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This research tries to assess the dependents and Long Term Care costs for next
years in Spain. To do this, it has been taken account data from the Survey on
Disabilities, Impairments and Health Status and population forecasts estimated
by INE, the legal rules passed between 2006 and 2008, and some former
studies about individual costs of long term care. The key point in this study is
the concept of cost per point of scale. Once calculated, forecasts till 2050 have been estimated. Finally, the results have been compared with those included in
the Long Term Care Act.
Quality of life, dependency and mental health are multidimensional constructs that cannot be observed directly yet can be deduced in an indirect manner through indicators or profiles generated from questionnaires. These questionnaires are based on the validity of information transmitted by the respondents about perceptions, feelings and attitudes. For this reason, the information is difficult to contrast with and translate to a measuring system. The use of questionnaires or rapid quality of life and mental health evaluation scales involve a process directed towards an early identification of specific problems so as to establish medical treatment. This work will review the most commonly used scales or questionnaires in determining these variables and their relationship with the nutritional status of the population.
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The system for the Promotion of Personal Autonomy and Care of Dependent Persons established by Act 39/2006 is funded through private contributions of dependent individuals and earmarked transfers in three main funds: a minimum level, an agreed level distributed among the various autonomous regions according to their relative needs, and a further voluntary additional contribution by Spain's autonomous regions. The resources distributed by the state to the regions are assigned, among other less important variables, according to the potentially dependent population and, to a lesser extent, according to the population already evaluated as dependent.
Because the concept of what constitutes disability has changed over the years from the population potentially dependent according to an estimate (estimated dependent individuals) to the actual number of dependent individuals recognized as such (declared dependent), some autonomous regions may have been overfunded or underfunded.
The funding obtained by the autonomous regions each year from 2007 to 2011 was compared with the funding that would have been assigned to each region if, since 2007, the variables and weighting that will be representative of the funding needs for 2013 (distribution mainly according to declared dependent individuals) had been taken into account.
From 2007-2011, regions where declared dependent persons outnumbered estimated disabled persons were underfunded (in Andalusia by more than 100 million euros). In contrast, regions where the situation was reversed were overfunded (by 49 million euros in Madrid and 37 million euros in the region of Valencia).
There is wide variation in public funding to the autonomous regions, depending on the number of individuals declared as dependent. Among other no less serious consequences, this situation could hamper the implantation of the Promotion of Personal Autonomy and Care of Dependent Persons Act in underfunded regions.
To provide estimates of the number of dependent individuals per grade and level for the period 2007-2045 and the cost associated with the care of these individuals for the System for Promoting the Autonomy and Care of Dependent Persons [Sistema para la Autonomía y Atención a la Dependencia (SAAD)].
Based on the Disabilities, Independence and Dependency Situations Survey (2008) and the scale for the assessment of grades and levels of dependency, we applied a two-stage estimation procedure to project the number of dependent individuals. In the first stage, we calculated the probability of a person being dependent and entitled to benefits by using a logit model. In the second stage, using an ordered logit model, we calculated the probability of distinct grades and levels of dependency in dependent persons entitled to benefits. Subsequently, we calculated expenditure projections based on average cost per point scale by grade and level of dependency.
Our results suggest a higher incidence of situations of dependency in female beneficiaries than in male beneficiaries, with higher growth rates for almost all categories of grade and level between 2007 and 2045. We estimated that in 2045 there will be 1,592,798 beneficiaries of the SAAD (596,332 men and 996,466 women). Moreover, between 2007 and 2045 the cost of care for dependent people will be multiplied by 2.64 for male beneficiaries and by 2.89 for female beneficiaries, amounting to 41,926 million euros in 2045.
The care of dependent persons is a major challenge for Spanish society both because of the number of persons that will require care and because of the greater economic cost involved. These findings should prompt a debate on how to fund services and benefits and how to ensure the sustainability of the system.
Fundamento: A pesar del consenso generalizado sobre lo que es una persona dependiente, su puesta en práctica en cada país arroja resultados completamente diferentes. El objetivo de este trabajo es comparar la aplicación de distintos baremos de valoración de la dependencia sobre la población la española y apreciar las diferencias existentes en sus resultados sobre el derecho a recibir ayudas. Método: Se aplican las escalas de valoración de la dependencia de Francia, Alemania y España sobre la población española reflejada en la EDDES de 1999 comparando el sistema español con cada uno de los otros dos usando el análisis factorial de correspondencias. Resultados: Según LA EDDES, el número de personas dependientes asciende, según a 1.398.767. Aplicando el baremo español 776.475 recibirían algún tipo de ayuda pública, con el baremo alemán serían 745.520 y con el baremo francés 315.514. Los resultados del análisis de correspondencias muestran cómo el baremo español posee mayor semejanza con el alemán que con el francés (los coeficientes de correlación de Spearman y de Kendall se reducen casi en un 40% cuando comparamos el sistema español con el francés). Conclusiones: A igualdad de características personales, la utilización de uno u otro modelo condiciona tanto la catalogación como persona dependiente como la posibilidad de recibir ayudas públicas. Por número de beneficiarios, el más generoso es el sistema español y el más restrictivo el francés, siendo este último el único en el que la edad es una variable limitativa.
Fundamento: El aumento creciente del envejecimiento poblacional, especialmente evidente en España, resalta la importancia de aproximarse a cuantificar y estimar la evolución de la dependencia en la población española de 65 y más años. Métodos: El volumen de dependencia se calculó aplicando las prevalencias estimadas para 1993 y 1999 en el estudio longitudinal «Envejecer en Leganés» a los censos de 1991 y 2001. La población de estudio la constituía una muestra aleatoria de 1.560 personas que vivían en sus domicilios en Leganés (Madrid). La tasa de respuesta inicial fue del 82% (n=1.283). Se volvieron a recoger datos de los participantes iniciales en 1995 (n=827), en 1997 (n=666) y en 1999 (n=475). La dependencia se definió como la necesidad de ayuda en al menos una de ocho tareas de Actividades Básicas de la Vida Diaria (ABVD). La prevalencia de dependencia según año de encuesta, edad, sexo y nivel de instrucción se estimó mediante modelos multinivel para medidas repetidas. Resultados: En el periodo 1993-1999 se observa una disminución en la dependencia para las ABVD tanto en hombres como en mujeres hasta los 83 años. A edades más avanzadas esta tendencia se invierte. La prevalencia es mayor en mujeres y en personas con bajo nivel de instrucción. El número de personas dependientes aumenta de 903.276 a 995.338 entre 1991 y 2001, existiendo un envejecimiento de la población dependiente. Conclusiones: La dependencia aparece a edades más tardías en las sucesivas cohortes. Esto implica una mayor esperanza de vida libre de discapacidad y una mayor complejidad de los cuidados necesarios para las poblaciones dependientes, que estarán constituidas fundamentalmente por mujeres muy ancianas. Las consecuencias para el futuro de las pensiones, las reformas laborales y los sistemas de servicios de salud y cuidados de larga duración son importantes.
Even if there is a wide consensus on the concept of a dependent individual, in practice national valuation systems produce completely different results. The objective in this work is to compare the application of different valuation scales for dependency on the Spanish population and to identify the differences in the results on the right to obtain public support.
The evaluation definition and schemes that are applied in France, Germany and Spain are implemented to the Spanish population using data from the Survey on Disabilities, Dependency and Health Status. The Spanish system is compared to the other two using factorial correspondence analysis.
According to the survey the total number of dependent individuals in the population is 1.398.767. Under the Spanish scale, 776.475 would receive some type of public support, under the German scale 745.520 would qualify and when applying the French scale, those would be 315.514. Correspondence analysis results show that the Spanish scale is much more similar to the German scale than it is to the French scale. (Spearman's correlation coefficient and Kendall's are reduced by almost 40% when the Spanish scale is compared to the French scale, rather than the German scale).
With the same personal conditions, the system used influences both the degree of severity of dependence and the possibility to become eligible to public funds. The Spanish system is the most generous and the French system is the most restrictive one, the latter also imposes limitations on age.
The progressive increase in population aging, specially evident in Spain, remark the importance to estimate the volume and the prevalence trends of dependency in the 65 years and over Spanish population.
The dependency volume was calculated applying the 1993 and 1999 estimated prevalences in the longitudinal study "Aging in Leganes" to the Spanish population of 1991 and 2001. A random study sample of 1560 subjects 65 years was selected in 1993 in the city of Leganes (Madrid). Response rate at baseline was 82% (n = 1283). New information was collected in 1995 (n = 827), 1997 (n = 666) and 1999 (n = 475). Dependency was defined as needing help in at least one of eight Activities of Daily Living ADL. A multilevel model for repeated measures was fitted regressing ADL dependency on age, sex, education and survey year.
There is a decline in ADL dependency by age in both, men and women. At advanced ages, this trend is reversed and there is an apparent increase in dependency. The prevalence is higher in women and in low educated subjects. The total number of ADL dependent people increased from 903,276 to 995,338 from 1991 to 2001 although the average age of dependent older people increased.
Postponement of disability means longer healthy life expectancy and increasing volumes of very elderly disabled people, particularly women. Consequences for health, labour reform and social security systems can be very important.
This paper aims to assess the long-term financial sustainability of the Spanish national health system using Generational Accounting, and investigates the effects of several financial options that governments may use to face the challenges posed by the demographic ageing process. Our results indicate, first, that population ageing will have a substantial impact on future health care expenditure, although the examination of past health expenditure trends seems to indicate that ageing is not the main force behind their growth. Second, we find that the policy proposals put forward to date to solve the financial problems of the health system are clearly insufficient to cope with the levels of expenditure predicted for the future. The Geneva Papers (2006) 31, 557–580. doi:10.1057/palgrave.gpp.2510104
Illness increases with age. All else being equal, an older population has greater needs for health care. This logic has led to dire predictions of skyrocketing costs apocalyptic demography". Yet numerous studies have shown that aging effects are relatively small, and all else is not equal. Cost projections rest on specific assumptions about trends in age-specific morbidity and health care use that are far from self-evident. Sharply contrasting assumptions, for example, are made by Fries, who foresees a "compression of morbidity" and falling needs. Long-term trends in health care use in British Columbia show minimal effects of population aging, but major effects, up and down, from changes in age-specific use patterns. Why then is the demographic apocalypse story so persistent, despite numerous contrary studies? It serves identifiable economic interests.
To date, both in Spain and virtually all the other European Union (EU) countries, dependency has been seen to be a fundamentally private problem to be dealt with by the family concerned. In this way, whether through informal carers or contracted professionals, in the domestic environment or in care homes, it is the dependent person themselves and their families who currently bear the majority of the costs. In light of this, current concern lies in the social change that is coming on, mainly the accelerated aging process and the increased participation of middle-aged women in the labour market, which heighten the need for collective organisation of that which until now has been resolved within family circles.In this context, at the same time that the Government announces to issue a «Long Term Care Law» by the end of 2005, our paper briefly analyzes what we consider the four crucial issues in this area: the current scope of dependency problems and its possible future evolution, the characteristics of the current spanish long-term care system and its main problems; the role that health services should have in the dependency issue; and finally, the benefits and drawbacks of the main alternatives that the Administration could manage in case it intends to increase its involvement in this field.
The National Center for Health Statistics is considering several techniques for combining mortality and morbidity rates into a single index, which might provide a more adequate measure of changes over time in the nation's health status. A technique which weights life table values according to disability time experienced at each age level and produces measures of expectation of life free of disability and expectation of disability is described. Results are presented using two alternative measures of disability time experienced by a population during a year. The two measures are (a) the total volume of disability, which encompasses all forms of long-term and short-term disability, and (b) bed disability, which includes only periods of institutional confinement and noninstitutional disability involving bed confinement. Expectation of disability-free lifetime was about 65 years in the United States in the mid-1960's, compared with a conventional life expectancy of about 70 years. The expected lifetime duration of all forms of disability was approximately 5 years, 2 years of which reflected disability before age 65, and 3 years was disability experienced by persons older than 65. Differences between males and females in expectation of disability are not great, but differences between whites and other persons are substantial and favorable to whites. Expectation of life free of bed disability was about 68 years, and expectation of bed disability was approximately 2 years. Of the 2 years expected bed disability, persons 65 and over account for over 1 year. Differences between males and females in expectation of bed disability are noticeable and favorable to males. Differences between whites and other persons, however, are not substantial.
The observation that average health care expenditure rises with age generally leads experts and laymen alike to conclude that population ageing is the main driver of health care costs. In recently published studies we challenged this view (Zweifel et al., 1999; Felder et al., 2000). Analysing health care expenditure of deceased persons, we showed that age is insignificant if proximity to death is controlled for. Thus, we argued that population ageing per se will not have a significant impact on future health care expenditure. Several authors (Salas and Raftery, 2001; Dow and Norton, 2002; Seshamani and Gray, 2004a) disputed the robustness of these findings, pointing to potential weaknesses in the econometric methodology. This paper revisits the debate and provides new empirical evidence, taking into account the methodological concerns that have been raised. We also include surviving individuals to test for the possibility that the relative importance of proximity to death and age differs between the deceased and survivors. The results vindicate our earlier findings of no significant age effect on health care expenditure of the deceased. However, with respect to the survivors, we find that age may matter. Still, a naive estimation that does not control for proximity to death will grossly overestimate the effect of population ageing on aggregate health care expenditure. Following Stearns and Norton (2004), we conclude that “it is time for time to death” in projections of future health care costs. The Geneva Papers on Risk and Insurance (2004) 29, 652–666. doi:10.1111/j.1468-0440.2004.00308.x