Eligibility and Inclusiveness of Long-Term Care Institutional Frameworks in Europe: A Cross-Country Comparison

Abstract

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.

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

“…As discussed in Carrino and Orso (2014), every main public LTC programme across countries or regions performs an assessment-of-need in order to build a "vulnerability profile" of the elder applicant, after which a decision on her eligibility status is taken by comparing the profile with a definition of "minimum objective vulnerability status", set by eligibility rules in the legislation (this holds true also for main private LTC insurances, which often borrow their eligibility criteria from the public regulations). Relevant heterogeneity exists among countries (and even within countries, when multiple nationwide programmes are implemented) on the very issue of defining vulnerability.…”

“…Still, Austria LTC regulations (at 2004, 2006) was rather unclear on the boundaries to the discretionary use of the allowance and no clear obligation to pay for care or to use care services was identifiable. As highlighted in Carrino and Orso (2014), Austrian patients have a high degree of freedom in the use of the benefit for financing their formal-care services, although the allowance can be converted into an inkind benefit in case of improper use of the money. After excluding Austria (1235 observations), results are in general confirmed.…”

Utility of Healthcare System-Based Interventions in Improving the Uptake of Influenza Vaccination in Healthcare Workers at Long-Term Care Facilities: A Systematic Review

“…They can also differ among countries and even within the same country, primarily due to distinctive regulations at the national or regional level and to peculiar needs of each geographical area. In fact, long-term care policies, including those regarding residential facilities, differ considerably between countries, due to nation's structure and organization, history, culture, or even economic performance [82][83][84][85][86]. This diversity partially explains the variety in the vaccination uptake among the staff in the studies included in this review (from 0%-100%), the interventions that have been implemented, and the effect of the interventions in improving vaccination.…”

Care choices in Europe: To Each According to His or Her Needs?

“…However, eligibility rules and the generosity of the systems differ. 30 , 31 In the following, we briefly describe the relevant aspects of the LTCI system of each country, putting a special focus on incentives set for informal and formal care. Because the market for private LTCI is relatively small in all countries, 32 , 33 we concentrate primarily on the public LTC settings.…”

“…ii Those who have mental limitations are assigned to GIR1 or GIR2; being classified into GIR4 or higher requires difficulties with at least 2 ADLs. 30 The APA is an earmarked in-kind benefit that can be used for LTC at home or for residential care. It is not means-tested but depends on the level of impairment as well as on individual income.…”