Authors: Janet C. Gornick, Candace Howes, and Laura Braslow
Publication: For Love and Money: Care Provision in the United States. Chapter 7, pp. 140-182
Publisher: Russell Sage Foundation
Editor: Nancy Folbre
Date: August 2012
Excerpt:
National, state, and local governments provide a complex array of services, benefits, and regulations that support children and adults in need of care and their caregivers. In this chapter, we assess how well the current system is working—and for whom. Assessing the adequacy of U.S. care policy provisions requires identifying a set of standards against which to evaluate these provisions. Yet, as decades of policy analysis scholarship have established, there is no single framework to use in assessing the adequacy of policy provisions. In our case, one approach would be to focus on the efficiency or effectiveness of existing care supports—that is, to assess outputs or outcomes relative to expenditures and other inputs across several areas of care policy. Another would call for surveying care recipients and caregivers to assess the degree to which they judge their needs to be met. Yet another would require establishing some absolute standards—one or more floors below which access to (or receipt of) care supports should not fall—and assessing the extent to which those in need of care and their caregivers have access and supports consistent with those standards. All of these approaches would, of course, require tackling challenging normative questions, especially about who needs and deserves care supports, how much and what kind of care is optimal or acceptable, and what the balance should be between public and private provisions. A comprehensive evaluation of this large package of care policies, using any of these frameworks, is outside the scope of this project. Instead, we focus on the adequacy of the current system from the vantage point of disparities in the receipt of care. Two axes strike us as particularly consequential: disparities by income and disparities by geography. In the first half of this chapter, we review relevant research to assess the interaction between household income and receipt of care, looking at families with high, low, and middle incomes. In the second half, we draw on policy data gathered for this project to assess the variations in the receipt of care across the U.S. states.
Link: The Disparate Impacts of Care Policy (PDF)