Equity and efficiency in community care: from muddle to model and model to?

The community care reforms were partly a response to critiques of inequity and inefficiency in targeting and weak impacts of services on outcomes of value in their own right. The article revaluates criticisms made in the 1980s in the light of reform outcomes. The evidence is from a before-after study of the perceptions of triads of users, caregivers and care managers in cohort of new users recruited in 1984/5 and 1995. The provisional findings suggest reallocation of resources in the direction suggested by the critiques and policy statements,greater flexibility in packages,higher productiveness but higher unit costs of service inputs. However,the reforms still fall short of the goals, and raise important dilemmas.