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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...

In this paper, we study how elderly individuals adjust their informal long-term care utilization to changes in the provision of formal care. Despite this is crucial to design effective policies of formal elderly care, empirical evidence is scant due to the lack of credible identification strategies to account for the endogeneity of formal care. We propose a novel instrument, an index that captures individuals' eligibility status for the long-term care programs implemented in the region of residence. Our estimates, which are robust to a number of different specifications, suggest that higher formal care provision would lead to an increase in informal care utilization as well. In the context of current theoretical economic model of care use, this result points to the existence of a substantial unmet demand of care among older people in Europe.

A lthough econo m ic literature has recently started to concentrate on the design, the scope and the regulations of m ain public program m es of Long-T erm-C are in E urope, no analysis have, so far, com pared different system s in term s of their degree of inclusiveness w ith respect to vulnerable elderly's health status. Focusing on several E uropean countries, this paper investigate how LT C regulations assess vulnerability, as w ell as how they define a m inim um level of objective-dependency that w ould entitle individuals to receive public benefits (in-kind or in-cash) for hom e-based care. O ur contribution is threefold. W e provide detailed inform ation on assessm ent and eligibility fram ew orks for eleven LT C program m es in E urope. W e show that substantial heterogeneities exist both at th e extensive m argin (the health-outcom es that are included in the vulnerability-assessm ent) and at the intensive m argin (the m inim um vulnerability threshold that defines benefit eligibility) of the assessm ent strategies. B uilding on this inform ation, w e com pare L T C program m es in term s of their degree of inclusiveness, i.e., w e investigate the extent to w hich each program m e is able to cover a standard population of elderly individuals facing functional and cognitive lim itations. T he com parison is perform ed follow ing both a directly-and an indirectly-adjusted strategy using SH A R E data.

In this paper, w e investigate w hether exposure to adverse experiences during childhood such as physical and em otional abuse affects a set of health and socio-econom ic outcom es across the lifespan using recent E uropean data from SH A R E (T he Survey of H ealth, A geing and R etirem ent in E urope). T he novelty of our approach consists in exploiting the recently published data on adverse childhood experiences for 19 SH A R E countries, w hich enables us to account for country-specific heterogeneity and investigate the long-run effects of exposure to early-life adverse circum stances on different adult outcom es. O ur results highlight a negative long-term effect of exposure to adverse childhood experiences -A C E s on risky behaviour such as sm oking, as w ell as on socio-econom ic outcom es like unem ploym ent and fam ily dissolution. AbstractIn this paper, we investigate whether exposure to adverse experiences during childhood such as physical and emotional abuse affects a set of health and socio-economic outcomes across the lifespan using recent European data from SHARE (The Survey of Health, Ageing and Retirement in Europe). The novelty of our approach consists in exploiting the recently published data on adverse childhood experiences for 19 SHARE countries, which enables us to account for country-specific heterogeneity and investigate the long-run effects of exposure to early-life adverse circumstances on different adult outcomes. Our results highlight a negative long-term effect of exposure to adverse childhood experiences -ACEs on risky behaviour such as smoking, as well as on socio-economic outcomes like unemployment and family dissolution.