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Comments to Ricardo Rodrigues’ presentation on LTC expenditures Giovanni Lamura* “Long-term care in Europe – discussing trends and relevant issues” Conference.

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Presentation on theme: "Comments to Ricardo Rodrigues’ presentation on LTC expenditures Giovanni Lamura* “Long-term care in Europe – discussing trends and relevant issues” Conference."— Presentation transcript:

1 Comments to Ricardo Rodrigues’ presentation on LTC expenditures Giovanni Lamura* “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 *: INRCA (Italian National Research Centre on Ageing) Centre for socio-economic research and elder care Ancona, Italy, e-mail: g.lamura@inrca.itg.lamura@inrca.it

2 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.

3 Level and composition of debt as % of GDP (2009)

4 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.

5 1.Standard care-mix: AU-BE-CZ-FI-DE- FR-IT-UK 2.Public-Nordic: DK-NL-SE 3.Family based: ES-IE-GR-PT 4.Transition: HU-PL-SI-SL 5.Baltic: LT-LV 5 4 3 3 3 2 2 1 1 1 LTC country clusters/regimes

6 Health related needs: 1. % of over 80 year old Social & economic needs: 2. % older people at risk of poverty (income level) DEMAND OF LTC match? PROVISION OF LTC Formal care Informal care (family, voluntary, friends etc.) Public 6. elder care expen- diture (% of GDP per capita) Private 7. % out-of-pocket payments for health care 3. female employment rate 55-64 4. % extended households (3+ adults) 5. % informal carers of older people 8. % over 65 receiving home care 9. % over 65 in residential care Possible LTC indicators

7 1.Standard care-mix: AU-BE-CZ-FI-DE- FR-IT-UK 2.Public-Nordic: DK-NL-SE 3.Family based: ES-IE-GR-PT 4.Transition: HU-PL-SI-SL 5.Baltic: LT-LV 5 4 3 3 3 2 2 1 1 1 LTC country clusters/regimes

8 Share of older people receiving home care and residential care Nordic Family-based Transition Baltic Standard-mix

9 Over 65 year old people in residential care (in %)

10 Over 65 year old people receiving home care (in %)

11 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.

12 Elder care expenditure (as % of per capita GDP)

13 13 Over 80 year old population (% on total)

14 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) Citizens thinking that „working adults should look after their elderly parents* (%)

15 Households with three or more adults (in %)

16 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.

17 Private health care expenditure (out of pocket payments as % of total expenditure)

18 Income level (GDP per capita as % of EU-average)

19 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.

20 Restrictions reported by employed carers (in %) N = 4427; only carers <= 65 years

21 Restrictions reported by not employed carers (in %) N = 2093; only carers <= 65 years

22 22 Use of support services for carers, by country (in%)

23 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.

24 In which areas do older people need more help? (in %)

25

26 Do nursing homes offer insufficient standards of care? Source: Special Eurobarometer 2007

27 Households employing privately paid home care workers (in %)

28 Families’ motivations to employ migrant workers % Source: Spano 2006

29 Thank you!


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