Will Resources for Elder Care Be Scarce?

Abstract

One of the major issues in the debate about the future of care is how to keep costs under control while meeting growing demands for care. Addressing that, especially on an international scale, is far from easy How are we to determine what the demands for care will most likely be? Even if it is not possible to estimate the future number of dependent elderly persons with any precision, it is hard to ignore the most probable scenario: a substantial increase in the number of the oldest old. What factors--demographic, cultural, economic--will shape the future use of care services, and how much reliance should policy-makers place on long-term projections of population, status, and need for services? What instruments are available to different societies and governments to control the cost of care? These are the sorts of questions we must try to answer in determining whether, and to what extent, we face a growing scarcity of resources as the elderly population grows. Countries participating in the project Ethics and the Care of the Elderly have totally different care systems. The Western European welfare states (the United Kingdom, Germany, Sweden, Belgium, and the Netherlands) have a mixed system of government regulation and free market elements, while the Eastern European countries (the Czech Republic and Hungary) are rebuilding their care systems in the post-communist era. And the United States is looking to reform its strongly market oriented care system. Yet despite substantial differences among the participating countries, we can identify various conceptual frameworks of factors that determine the use of care services. But a single, generally accepted theory about the use of services is not available so far. This sets limitations on the possibilities of predicting the future needs for services. For this reason, projections of service utilizations are often limited to demographic projections. These kinds of projections will be presented for the Netherlands and Sweden. The outcomes are discussed in terms of trends in utilization patterns and government policies. A Conceptual Framework for the Use of Health Services There is a long tradition of research aimed at explaining the use of care. In these studies a wide range of factors was found to influence service use on both the demand side and the supply side. The most important determinant of service utilization is status, both as perceived by the individual and as revealed by diagnoses. On the demand side of service use the central questions addressed by these studies are: what factors (apart from status) influence the use of services, and why does one person with a problem visit a professional caregiver while another person with the same problem does not? Different studies assess the importance of secondary variables differently. Depending on the approach taken by a particular study, the relevant factors pertain to any of four domains: the demographic (age, sex, socioeconomic status, income), the social-psychological (motivation, personality, medical knowledge, attitudes toward health, satisfaction with caregivers, the health belief model), the sociocultural (norms and values in one's own group, religion, nationality, and ethnicity), and the financial-economic (health insurance system, out-of-pocket payments).[1] Often factors from several areas are combined into one model, which may also include factors on the supply side of service use, such as ratios of personnel to patients or distance to service location. The aim is to explain as much variance in service utilization as possible.[2] By taking into account both services and social services it appears that the most important variables on the demand side of service use are: age, sex, household composition, education, income, housing, social network, domestic skills, development of technologies to enable care recipients to live independently for longer, and attitudes toward and illness. …