1. Typology of LTC systems based on system characteristics Markus Kraus, Thomas Czypionka, Monika Riedel, Gerald Röhrling, Andreas Goltz 8 th European Conference on Health Economics Connecting Health and Economics 7 th – 10 th of July, Helsinki

2. 2 Outline  Introduction  Data collection  Method  Variables  Results

3. 3 Introduction  ANCIEN is a research project financed under the 7 th Research Framework Programme of the European Commission. The project includes 20 partner institutions from EU member states such as CEPS, CPB, DIW, FPB, IHS, LSE and is organized in 7 work packages. It started in January 2009 and will last 44 months.  The objective of the project is:  to review the long-term care (LTC) systems in EU member states,  to assess the actual and future numbers of elderly care-dependent people in selected countries and  to develop a methodology for comprehensive analysis of actual and future LTC needs and provision across European countries, including the potential role of technology and policies on maintaining and improving quality  The objective of WP 1 is to portray long-term care systems in light of provision of care and financing and to derive a typology of LTC systems.

4. 4 Data collection - literature review  Literature review to identify relevant typologies, indicators, variables

5. 5 Data collection – questionnaire, problems  Questionnaire was designed and sent to the national experts. It was organized in several blocks of questions focussing on macrostructure, funding and financing, informal care, formal institutional care, formal home based care and policy issues.  Approach:  Availability and comparability of quantitative data is rather limited (even when cooperating with national experts)  Two fold strategy to derive typology: Approach 1: focuses on system characteristics; it relies on qualitative characteristics and uses ordinal scaled variables; including all 22 countries Approach 2: focuses on use and financing; it is based on quantitative information and uses metric and pseudo-metric variables; including only a selection of countries

6. 6 Method (1)  2-step-procedure to derive the typology based on system characteristics 1 st step:  Allocate variables to one of two groups, one describing the organizational depth and one the financial generosity of LTC systems, and recode all variables with ordinal values.  Rationale behind coding: „Which system characteristic is more preferable from the patient‘s point of view?“  Most preferable option was coded „3“, least preferable option was coded „1“.  By summing up the organization variables one gets an index in which countries with high values could be interpreted as countries with high degree of patient friendliness and vice versa.

7. 7 Method (2)  By summing up the funding variables one gets an index where countries with high values could be interpreted as countries with high degree of patient friendliness and vice versa. 2 nd step:  Formal cluster analysis with SPSS K means clustering algorithm

8. 8 Variables  Organizational depth:  Means-tested access  Entitlement  Availability of cash benefits  Choice of provider  Quality assurance  Integration / coordination of care  Financial generosity:  Cost sharing  Public expenditures as share of GDP

9. 9 Results (1) Source: own compilation

10. 10 Results (2)  Western countries tend to have LTC-systems with a higher degree of patient friendliness.  Organizational depth: there is NO clear distinction between Western and Eastern European countries. Only Lithuania, Poland, Romania, and to a lesser degree Hungary are lacking behind in this matter.  Financial generosity: a gap between Western and Eastern European countries can be observed. Western European countries tend to be more generous to care recipients than Eastern European countries.  A Scandinavian, Continental and Mediterranean country group cannot be exactly identified but there is some degree of compatibility to this classification.

11. 11 Results (3)  The Eastern European countries do not form a cluster by themselves. Though sharing the feature of low spending on LTC, they differ widely with regard to organizational aspects.  Not even the Baltic States are altogether in one cluster. They are spread over three clusters.

12. 12 Thank you for your attention!

13. 13 Contact Markus Kraus Institute for Advanced Studies (IHS) Stumpergasse 56 A- 1060 Vienna Phone: +43 1/59991 141 E-Mail: kraus@ihs.ac.at

14. 14 LTC system characteristics by country Source: own compilation