Transcript care

“Long-term care in Europe – discussing trends and relevant issues”
Conference held under the project “Mainstreaming Ageing: Indicators to Monitor Implementation”
Budapest, 22-23 February 2010
Comments to Ricardo Rodrigues’
presentation on LTC expenditures
Giovanni Lamura*
*: INRCA (Italian National Research Centre on Ageing)
Centre for socio-economic research and elder care
Ancona, Italy, e-mail: [email protected]
Policy implications
derived from the stylised facts I
•
As a relative newcomer, LTC gets limited public
resources…
•
…yet, despite policy discourse and public
preferences, most resources go to institutional care;
•
It is care at home that is key to provide care to most;
•
Expenditure on LTC is not purely age-driven:
• Policy choices;
• Quality;
• Availability of informal care.
•
Reduced LTC services in some countries… too low
to be sustainable.
Level and composition of debt as % of GDP
(2009)
UK
Spain
Switzerland
France
Italy
Germany
US
China
India
0
50
100
Financial institutions
150
200
Families
250
300
Industries
350
400
State
Policy implications
derived from the stylised facts I
•
As a relative newcomer, LTC gets limited public
resources…
•
…yet, despite policy discourse and public
preferences, most resources go to institutional care;
•
It is care at home that is key to provide care to most;
•
Expenditure on LTC is not purely age-driven:
• Policy choices;
• Quality;
• Availability of informal care.
•
Reduced LTC services in some countries… too low
to be sustainable.
LTC country clusters/regimes
1. Standard care-mix:
AU-BE-CZ-FI-DEFR-IT-UK
1
2
5
3
1
2
3. Family based:
ES-IE-GR-PT
4
4. Transition:
HU-PL-SI-SL
1
3
2. Public-Nordic:
DK-NL-SE
5. Baltic: LT-LV
3
Possible LTC indicators
Social & economic needs:
2. % older people at risk of poverty
(income level)
Health related needs:
1. % of over 80 year old
DEMAND OF LTC
match?
PROVISION OF LTC
Formal care
Public
Private
6. elder care expenditure (% of GDP
per capita)
7. % out-of-pocket
payments for
health care
8. % over 65 receiving home care
9. % over 65 in residential care
Informal care
(family, voluntary, friends etc.)
3. female employment rate 55-64
4. % extended households (3+ adults)
5. % informal carers of older people
LTC country clusters/regimes
1. Standard care-mix:
AU-BE-CZ-FI-DEFR-IT-UK
1
2
5
3
1
2
3. Family based:
ES-IE-GR-PT
4
4. Transition:
HU-PL-SI-SL
1
3
2. Public-Nordic:
DK-NL-SE
5. Baltic: LT-LV
3
Share of older people receiving home care
and residential care
Standard-mix
Family-based
Transition
Baltic
Nordic
Over 65 year old people in residential care
(in %)
Standard care
mix
Public-nordic
Family based
Transition
Baltic
0
5
10
15
20
Over 65 year old people receiving home care
(in %)
Standard care
mix
Public-nordic
Family based
Transition
Baltic
0
5
10
15
20
Policy implications
derived from the stylised facts I
•
As a relative newcomer, LTC gets limited public
resources…
•
…yet, despite policy discourse and public
preferences, most resources go to institutional care;
•
It is care at home that is key to provide care to most;
•
Expenditure on LTC is not purely age-driven:
• Policy choices;
• Quality;
• Availability of informal care.
•
Reduced LTC services in some countries… too low
to be sustainable.
Elder care expenditure
(as % of per capita GDP)
Standard care
mix
Public-nordic
Family based
Transition
Baltic
0
2
4
6
8
10
12
13
Over 80 year old population (% on total)
Standard care
mix
Public
Family based
Transition
Baltic
0
1
2
3
4
5
6
Citizens thinking that „working adults should
look after their elderly parents* (%)
Standard care
mix
Public-nordic
Family based
Transition
Baltic
0
20
40
60
80
100
Source: EUROBAROMETER („If, in the future, working adults would have to look after their elderly parents more
than nowadays, would you say that this would be rather a good thing or rather a bad thing?“, Alber & Köhler 2004)
Households with three or more adults (in %)
Standard care
mix
Public-nordic
Family based
Transition
Baltic
0
10
20
30
40
50
Policy implications
derived from the stylised facts II
•
Funding mix: users/families still shoulder a great
deal of the financial costs of (institutional) care;
•
Solutions to guarantee fiscal sustainability… must
be sustainable themselves;
•
Anticipating change… issues to look at:
• Coordination of health and social care;
• Quality of care;
• “Consumer choice”;
• Alzheimer and other dementias;
• Changes in informal care;
• Workforce and migrant carers.
Private health care expenditure
(out of pocket payments as % of total expenditure)
Standard care
mix
Public-nordic
Family based
Transition
Baltic
0
5
10
15
20
25
30
35
40
Income level
(GDP per capita as % of EU-average)
Standard care
mix
Public-nordic
Family based
Transition
Baltic
0
20
40
60
80
100
120
140
Policy implications
derived from the stylised facts II
•
Funding mix: users/families still shoulder a great
deal of the financial costs of (institutional) care;
•
Solutions to guarantee fiscal sustainability… must
be sustainable themselves;
•
Anticipating change… issues to look at:
• Coordination of health and social care;
• Quality of care;
• “Consumer choice”;
• Alzheimer and other dementias;
• Changes in informal care;
• Workforce and migrant carers.
Restrictions reported by employed carers
(in %)
Germany
Greece
Sweden
UK
reduced working hours
occasional work
Italy
career problems
Poland
0
5
N = 4427; only carers <= 65 years
10
15
20
25
Restrictions reported by not employed carers
(in %)
UK
Greece
Germany
Italy
cannot work at all
had to give up work
Poland
can't develop professionally
can work only occasionally
Sweden
0
5
N = 2093; only carers <= 65 years
10
15
20
25
22
Use of support services for carers, by country
(in%)
DE
UK
SE
PL
IT
EL
0
5
10
15
20
25
30
35
40
Policy implications
derived from the stylised facts II
•
Funding mix: users/families still shoulder a great
deal of the financial costs of (institutional) care;
•
Solutions to guarantee fiscal sustainability… must
be sustainable themselves;
•
Anticipating change… issues to look at:
• Coordination of health and social care;
• Quality of care;
• “Consumer choice”;
• Alzheimer and other dementias;
• Changes in informal care;
• Workforce and migrant carers.
In which areas do older people need more help?
(in %)
DOMESTIC CARE
CARE ORGANISATION
EMOTIONAL SUPPORT
HEALTH CARE
TRANSPORTATION
PERSONAL CARE
FINANCIAL SUPPORT
0
10
current help is insufficient
20
30
40
50
60
fully dependent older people
In which areas do older people need more help?
(in %)
DOMESTIC CARE
CARE ORGANISATION
EMOTIONAL SUPPORT
HEALTH CARE
TRANSPORTATION
PERSONAL CARE
FINANCIAL SUPPORT
0
10
current help is insufficient
20
30
40
50
60
fully dependent older people
Do nursing homes offer insufficient standards of care?
Source: Special Eurobarometer 2007
Households employing
privately paid home care workers (in %)
ITALY
GREECE
UK
GERMANY
POLAND
SWEDEN
0
2
4
6
8
10
12
14
Families’ motivations to employ migrant
workers
To guarantee constant care
To keep elder at home
To keep same life style
To safeguard own family
To provide necessary amount of care
Lack of alternatives
To be able to keep on working
Cheaper than other alternatives
20
Source: Spano 2006
30
40
50
60
70
80
90
%
Thank you!