1 Estimating Expenditure on Long-term Care Manfred Huber Social Policy Division Directorate for Employment, Labour and Social Affairs 6 th Meeting of Health Accounts Experts and Correspondents for Health Expenditure Data 30 September – 1 October 2004

2 Expenditure on long-term care - overview of presentation Results and conclusions from data work for the Long- term care study under the OECD Health Project A working definition used for data work under the Long- term care study Methodological issues for further work A project proposal for continued work on data and methodology in 2005

3 Expenditure on long-term care - Long-term care study: Intro. Project component of the OECD Health Project Nineteen countries: Australia, Austria, Canada, Germany, Hungary, Ireland, Japan, Korea, Luxemburg, Mexico, Netherlands, New Zealand, Norway, Poland, Spain, Sweden, Switzerland, United Kingdom, United States Focus: review of recent reform, continuum of care and innovative ways of supporting care at home (consumer choice, care allowances etc.), quality of care, cross- sectional data on expenditure and beneficiaries

4 Expenditure on long-term care - Long-term care study Network of national experts (mainly from Ministries) Questionnaire on organisation of systems, data (on programme level, where possible), policy trends and reform Publication as separate study.... complemented by working papers: Consumer choice; expenditure and services;

5 Expenditure on long-term care - Long-term care study: results (1)

6 Expenditure on long-term care - Long-term care study: results (2) Public expenditure

7 Expenditure on long-term care Long-term care study: results (3)

8 Expenditure on long-term care Long-term care study: results (4)

9 Expenditure on long-term care - a working definition used for the Long-term care study (1) A range of services of help with basic activities of daily living for persons who are over an extended period of time no longer able to perform these tasks independently, provided in a variety of settings (home and community versus institutions). Includes: support to informal carers (respite care) and expenditure on personal budgets, consumer directed care, and care allowances.

10 Expenditure on long-term care - a working definition used for the Long-term care study (2) Includes: services intrinsically linked to long-term care, such as: prevention and treatment of pressure ulcer, chronic pain, palliative care in nursing-homes; cost of accommodation in nursing homes Excludes: lower level services (home making, meals-on- wheals, transport, social activities), where these are provided separately; Excludes: medical services such as intermittent hospitalisation, special rehabilitation, diagnostic, treatment of chronic illness (drugs to control blood pressure etc.)

11 Data on long-term care services - a “ hit list” of comparability issues 1. Residential care facilities included (retirement homes) 2. Accommodation in nursing homes excluded 3. Home and community care excluded (in total) 4. Older persons versus all long-term care 5. “Long-term care” in “untypical” settings (hospitals etc.) 6. Boundaries of home care (home-making etc. included) 7. Private expenditure substantial but unknown

12 Expenditure on long-term care - further methodological issues Boundaries of residential care versus long-term care (growing number of assisted living facilities and of types of arrangements); Definition of levels of care needs and mapping of eligibility criteria under public programmes; Use of WHO ICF classification for defining long-term care needs; Boundary of care allowances versus income support and other social benefits; health accounting versus household satellite accounting

13 Expenditure on long-term care - A project proposal for 2005 Finalise documentation and description of initial data set Draft refined definitions and guidelines for round of discussions with experts (first half 2005) Refined definition and guidelines plus improved test data set by 2005 with conclusions for implementation Increase number of countries covered Explore feasibility of time series and fill other gaps in existing data set Explore feasibility of uniform age-breakdown

14 Expenditure on long-term care - Feedback Delegates and Correspondents are invited to: COMMENT on conclusions from recent data work NOTE the planned project in 2005 of improved data collection on long-term care and further methodological work EXPRESS interest to participate in 2005 project