Decentralization and Re-familialization in Informal Care: Adaptability and Inequalities in Social Care Policies in the Netherlands

Abstract

Reflecting wider European trends, Dutch policymakers have decentralized and re-familialized social care policy to reduce spending, potentially allowing for local disparities in access to formal care and informal care responsibilities. We examine the divergence in municipalities’ approaches to familialism (i.e., their support for and activation of informal caregivers), whether local demographic, cultural, political, and financial factors inform municipalities’ degree of familialism, and whether familialism relates to local social care take-up and expenditure. Analyzing survey data from 242 Dutch municipalities, we find some municipal variation in familialism, which is, however, not related to the local context, or to social care take-up or expenditure. Contrary to expectations, care take-up is lower in municipalities with higher care needs. Our findings suggest that decentralization does not deliver on its promise of adaptability and equality of outcomes when legal and budgetary restraints limit local policy discretion. Likewise, re-familialization does not necessarily reduce reliance on public care services.