Home Sweet Home? Public Financing and Inequalities in the Use of Home Care Services in Europe

Abstract

I n c o m e -r e l a t e d i n e q u a l i t i e s i n h e a l t h c a r e a c c e s s h a v e b e e n f o u n d i n s e v e r a l E u r o p e a n c o u n t r i e s b u t l i t t l e i s k n o w n a b o u t t h e e x t e n t o f i n e q u a l i t i e s i n t h e p r o v i s i o n o f L o n g T e r m C a r e s e r v i c e s ( L T C ) . T h i s p a p e r f i l l s t h i s g a p : i t a d d r e s s e s e q u i t y i s s u e s r e l a t e d t o t h e p r o v i s i o n o f h o m e c a r e s e r v i c e s a c r o s s t h r e em a c r o -a r e a s i n E u r o p e w h i c h a r e h i g h l y h e t e r o g e n e o u s i n t e r m s o f t h e d e g r e e o f p u b l i c f i n a n c i n g o f L T C a n d t h e s t r e n g t h a n d t h e s o c i a l v a l u e o f f a m i l y t i e s . U s i n g c r o s s -c o u n t r y c o m p a r a t i v e m i c r o -d a t a f r o m S H A R E ( S u r v e y o f H e a l t h , A g e i n g a n d R e t i r e m e n t i n E u r o p e ) s u r v e y , w e e s t i m a t e a n d d e c o m p o s e a n E r r e y g e r s c o n c e n t r a t i o n i n d e x o f t h e u s e o f b o t h p a i d d o m e s t i c h e l p ( " u n s k i l l e d " c a r e ) a n d p e r s o n a l n u r s i n g c a r e ( " s k i l l e d " c a r e ) , m e a s u r i n g t h e c o n t r i b u t i o n o f i n c o m e , n e e d s a n d n o n -n e e d s f a c t o r s t o o v e r a l l i n e q u a l i t y . W e b a s e t h e d e c o m p o s i t i o n o n a b i v a r i a t e p r o b i t m o d e l w h i c h t a k e s i n t o a c c o u n t t h e r e c i p r o c a l i n t e r a c t i o n b e t w e e n f o r m a l a n d i n f o r m a l h o m e c a r e u s e . W e f i n d e v i d e n c e o f h i g h h o r i z o n t a l i n e q u i t y i n t h e u s e o f u n s k i l l e d h o m e c a r e i n a r e a s w h e r e p u b l i c f i n a n c i n g o f L T C i s r e l a t i v e l y l o w ( S o u t h e r n E u r o p e ) w h i l e m o d e r a t e i n e q u a l i t i e s e m e r g e s i n a r e a s w h e r e p u b l i c -p r i v a t e m i x o f f i n a n c i n g i s m o r e b a l a n c e d ( C o n t i n e n t a l E u r o p e ) . A t t h e s a m e t i m e , w e d o n o t d e t e c t i n e q u i t y i n N o r t h e r n E u r o p e c h a r a c t e r i z e d b y h i g h p u b l i c s p e n d i n g o n u n i v e r s a l s e r v i c e s e q u i t a b l e f o r a l l , i n c l u d i n g L T C p u b l i c c o v e r a g e . I n a l l a r e a s , i n f o r m a l c a r e h a s b e e n f o u n d t o b e a s u b s t i t u t e f o r p a i d u n s k i l l e d c a r e a m o n g t h e p o o r a n d t h i s c o n t r i b u t e s t o f u r t h e r s k e w i n g Vincenzo Carrieri * Cinzia Di Novi + , Cristina Elisa Orso ♣ t h e d i s t r i b u t i o n o f t h e u s e o f f o r m a l c a r e s e r v i c e s t o w a r d s t h e r i c h . Keywords AbstractIncome-related inequalities in health care access have been found in several European countries but little is known about the extent of inequalities in the provision of Long Term Care services (LTC). This paper fil...

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