Demand of Long-Term Care and Benefit Eligibility Across European Countries

Abstract

I n t h e c o n t e x t o f a n u n p r e c e d e n t e d a g i n g p r o c e s s , t h e r o l e o f d o m i c i l i a r y c a r e f o r o l d e r a d u l t s i s b e c o m i n g i n c r e a s i n g l y e s s e n t i a l . I n o r d e r t o d e s i g n e f f e c t i v e a n d p r o a c t i v e p o l i c i e s o f f o r m a l e l d e r l y -c a r e , i t i s c r u c i a l t o u n d e r s t a n d h o w v u l n e r a b l e e l d e r l y i n d i v i d u a l s w o u l d a d j u s t t h e i r i n f o r m a l l o n g -t e r m c a r e u t i l i z a t i o n t o c h a n g e s i n t h e f o r m a l-c a r e p r o v i s i o n . A l t h o u g h t h e o r e t i c a l f r a m e w o r k s h a v e b e e n p r o p o s e d , s h o w i n g t h a t a p o s i t i v e r e l a t i o n s h i p c o u l d a r i s ew h e n t h e e l d e r l y e x h i b i t a n e x c e s s d e m a n d o f c a r e , e m p i r i c a l e v i d e n c e i s s c a n t , d u e t o t h e l a c k o f c r e d i b l e i n s t r u m e n t s t o a c c o u n t f o r t h e e n d o g e n o u s n a t u r e o f f o r m a l -c a r e d e c i s i o n s . W e p r o p o s e a n o v e l i n s t r u m e n t , a n i n d e x t h a t c a p t u r e i n d i v i d u a l s ' e l i g i b i l i t y s t a t u s t o t h e L T C d o m i c i l i a r y p r o g r a m m e s i m p l e m e n t e d i n t h e i r o w n n a t i o n o r r e g i o n . T h a t i s , a d u m m y v a r i a b l e -b e i n g e l i g i b l e o r n o tw h i c h i s g r o u n d e d o n t h e L T C r e g u l a t i o n c o n t e x t a t n a t i o n a l o r r e g i o n a l l e v e l, b u t s t i l l h a s i n d i v i d u a l w i t h i n r e g i o n v a r i a t i o n d u e t o d i f f e r e n c e s i n h e a l t h c o n d i t i o n s a n d v u l n e r a b i l i t y a s s e s s m e n t . W e e s t i m a t e a n I V t w o -p a r t m o d e l u s i n g a r e p r e s e n t a t i v e s a m p l e o f t h e o v e r 6 0 p o p u l a t i o n f o r n o n -i n s t i t u t i o n a l i s e d i n d i v i d u a l s i n A u s t r i a , G e r m a n y , F r a n c e a n d B e l g i u m . O u r r e s u l t s, w h i c h a r e r o b u s t t o a n u m b e r o f d i f f e r e n t s p e c i f i c a t i o n s , p o i n t a t t h e l a c k o f c r o w d i n g -o u t o f t h e i n f o r m a l -b y t h e f o r m a l -c a r e , t h u s s u g g e s t i n g t h e e x i s t e n c e o f a s u b s t a n t i a l u n m e t d e m a n d o f L T C a m o n g t h e e l d e r l y . Keywords Abstract:In the context of an unprecedented aging process, the role of domiciliary care for older adults is becoming increasingly essential. In order to design effective and proactive policies of formal elderly-care, it is crucial to understand how vulnerable elderly individuals would adjust their informal long-term care utilization to changes in the formal-care provision. Although theoretical frameworks have been proposed, showing that a positive relationship could arise when the elderly exhibit an excess demand of care, empirical evidence is scant, due to the lack of credible i...

Effects of formal home care on spousal health outcomes

“…Our second main finding is in line with Carrino et al (2018), who find complementarity between formal home care and informal caregiving in four European countries and interpret it in light of substantial unmet LTC needs in the population -home care professionals likely identify unmet needs and require additional support from relatives, possibly and especially spouses. To investigate this further, we look at the duration and intensity of formal home care utilization in our data, in the waves where we do have such information (only waves 1, 2, and 7, which prevented us from looking at this formally, using our identification strategy).…”

“…Fully addressing endogeneity of formal home care (with survey data) likely requires finding a valid instrumental variable, like the ones employed by Juin (2019), who uses a local-level indicator of reliance on a subsidy for formal home care use in France, Perdrix and Roquebert (2019), who use the lowest regulated price of formal home care at the local level, also in France, or Carrino et al (2018), who use an indicator of eligibility for public home care programs based on variations in needs-based eligibility criteria across four European countries. However, such strategy is likely to require focusing on fewer countries, like those studies, because it is hard to collect the data for and devise an instrument that is comparable across countries.…”

“…In fact, Juin (2019), who consider French noncoresiding adult children caring for their parents, finds that an increase in formal home care hours protects the health of caregivers. Besides, if the main explanation for complementarity between formal home care and informal care (along the extensive margin) is indeed the existence of significant unmet LTC needs, as advanced by Carrino et al (2018), then as formal home care reaches more people, the mechanism whereby home care providers identify needs and solicit more support from spouses fades.…”

“…substitutability). However, Carrino et al (2018), using data for France, Germany, Austria, and Belgium, find evidence of complementarity. The authors interpret this finding in light of substantial unmet LTC needs in European populations (Spasova et al 2018), whereby it is possible that additional public supply of formal home care leads to greater informal care use, e.g.…”

“…because formal home care providers identify unmet needs. Both studies address the endogeneity of formal home care with policy-related instrumental variables, namely local-level regulated formal home care prices (Perdrix and Roquebert 2019) and an indicator of eligibility for public home care programs based on self-reported limitations and cross-national variations in needs-based eligibility criteria (Carrino et al 2018). A few other studies indirectly consider the role of formal LTC in shaping the impact of informal caregiving on health by looking separately at (groups of) countries with different generosity of formal LTC policies (e.g.…”