Converging methods to link social and health care systems and informal care-confronting nordic and mediterranean approaches

The substantial growth in health expenditures in European countries over recent decades has brought about serious problems for health care management (Burau, 2007; Dixon and Mossialos, 2002; Thomson et al., 2009) and finance (Directorate-General for Economic and Financial Affairs, 2002a, b; Economist Intelligence Unit, 2011), especially in Mediterranean countries. In 2008, European Union (EU) countries devoted 8.3 per cent of their GDP on average (Spain 9 per cent and Finland 8.4 per cent) to health spending, which was up from 7.3 per cent in 1998 (OECD, 2010). This situation can be explained by the concomitance of demographic, social and cultural changes in Europe (Jackson and Howe, 2003; Lee et al., 2010) as well as by the principles that have guided health care policy over the past 40 years. In Spain, for instance, one of the reasons for the sharp increase in health expenditure — with a total outlay on health that increased from 5.3 per cent of GDP in 1980 to 9.2 per cent in 2009 — is the increasingly arbitrary distinction made between health and social care systems and the lack of long-term care (LTC) services, which is typical not only for Mediterranean welfare systems (García-Armesto et al., 2010; OECD, 2011).

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