Against the backdrop of an increasingly ageing population in need of welfare provision, Takeshi Hieda makes a unique and important contribution to our political understanding of long-term care with the publication of this book. Using a sound theoretical framework embedded within political science, and building on the burgeoning but somewhat empirically limited social policy literature in this area, the author uses a multi-method approach to investigate why there appear to be unequal distributions of welfare spending for long-term care between different advanced democracies. He unravels this by arguing that political institutions, and the relationships they have with their respective societies, affect the development of older people's care programmes. This is particularly in relation to the electoral rules, party systems and degrees of competitiveness a political institution may have. A thrust of the author's political logic and reasoning is the assertion that the political conditions under which universalistic social policy is likely to thrive lead to the development of generous long-term care programmes for older people.

The first two chapters lay out the purpose of the study, methodological approaches and hypotheses, as well as discussing and rationalising the theoretical and analytical framework comprehensively, which focuses on historical rational-choice institutionalism. The third chapter takes this forward by examining the differences between electoral rules that are centred on voting for a specific party, and those that are more person-oriented, arguing that the former, with its one party dominance, contributes more towards public spending for older people's care services than the latter. Chapters 4 to 6 consist of comparative case studies of long-term care policy development and reforms in Sweden, Japan and the USA respectively. Comparisons are made between social care services for older people, associated policy-making processes, and how older people's care programmes are politically structured. Chapter 7 indicates the key findings of empirical sections and connects them to the theoretical arguments, revealing the political logic under which electoral rules promote the development of universalistic social care services, contrasting them with conditions under which particularistic policies are created. The last chapter assesses the effects of electoral rules and party systems on social protection from an institutionalist perspective, and sets out alternative explanations.

A strength of the study lies in is its theoretical contributions. First, it offers an account of the qualitative variations of welfare systems in advanced industrial societies; secondly, it contributes to the on-going discussions on the relationship between electoral rules and welfare states; and, thirdly, by taking into consideration new social ‘risks’, it brings the analysis up-to-date and sheds light on the impact of social cleavages other than class relations. Further to this, the author has capitalised on both qualitative and quantitative approaches and been quite creative in his methodological approach, given the notorious difficulties in obtaining valid and reliable indicators for measurement in this area. There is some reliance on old OECD data for the quantitative analysis (data extracted from 1980 to 2001) which may offset the relevance of some analysis and limit generalisability to other countries that have since been included in datasets. However, this is complemented by blending a case study analysis of the detailed political process of policy focusing on older people, exploring how political institutions structure their policy-making processes. The three countries that the author chose for case study comparison do provide some complimentarity, but it is possible that they were chosen more for the ease of access to data that provided the level of detailed scrutiny required. Nevertheless, the rich comparative description and analysis significantly enhances our understanding of political science in this area and is both insightful and stimulating.