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European Study of Long-Term Care Expenditure
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... Yet, the international comparison of long-term care expenditure is a fairly new research topic. It has in recent years been advanced by a number of studies on age-related public-expenditure projections (European Commission 2006; OECD 2006a; Comas-Herrera and Wittenberg, 2003) and comparative policy studies and structural overviews (Pacolet 1998 This paper examines differences in long-term care expenditure between countries and trends over time. It starts by analysing data availability and data quality from existing international sources, namely from the OECD and Eurostat. ...
... In addition, because of the productivity decrease, income decreases for patients who are not retired. The long-term care expenditures for European countries were evaluated [23], but the European countries studied were Germany, Italy, Spain and the United Kingdom. No Eastern European country (including Romania) was considered in this study. ...
Background:
Cardiovascular disease (CVD) is the main cause of morbidity and mortality worldwide, but it also is highly preventable. The prevention rate mainly depends on the patients' readiness to follow recommendations and the state's capacity to support patients. Our study aims to show that proper primary care can decrease the CVD-related morbidity rate and increase the economic efficiency of the healthcare system. Since their admission to the European Union (EU), the Eastern European countries have been in a quest to achieve the Western European standards of living. As a representative Eastern European country, Romania implemented the same strategies as the rest of Eastern Europe, reflected in the health status and lifestyle of its inhabitants. Thus, a valid health policy implemented in Romania should be valid for the rest of the Eastern European countries.
Methods:
Based on the data collected during the EUROASPIRE III Romania Follow Up study, the potential costs of healthcare were estimated for various cases over a 10-year time period. The total costs were split into patient-supported costs and state-supported costs. The state-supported costs were used to deduce the rate of patients with severe CVD that can be treated yearly. A statistical model for the evolution of this rate was computed based on the readiness of the patients to comply with proper primary care treatment.
Results:
We demonstrate that for patients ignoring the risks, a severe CVD has disadvantageous economic consequences, leading to increased healthcare expenses and even poverty. In contrast, performing appropriate prevention activities result in a decrease of the expenses allocated to a (eventual) CVD. In the long-term, the number of patients with severe CVD that can be treated increases as the number of patients receiving proper primary care increases.
Conclusions:
Proper primary care can not only decrease the risk of major CVD but also decrease the healthcare costs and increase the number of patients that can be treated. Most importantly, the health standards of the EU can be achieved more rapidly when primary care is delivered appropriately. JEL: I18, H51.
... Policies for providing residential aged care vary between countries, between regions and over time. There are geographical differences in numbers of places provided [10][11][12][13]and in dependency levels at admission [12, 14]. In New Zealand, there is comparatively little sheltered (supported ) housing, and only limited payment to family carers. ...
in Auckland, New Zealand in 1988, 7.7% of those aged over 65 years lived in licenced residential aged care. Age-specific rates approximately doubled for each 5-year age group after the age of 65 years. Even with changes in policies and market forces since 1988, population increases are forecast to drive large growth in demand. This study shows previously unrecognised 20-year trends in rates of care in a geographically defined population.
four cross-sectional surveys of all facilities (rest homes and hospitals) licenced for long-term care of older people were conducted in Auckland, New Zealand in 1988, 1993, 1998 and 2008. Facility staff completed survey forms for each resident. Numbers of licenced and occupied beds and trends in age-specific and age-standardised rates in residential aged care are reported.
over the 20-year period, Auckland's population aged over 65 years increased by 43% (from 91,000 to 130,000) but actual numbers in care reduced slightly. Among those aged over 65 years, the proportion living in care facilities reduced from 1 in 13 to 1 in 18. Age-standardised rates in rest-home level care reduced from 65 to 33 per thousand, and in hospital level care, from 29 to 23 per thousand. Had rates remained stable, over 13,200 people, 74% more than observed, would have been in care in 2008.
growth predicted in the residential aged care sector is not yet evident. The introduction of standardised needs assessments before entry, increased availability of home-based services, and growth in retirement villages may have led to reduced utilisation.
... The ADHOC project has advanced quite substantially the knowledge about HC in Europe. While previous evaluation was limited at the comparison of care systems and policies303132333435, the ADHOC project was designed to provide information about as yet unanswered questions. The project focused primarily on the description of HC services users, particularly their health and functional status and the relevant aspects of living conditions. ...
During the 1990s, use of home care sector has increased substantially in Europe. However, research on home care continues to be underreported. This article summarizes the findings from the "Aged in Home Care" (ADHOC) study - carried out from 2001 to 2004 in Europe - and women's situation in European Home Care.
The review is based on 4 book chapters as well as on 23 articles listed in PubMed and published from August 2004 to October 2008. ADHOC used a standardized data set collected with the Resident Assessment Instrument for Home Care (RAI-HC 2.0); this instrument was used to assess 4010 home care clients at 11 European sites. The included articles analyzed the sociodemographic and clinical characteristics, basic physical needs, provision of selected preventive measures, and medication data from the ADHOC sample. In addition home service provision, quality indicators, and selected outcomes of home care intervention during the course of 1 year were assessed.
The mean subject age was 82.3 years; women were on average 2 years older than men and more frequently lived alone, 74% were women. Women suffered more frequently from pain, depression, and extreme obesity. There were marked regional differences in both the functional status of the clients and the characteristics and use of home care services.
The implementation of a common assessment instrument for HC clients may help contribute the necessary wealth of data for (re)shaping home care in Europe. Policy makers and service providers may learn about best practices in the European context.
... Nicht gedeckte Kosten werden von den zuständigen Sozialhilfeträgern übernommen, also letztlich von Ländern und Gemeinden aus allgemeinen Steuermitteln getragen. 9 Dabei besteht allerdings die Möglichkeit, diese Sozialhilfeausgaben auf dem Regressweg (teilweise) wieder einzubringen oder von anderen kostenersatzpflichtigen Personen einzufordern. 10 Obwohl die Sozialhilfegesetze der einzelnen Länder erheblich divergieren, sind Kostenersatzpflichten für bestimmte Personen in allen Ländern vorgesehen: 11 Zum einen sind im gesamten Bundesgebiet die Erben eines Sozialhilfeempfängers für den Ersatz der Sozialhilfeausgaben bis zum Wert des Nachlasses verpflichtet, da der Kostenersatzanspruch der Sozialhilfeträger gleich einer anderen Schuld auf den Nachlass übergeht. ...
Neben dem Pensions- und dem Gesundheitssystem ist der Pflegebereich das dritte Aufgabengebiet der Sozialpolitik, das stark von der demographischen Entwicklung gepr�gt ist. Schon derzeit sind die Budgets der L�nder und Gemeinden durch die Mittel f�r die Pflege, vor allem f�r die in Alten- und Pflegeheimen geleistete, stark beansprucht und es ist zu erwarten, dass mit einer Zunahme des Anteils �lterer Menschen an der Gesamtbev�lkerung ein wachsender Ausgabenanteil f�r diesen Bereich erforderlich sein wird. Angesichts dieser Entwicklung gewinnt die Frage nach der Finanzierung immer mehr an Bedeutung: wer soll f�r die Pflege zahlen? Diese Fragestellung deutet die verteilungspolitische Dimension des Problems an, die ja bei allen staatlichen Ma�nahmen, aber eben insbesondere im Bereich der Sozialpolitik eine gro�e Rolle spielt. Im vorliegenden Beitrag wird dazu aus der Sicht von �konomen versucht, verschiedene wichtige Aspekte herauszuarbeiten und mit �konomischen Effizienz�berlegungen zu verkn�pfen, wobei die Finanzierung der station�ren Pflege im Mittelpunkt steht. Faktische L�sungen k�nnen allerdings nur durch den politischen Entscheidungsprozess zustande kommen, auf der Basis von Wertvorstellungen, die �ber die �konomische Sicht hinausgehen. Bei der Finanzierung des Pflegebereichs stellt sich zun�chst die typische Frage, die mit der Rolle des �ffentlichen Sektors (des Staates) immer verkn�pft ist: was soll individuelle Aufgabe der jeweiligen betroffenen Personen selbst sein und was soll als kollektive Aufgabe im �ffentlichen Bereich angesiedelt sein? Im Vordergrund steht also das Verh�ltnis zwischen kollektivem Schutz (das hei�t Kosten�bernahme durch die �ffentliche Hand) und eigenen Leistungen der Pflegebed�rftigen sowie ihrer Angeh�rigen. Weitere wichtige Aspekte betreffen die Verteilung der Lasten, sowohl innerhalb einer Generation als auch zwischen den Generationen, und auch die Risikoteilung zwischen von Pflegebed�rftigkeit in unters
Long-term care (LTC) in the new EU member states, which used to belong to the former socialist countries, is not yet a legally separated sector of social security. However, the aging dynamics are more intensive in these states than in the old EU member states. This paper analyses the process of creating an LTC sector in the context of institutional reforms of social protection systems during the transition period. The authors explain LTC’s position straddling the health and social sectors, the underdevelopment of formal LTC, and the current policies regarding the risk of LTC dependency. The paper is based mainly on the analysis of information provided by country experts in the ANCIEN project.
In the Italian debate on welfare policies, the issue of elderly non selfsufficient people does not yet receive the due attention, though its importance will grow abruptly in a few years. The extraordinary acceleration of the compression of mortality does not seem just now adequately counterbalanced by an equal compression of morbidity. On the basis of the evidence of some recent Italian surveys, the a. explores the dynamics of economic covering of the elderly disability in the current Italian welfare system, particularly focussing on the caring allowance for disabilities named "assegno di accompagnamento", and remarks a clear-cut mismatch between demand of economic support and welfare supply, which is markedly age-dependent. The covering is redundant and partially improper among the 'young' elderly, whereas it is hard lacking among the over-85, just in that life span destined to increase most rapidly. It is true that the improper covering can be reabsorbed by inserting the clinical frame of illnesses of the elderly among the evaluation criteria to assign an welfare allowance. However, the enlargement of the evaluation criteria produces in turn a growing demand of cash support by the oldest old people, who are both fast growing and most exposed to a risk of disability.
In about two decades, Spain was transformed from one of the most centralised countries to one of the most decentralised. Spending functions were devolved rapidly. The regions have exercised their discretionary powers quite extensively and innovative policies have been implemented. But devolution was also accompanied by a hike in public employment and pressures on public spending, reflecting duplication in resources and poor co-ordination across and between government levels. The recent devolution of taxing powers could raise the accountability of the regions and, thus, cost-consciousness, although their effective use has been limited. Securing fiscal discipline would require better information on sub-national governments’ policies and outcomes so as to allow citizens to press for improved performance. The financing system of the regions also needs to be reformed to ensure sustainability in the face of changing demographics, while the fiscal rules need to be upgraded to avoid recourse to off-budget operations. This Working Paper relates to the 2005 OECD Economic Survey of Spain (www.oecd.org/eco/surveys/spain).
Optimiser l’impact de la décentralisation en Espagne
En l’espace de deux décennies, l’Espagne, qui était l’un des pays les plus centralisés, est devenue l’un des plus décentralisés. Les compétences en matière de dépenses ont été transférées rapidement. Les régions ont souvent été innovantes, adaptant leur offre de services publiques aux préférences locales. Toutefois, ces transferts se sont aussi accompagnés d’une hausse de l’emploi public et de pressions sur les dépenses publiques, ce qui reflète une duplication des ressources et un manque de coordination à chaque niveau d’administration et entre les différents niveaux. Le récent transfert de pouvoirs fiscaux aux régions pourrait renforcer leur responsabilité, et donc leur souci de maîtriser les coûts, bien qu’elles n’aient que peu utilisé ces pouvoirs. Assurer la discipline budgétaire nécessiterait une information plus complète sur les politiques et les résultats des administrations territoriales afin que les citoyens puissent réclamer une amélioration des performances. Il faut aussi réformer le système de financement des régions pour en assurer la viabilité face aux changements démographiques, tandis que les règles budgétaires devraient être ajustées de façon à éviter le recours aux opérations extrabudgétaires. Ce Document de travail se rapporte à l'Etude économique de l'OCDE de l’Espagne, 2005 (www.oecd.org/eco/etudes/espagne).
Reforms reducing the generosity of pensions have distributional effects on future generations if individuals care about their descendants’ welfare, but only affect elderly individuals if bequests are the unintentional result of precautionary savings. And safety-net programmes such as unemployment insurance may displace sources of private help, such as that provided by living parents to their children in need. This paper provides comparable measures of how expected bequests and transfers vary with cumulated parental earnings in the United States, West Germany and the United Kingdom. The strength of bequest motives is empirically very weak in the available data. Private inter vivos transfers, which appear to depend on the recipients’ economic situation, are partly crowded out by public unemployment insurance programmes. Together, involuntary bequests and intentional inter vivos transfers appear to be an important channel of intergenerational inequality transmission, and strengthen substantially the relationship between an individual's and his parents’ economic status.
— Ernesto Villanueva
The first technical report of the PSSRU's model to simulate future demand for long-term care and associated costs, setting out the rational for the model. This report considers the relationship between need, demand and supply of care and the relationship between different variables that may affect the future deman for care and associated expenditure.
Successive Government policies have emphasised the objective of caring for older people in the community rather than in residential settings. This paper looks at patterns of care for frail older people living in private households, using data from the 1998/9 General Household Survey (GHS) on people aged 65 and over.
The 1998/9 GHS is of particular interest. It is the first GHS data on older people to allow the community care changes of the early 1990s to be taken into account. The 1994/5 data were collected too soon after the changes for their impact to be observed. In addition, for the first time, the 1998/9 GHS contains questions that identify people needing regular daily help, who constitute some of the most dependent older people in the community.
The analysis presented here was undertaken in the context of a study of future demand for long-term care for older people by the Personal Social Services Research Unit. A similar analysis of patterns of care was conducted using the 1994/5 GHS (Wittenberg et al. 1998). The study therefore provides an opportunity to compare trends in patterns of care between 1994/5 and 1998/9.
