The elderly: different countries, different assistance

Europeans are living longer and longer, but the number of inequalities in health conditions is increasing, especially among elderly people. This context, combined with transformations occurring in the labour market and in family structures, greatly contributed to increase the importance of both economic and social services addressed to the elderly, especially in terms of public “long-term care”.

The number of elderly people in need of this long-lasting assistance is constantly increasing, and it is expected to grow even more in the coming decades, with considerable consequences on the sustainability and effectiveness of public programs throughout the whole Europe.

In a new publication printed by Palgrave MacMillan, Agar Brugiavini, Ludovico Carrino, Cristina Elisa Orso and Giacomo Pasini (pictured), economists from the Department of Economics of Ca’ Foscari, a crucial and often underestimated aspect of these programs is analysed: the formal definition of the “need” for minimum assistance and the rules of access to it. These rules are, indeed, an essential tool to determine the potential demand, the “target population”, for a program of assistance.

Is it possible to quantify differences between countries according to the institutional definition of need? What consequences do these differences imply in terms of economic coverage and costs, present and future?

“It is a particularly relevant issue - the researchers explain - not fully addressed by literature yet, and reason of numerous calls coming from international authorities (such as the OCSE and the OMS), who have repeatedly recommended a greater push towards the alignment of the rules regarding long-term care in Europe”.

In the book, the authors present an original and comprehensive overview of the European public offer in terms of formal care. The book shows that one distinctive feature of the European framework is the great variability in the methods of assessing the need for assistance and its rules of access, and the remarkably fragmented nature of the services offered, in terms of monetary support and social benefit. In other words, seniors with the same limitations (functional or cognitive) may be subject to very different levels of economic coverage depending on their European region of residence.

In this confusing context, the book offers two substantial contributions. It provides a new comparative measure for the effectiveness of public supply, estimating the potential demand associated with each program, and offering an analysis that highlights how a reform of the rules (for example the adoption of a single “European” regulation) could change the status quo in the number of the elderly benefiting from long-term care services.

For the first time, it is clear that differences in the rules of access select very different “target populations”. Secondly, the publication bases its empirical estimates on microdata coming from large sample surveys, representing the over-fifties living in Europe, including the UK (ELSA - English Longitudinal Study on Ageing and SHARE - Survey of Health, Ageing and Retirement in Europe). This method allows to take into account the different epidemiological characteristics of the various countries involved in the calculation of potential demands.

This book is aimed, on the one hand, to health economics, sociology and public policy scholars; on the other, to policy makers and professionals interested in planning and evaluating services. Last but not least, the book turns out to be an agile compendium for undergraduate or specialization courses in aging, health economics and policy evaluation.