ANCIEN Typologies of LTC systems based on use and financing of care Esther Mot (CPB) Peter Willemé (FPB) asisp Annual Network Meeting, March 30, 2011

ANCIEN, general information  Assessing Needs of Care in European Nations  research for EC in 7th Framework Programme  January 2009 – August 2012  21 EU-countries included

ANCIEN, general information 2  Coordination: Center for European Policy Studies (CEPS): Güldem Okem  Scientific coordination Federal Planning Bureau (FPB): Peter Willemé Netherlands Bureau for Economic Policy Analysis (CPB): Esther Mot  Work package 1 managed by Institut für Höhere Studien, Wien

ANCIEN, objectives  describe and characterise systems of LTC in Europe  analyse the need for care (in relation to demography and lifestyle)  analyse developments in the supply and demand for formal and informal care  analyse the potential role of technology in solving LTC problems

ANCIEN, objectives continued  analyse efforts to improve the quality of LTC  project the use of LTC on the basis of developments in need and supply  evaluate the performance of different types of LTC systems

Work Package 1  description of LTC-systems in Europe  development of typology  selection of countries to model needs (demography, lifestyle) supply (formal and informal) use of care

WP1, data collection  data on LTC collected by national experts standardised format problems with data collection  country reports  typologies

WP1, two methods of clustering  mostly organisational, 21 countries Means-testing, entitlement Availabilility of cash benefits, choice of provider Quality assurance, coordination Cost-sharing for types of LTC Public expenditure as share of GDP  use and financing of care, 14 countries

Use and financing typology  selection of 8 metric variables for 14 countries  cluster-analysis factor analysis on 8 variables, 4 variables used k-means clustering meta-analysis

Variables  public spending* (related to GDP and needs)  share of private expenditures*  informal care use*  IC support*  formal care use  role of cash benefits  accessibility  targeting

Result

Result, by cluster informal care oriented, low private financing Belgium*, Czech Republic, Germany, Slovakia * medium spender low spending, low private, high IC use, high IC support, cash benefits modest generous, accessible and formalized Denmark, the Netherlands, Sweden high spending, low private, low IC use, high IC support, cash benefits modest informal care oriented, high private financing Austria, England, Finland, France, Spain medium spending, high private, high IC use, high IC support, cash benefits high high private financing, informal care seems necessity Hungary, Italy low spending, high private, high IC use, low IC support, cash benefits medium

Star plot of LTC systems

Organisational typology

Comparison of typologies  attractiveness ordering of systems making assumptions on preferences  results similar ordering for 10 countries different for Belgium, France, Germany and Italy extent of private funding can partly explain differences

Countries to be modelled (considering data availability)  Germany  the Netherlands  Spain  Poland (?)

Comparison of selected countries and Finland Germany Netherlands FinlandSpainPoland cluster12334 (?) public spending % GDP corrected pop private funding share of total 27% (all ages) 15% (all ages) 28% 21 – 40%

Comparison, continued GermanyNetherlandsFinlandSpainPoland informal care use % pop NA informal care support benefits and income support formal care use % pop NA cash benefits euro, average HBC+FIC, corrected accessi- bility high low targetinghighmediumNAhigh

Conclusion  large impact of available information different clustering with richer dataset  3 variables crucial: needs-corrected public spending, private funding, informal care support

Conclusion 2  stable clustering of Nordic countries with generous systems with large role for formal care (under different approaches): Sweden, Denmark, Netherlands  important role for informal care in all other clusters distinction by private financing, IC support, use of formal care, role of cash benefits

Conclusion 3  most new member states only to be analysed with organisational approach  low financial generosity for most NMS Latvia and Slovenia exceptions  large differences in organisational depth among NMS

More information:  general information country reports on LTC systems typology report: Kraus, M., M. Riedel, E. Mot, P. Willemé, G. Röhrling, T. Czypionka (2010), A typology of systems of Long-Term Care in Europe - Results of Work Package 1 of the ANCIEN Project  (Netherlands Bureau for Economic Policy Analysis)