The greater visibility of societal ageing and higher share of individuals with disabilities have created new challenges for housing and urban policies. Housing needs can influence individual choice of living environment and the willingness to undertake housing improvements. This is especially relevant in southern European countries where the family is still the main provider of care for the elderly. This study makes an empirical analysis of the underlying preferences for housing and perceptions of housing suitability in the event of dependency in old age, drawing upon a new representative database of the Spanish population. It explores whether preferences are stable for different age-groups and different levels of individual affluence, calculated in terms of income and housing assets. The study found preferences for `ageing in place', which became stronger as individuals grew older. The effect of affluence, or the `wealth effect', was considerable. Acting independently and exhibiting higher health needs, it restrained individuals from choosing institutional care options. Those respondents who preferred to `age in place' were relatively less affluent. Those with relatively less formal education, preferred living with their relatives.

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The methods were analysed because they are the most frequently used but the same methodology could be employed to compare other outlier determination methods. Outliers should be calculated because they ought to be valued differently from inlier cases.

Background Heterogeneity in drug access throughout Europe may be influenced by differences in drug-assessment strategies. The EUnetHTA’s assessment core model (EUnetHTA-core) and the EVIDEM’s multicriteria framework are reference methodologies in this context, the latter including a wider compromise between non-contextual and contextual criteria. Compliance of 37 European Health Technology Assessment bodies (HTAb) with EUnetHTA-core has been reported, but the use of EVIDEM by this HTAb is still unknown. Methods To describe the uptake and use of multicriteria approaches to evaluate drug value by European HTAb using EVIDEM as reference framework, a multicriteria framework was obtained based on EVIDEM model. The criteria used for drug appraisal by HTAb was extracted from the EUnetHTA report, and completed through search of websites, publications and HTAb reports. Use of EVIDEM assessment model in 37 European HTAb has been described semi-quantitatively and summarized using an alignment heatmap. Results Aligned, medium or misaligned profiles were seen for 24,3%, 51,4% and 24,3% of HTAb when matching to EVIDEM dimensions and criteria was considered. HTAb with explicit responsibilities in providing specific advice on reimbursement showed more aligned profiles on contextual and non-contextual dimensions. Conclusions EUnetHTA’s core model is limited in assessing medicines while EVIDEM’s framework provides contextual dimension used by some HTAb in Europe that can be escalated to other agencies. Most of the 37 European HTAb have room to broaden their contextual assessment tools, especially when social and medical perception of need requires to be explicit to support payer’s decision on reimbursement.

The access to publicly funded long-term care (LTC) in Spain has been traditionally rationed through the use of means tests based on individuals' current income and needs. However, individuals' wealth, primarily housing assets, is progressively taken into account. Parallel to this feature, the responsibilities for the organization of LTC services have been devolved to region-states -autonomous communities (ACs), giving rise to some regional heterogeneity, though limited evidence has been reported on the underlying determinants. This paper examines the current role of housing assets in determining public and private funding for long-term care in Spain. Secondly, we present a qualitative and quantitative examination of the regional heterogeneity in the provision and public funding criteria determining eligibility for public support for LTC. Finally, we report survey evidence on the individual's willingness to sell (WTS) their housing assets in order to either totally or partially finance the access to LTC. Our findings suggest that housing assets are the main source of wealth accumulation at old age. Yet there is significant regional heterogeneity in the access to LTC resulting from regional differences in the means testing criteria. Progressively, all ACs are considering housing assets in their means testing criteria. Interestingly, individuals' willingness to sell their housing assets declines with age and is more common among less skilled and widowed individuals.