Care Provision Presentation to Care Economy Brainstorming Session, World Bank, Washington DC February 25, 2009 Susan Himmelweit, Open University

Care Adequate care is necessary infrastructure: –To prevent social problems and provide for basic needs –To sustain employment levels, particularly women’s, and the revenues they provide To examine ways of providing care need to think about how it differs from other goods: –Involves relationships Limits possibility of productivity increases without reducing quality Cost of care provision rises relative to other goods (Baumol – effect of rising productivity elsewhere in the economy) Market mechanisms costly and may be insensitive to quality –Need for care and ability to provide/pay for it unequally distributed Exchange won’t provide adequate coverage –Basic need with strong (gendered) norms about it provision People may provide care at great cost to themselves

Effects on care provision in different sectors: Domestic –Opportunity costs of unpaid care-giving rise along with costs of market substitutes –Living standards of care givers fall increasingly behind those of others Private for profit sector –Quality difficult to assess; quality measures of often miss relational aspects; –Relational nature limits use of exit as a way of improving quality –Providers compete on price; hard to lower cost without lowering quality (eg lower staff ratios) –Continual search for cheaper workers; low training standards –Without regulation, race to the bottom unlikely to be impeded –Regulations hard to frame to capture relational aspects

Effects on care provision in different sectors: Public sector –Easily painted as inefficient because of rising costs –May be more expensive than private sector because of higher standards –Professional/Public service ethos can be an effective prtetcion from erosion of standards but not if public sector run on purley commercial principles Voluntary sector –Trust advantages over private sector providers but –Tendency to self-exploitation and burn out –Continual churn as funding always inadequate Both public and voluntary sectors important –in setting standards and best practice –may be the only sectors where training takes place

Without policy intervention Care provision will be: –Inadequate to meet many people’s care needs –Impose high costs on some (particularly women) –Limit carers’ access to other opportunities to contribute to the economy Because of rising care needs and costs, care provision will have increasing effect on economy (even narrowly defined) Increasing proportion of budgets will be determined by care policy Important to see this as investment not just current expenditure Important to mainstream care by assessing effects of all policies on both care recipients and providers

Policy can help with: Regulating and sstandards of care provision Regulating conditions of care workers (including domestic employment): –Pay and career structures –Providing migration opportunities that are mutually beneficial and don’t just reproduce care problems further down a global chain –Enhance training opportunities (in care or other fields) –Public sector can set standards Finding ways of making care and employment compatible: –Social protection of those with caring responsibilities –Funded leave systems for care - formal employment –Provision of public care services –Subsidies to the private purchase of care

Policies on care impact on gender inequalities Research needed to ensure that such policies reduce rather than increase inequalities, e.g: –employment polices that do not make workers with caring responsibilities pay for flexibility in other ways; –financial support for care-giving in ways that do not impede women's labour market opportunities; –migration policies that do not make those needing care in poorer countries lose out; –training policies that enable women's caring skills to be better recognised.

Mainstreaming care Requires culture shift to change: notion of what counts as investment criteria of success, to be assessed by: –the quality of the conditions under which those needing care live; –the extent to which meeting their care needs has enabled their full and equal participation in society; –the extent to which the gap narrows between the opportunities and economic conditions of those providing care and others in society; – the extent of any reduction in gender differences in who provides care.