Restructuring the welfare state: reforms in long-term care in Western European countries

Abstract

The need for long-term care (LTC) is projected to increase in all European countries due to the ageing of the population. The number of people aged 65 and older will double in EU-15 countries by 2050 under a pure ageing scenario and will increase by more than 30 per cent under the constant disability scenario. The aim of this paper is to see how different individual characteristics and the LTC systems around Western Europe influence the utilisation of formal LTC (in terms of frequency of services received). The data used from this study come from the Survey of Health Ageing and Retirement in Europe (SHARE) 2004-2005. We test here the individuals and systems characteristics determining the influence of use professional home-based LTC service (nursing care, domestic home assistance and meals-on-wheals). The frequencies are modelled using a negative binomial regression model. Our findings indicate that utilisation of professional home-based LTC increases significantly with factors like age, education, income and ADL (Activities of Daily Living) score. We found that the utilisation of LTC services is closely linked to the policy priorities, the financing and the organisations of the LTC system. In countries like the Netherlands, where a greater policy emphasis is put on home-based care, the utilisation of home-based LTC is higher compared with most of the other countries in the study.

Negotiating User Preferences, Discrimination, and Demand for Migrant Labour in Long-Term Care

“…Developments in both countries, and across Europe, have brought about the increasing role of the market in long-term care (Pavolini and Ranci 2008). Market reforms have been pursued in relation to pressures for cost containment, but also for improving the "personalization" of provision to the needs and preferences of individual users (Needham 2011).…”

A structured review of long-term care demand modelling

“…In essence, this can result in underestimation of the true cost of care and creates issues for modelers that wish to establish the progression of patients through the system. Finally, like many healthcare systems LTC is not stagnant and has been host to a number of fundamental reforms (Pavolini & Ranci, 2008), not least with respect to policy, scope and coverage. Where policy has changed in quick succession, modelers face the dilemma of taking into account the influences of past changes on increasingly limited intervals of historical data before being able to provide robust projections.…”

“…In part, this appears to be largely due to the belief that changes in population demographics this century as a result of high birth rates in the post-war period, together with an increasing probability of surviving into older age (Spillman & Lubitz, 2000), will further increase the burden on healthcare systems to provide LTC to elderly patients. Furthermore, a decrease in the ability of family-support networks to assist those in need of LTC could be cited as an additional pressure for many already overstretched LTC systems (Pavolini & Ranci, 2008).…”

Politiques du care et gouvernement de la vie: Une typologie des pratiques locales en Suisse

“…15 Pour une discussion du cas de la médiation comme instrument, voir Lucas (2010). la prise en charge des situations de dépendance en Europe soulignent la grande diversité des prestations disponibles (Bettio et Plantenga 2004 ;Anttonen et Sipil�� 2005 ;Pavolini et Ranci 2008). Or, par le jeu des discours et des prestations concrètes dispensées, les politiques du care défi-nissent et consolident les normes de la « bonne vie » des personnes dépen-dantes et des aidant-es, notamment quant à leur degré de sociabilité.…”