BackgroundThe challenges posed by the rapidly ageing population, and the increased preponderance of disabled people in this group, coupled with the rising level of public expenditure required to service the complex organization of long term care (LTC) delivery are causing increased pressure on LTC systems in Europe. A pan-European survey was carried out to evaluate whether patterns of LTC can be identified across Europe and what are the trends of the countries along them.MethodsAn ecological study was conducted on the 27 EU Member States plus Norway and Iceland, referring to the period 2003-2007. Several variables related to organizational features, elderly needs and expenditure were drawn from OECD Health Data and the Eurostat Statistics database and combined using Multiple Factor Analysis (MFA).ResultsTwo global Principal Components were taken into consideration given that their expressed total variance was greater than 60%. They were interpreted according to the higher (more than 0.5) positive or negative correlation coefficients between them and the original variables; thus patterns of LTC were identified. High alignment between old age related expenditure and elderly needs characterizes Nordic and Western European countries, the former also having a higher level of formal care than the latter. Mediterranean as well as Central and South Eastern European countries show lower alignment between old age related expenditure and elderly needs, coupled with a level of provision of formal care that is around or slightly above the average European level. In the dynamic comparison, linear, stable or unclear trends were shown for the studied countries.ConclusionsThe analysis carried out is an explorative and descriptive study, which is an attempt to reveal patterns and trends of LTC in Europe, allowing comparisons between countries. It also stimulates further researches with lower aggregated data useful to gain meaningful policy-making evidence.Please see related article: http://www.biomedcentral.com/1741-7015/9/124
Background: The ageing population in Europe is putting an ever increasing demand on the longterm care (LTC) services provided by these countries. This study analyses the relationship between the LTC institutional supply of beds and potential care needs, taking into account the social and health context, the supply of complementary and alternative services, along with informal care.
BackgroundMortality amenable to health-care services (‘amenable mortality’) has been defined as “premature deaths that should not occur in the presence of timely and effective health care” and as “conditions for which effective clinical interventions exist.” We analyzed the regional variability in health-care services using amenable mortality as a performance indicator. Convergent validity was examined against other indicators, such as health expenditure, GDP per capita, life expectancy at birth, disability-free life expectancy at age 15, number of diagnostic and laboratory tests per 1,000 inhabitants, and the prevalence of cancer and cardiovascular diseases.MethodsAmenable mortality rate was calculated as the average annual number of deaths in the population aged 0–74 years per 100,000 inhabitants, and it was then stratified by gender and region. Data were drawn from national mortality statistics for the period 2006–08.ResultsDuring the study period (2006–08), the age-standardized death rate (SDR) amenable to health-care services in Italy was 62.6 per 100,000 inhabitants: 66.0 per 100,000 for males and 59.1 per 100,000 for females. Significant regional variations ranged from 54.1 per 100,000 inhabitants in Alto Adige to 76.3 per 100,000 in Campania. Regional variability in SDR was examined separately for male and females. The variability proved to be statistically significant for both males and females (males: Q-test = 638.5, p < 0.001; females: Q-test = 700.1, p < 0.001). However, among men, we found a clear-cut divide in SDR values between Central and Southern Italy; among women, this divide was less pronounced. Amenable mortality was negatively correlated with life expectancy at birth for both genders (male: r = −0.64, p = 0.002; female: r = −0.88, p <0.001) and with disability-free life expectancy at age 15 (male: r = −0.70, p <0.001; female: r = −0.67, p <0.001). Amenable mortality displayed a statistically significant negative relationship with GDP per capita, the quantity of diagnostic and laboratory tests per 1,000 inhabitants, and the prevalence of cancer.ConclusionsAmenable mortality shows a wide variation across Italian regions and an inverse relationship with life expectancy and GDP per capita, as expected.
This paper studies gender differences in disability free life expectancy (DFLE), taking into account mortality and disability contributions. After analysing the types of disability that account for such differences, it goes on to examine temporal variability and age contributions to mortality and disability variation. The method used is an extension of Arriaga's model proposed by Nusselder. In 2005, disability free life expectancy at age 30 was 46.23 years for men and 48.74 years for women, with a gender difference of 2.51 years. Decomposing this difference we find that the mortality effect is 3.70 years, while the disability effect is negative and equal to -1.19 years. Ten years earlier, in 1994, DFLE at age 30 was 43.24 years for men and 46.55 years for women, with a difference between genders of 3.32 years. This broke down to a mortality effect of 4.33 years and a disability effect of -1.02 years. In conclusion, the gap in DFLE between men and women is narrowing, thanks to the more rapid drop in mortality rates in men. With respect to disabilities women are disadvantaged, although the difference (in both total disability and different types of disability) has been almost stable in recent years.
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