Fairness and Eligibility to Long-Term Care: An Analysis of the Factors Driving Inequality and Inequity in the Use of Home Care for Older Europeans.

Stefania Ilinca,Ricardo Rodrigues,Andrea Schmidt

doi:10.3390/ijerph14101224

Abstract

In contrast with the case of health care, distributional fairness of long-term care (LTC) services in Europe has received limited attention. Given the increased relevance of LTC in the social policy agenda it is timely to evaluate the evidence on inequality and horizontal inequity by socio-economic status (SES) in the use of LTC and to identify the socio-economic factors that drive them. We address both aspects and reflect on the sensitivity of inequity estimates to adopting different definitions of legitimate drivers of care need. Using Survey of Health, Ageing and Retirement in Europe (SHARE)data collected in 2013, we analyse differences in home care utilization between community-dwelling Europeans in nine countries. We present concentration indexes and horizontal inequity indexes for each country and results from a decomposition analysis across income, care needs, household structures, education achievement and regional characteristics. We find pro-poor inequality in home care utilization but little evidence of inequity when accounting for differential care needs. Household characteristics are an important contributor to inequality, while education and geographic locations hold less explanatory power. We discuss the findings in light of the normative assumptions surrounding different definitions of need in LTC and the possible regressive implications of policies that make household structures an eligibility criterion to access services.

Highlights

As a growing number of older people in Europe find themselves in need of support, the policy relevance of long-term care (LTC) organization has considerably increased [1]
Despite the attention afforded to the increasing share of frail older people and the high costs associated with it, two aspects have been mostly overlooked in the literature: the issue of how equitable the use of LTC is and how this might vary between countries in Europe [2,3]
Income inequality among households led by older individuals, as measured by the Gini coefficient, is highest in France, Belgium and Italy, while Austria, Denmark and Sweden are the countries with the least unequal income distribution

Summary

Introduction

As a growing number of older people in Europe find themselves in need of support, the policy relevance of long-term care (LTC) organization has considerably increased [1]. Despite the attention afforded to the increasing share of frail older people and the high costs associated with it, two aspects have been mostly overlooked in the literature: the issue of how equitable the use of LTC is and how this might vary between countries in Europe [2,3]. This stands in contrast with health care, for which a wide body of literature attesting to a socio-economic gradient in the use of different forms of health care has accumulated [4,5,6,7].

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Results

Discussion

Conclusion