text analysis method based on text mining to analyze 3,618 provincial policies in China. Considering the pilot demonstration projects for elderly care selected by the Chinese government in recent years, this paper finds that local elderly care policies have a three-phase evolution, and the priorities in each phase are solving the legacy of transition, expanding private sector participation, and realizing the well-being of the elderly. Moreover, mature regions use more environmental policy instruments, and the most effective are financial services, regulatory systems, and strategic guidance. For immature regions, it is necessary to use more core instruments on the premise of using basic instruments so that public policies can serve local development and realize the well-being of the elderly.

Stigma, Structural Vulnerability, and “What Matters Most” Among Women Living With HIV in Botswana, 2017

Objectives. To explore whether beneficial health care policies, when implemented in the context of gender inequality, yield unintended structural consequences that stigmatize and ostracize women with HIV from “what matters most” in local culture. Methods. We conducted 46 in-depth interviews and 5 focus groups (38 individuals) with men and women living with and without HIV in Gaborone, Botswana, in 2017. Results. Cultural imperatives to bear children bring pregnant women into contact with free antenatal services including routine HIV testing, where their HIV status is discovered before their male partners’. National HIV policies have therefore unintentionally reinforced disadvantage among women with HIV, whereby men delay or avoid testing by using their partner’s status as a proxy for their own, thus facilitating blame toward women diagnosed with HIV. Gossip then defines these women as “promiscuous” and as violating the essence of womanhood. We identified cultural and structural ways to resist stigma for these women. Conclusions. Necessary HIV testing during antenatal care has inadvertently perpetuated a structural vulnerability that propagates stigma toward women. Individual- and structural-level interventions can address stigma unintentionally reinforced by health care policies. (Am J Public Health. Published online ahead of print June 10, 2021: e1–e9. https://doi.org/10.2105/AJPH.2021.306274 )