Long-term care financing in Europe: An overview

Anne Neubert,

Petra Baji,

Marzena Tambor,

Wim Groot,

László Gulácsi,

Milena Pavlova


Despite the growing interest in the sustainability of long-term care (LTC) systems, only a few studies have investigated the differences in the LTC financing across European countries. The objective of this paper is to describe the financing of LTC in Europe. For this purpose, we use indicators on LTC financing taken from international databases and reports. Desk research was carried out to identify relevant indicators. Hierarchical cluster analysis was used to identify typologies in LTC financing across the EU/EEA countries based on seven indicators selected. We found large differences in LTC financing across the EU/EEA countries in terms of total expenditure, the division of expenditure between the social and health care system, and in the role of in-kind and cash benefits. Four main financial models across the EU/EEA countries could be distinguished. Further, we identified some shortages in data reporting on the financing of LTC services. Some limitations and contradictions related to the indicators of LTC financing are highlighted. In particular, we stress the need for more comprehensive data to enable further cross-country comparisons and to provide valid input for policy.

* Przygotowanie do wydania elektronicznego finansowane w ramach umowy 637/P-DUN/2019 ze środków Ministra Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.

Słowa kluczowe: analiza skupień, Europa, finansowanie, opieka długoterminowa, cluster analysis, Europe, financing, funding, long-term care

1. Leichsenring K., Billings J., Nies H., Long-term care in Europe: Improving policy and practice, Palgrave Macmillan, Basingstoke, UK 2013.

2. Huber M., Rodrigues R., Hoffmann F., Gasior K., Marin B., Facts and Figures on Long-term Care. Europe and North America, European Centre, Vienna 2009, https://www.berndmarin.eu/wp-content/uploads/2017/09/2009-Facts-and-Figures-on-Long_Term-Care_Europe-and-North-America_overview.pdf (accessed: 10.08.2019).

3. Deusdad B.A., Pace C., Anttonen A., Facing the challenges in the development of long-term care for older people in Europe in the context of an economic crisis, “Journal of Social Service Research” 2016; 42 (2): 144‒150, https://www.tandfonline.com/doi/full/10.1080/01488376.2015.1133147 (accessed: 10.08.2019).

4. Gori C., Changing long-term care provision at the local level in times of austerity – a qualitative study, “Ageing & Society” 2018; 1‒26, https://www.cambridge.org/core/journals/ageing-and-society/article/changing-longterm-care-provision-at-the-local-level-in-times-of-austerity-a-qualitativestudy/6B69E558F9ACDBE8067E216A768B20B (accessed: 10.08.2019).

5. Brodsky J., Habib J., Hirschfeld M., Key policy issues in long-term care, World Health Organization, Geneva 2003.

6. European Commission, Joint Report on Health Care and Long-Term Care Systems & Fiscal Sustainability, Vol. 2, European Commission, Brussels 2016, https://publications. europa.eu/en/publication-detail/-/publication/8f7a1f6b-b538- 11e6-9e3c-01aa75ed71a1/language-en (accessed: 10.08.2019).

7. Kraus M., Riedel M., Mot E., Willemé P., Röhrling G., A Typology of Long-Term Care Systems in Europe, ENEPRI Research Report No. 91, August 2010, https://irihs.ihs.ac.at/id/eprint/3649/1/ENEPRI%20RR%20No%2091%20Typology%20of%20LTC%20%20Systems%20in%20Europe.pdf (accessed: 10.08.2019).

8. Anderson J.E., Public policymaking: Cengage Learning, Stamford, CT 2014.

9. WHO, Everybody’s business-strengthening health systems to improve health outcomes: WHO’s framework for action, 2007, https://apps.who.int/iris/bitstream/handle/10665/43918/9789241596077_eng.pdf (accessed: 10.08.2019).

10. Kapllanaj M., Pino S., Haxhiymeri E., Mother employment and the role of care services in Albania, “European Scientific Journal” 2016; 12 (5): 129‒139.

11. Vullnetari J., King R., ‘Does your granny eat grass?’ On mass migration, care drain and the fate of older people in rural Albania, “Global Networks” 2008; 8 (2): 139‒171.

12. Vullnetari J., King R., ‘Washing men’s feet’: Gender, care and migration in Albania during and after communism, “Gender, Place & Culture” 2016; 23 (2): 198‒215.

13. Hirose K., Czepulis-Rutkowska Z., Challenges in Longterm Care of the Elderly in Central and Eastern Europe, ILO DWT and Country Office for Central and Eastern Europe, Budapest 2016, https://www.ilo.org/budapest/what-wedo/publications/WCMS_532427/lang--en/index.htm (accessed:10.08.2019).

14. Lipsitz L.A., The Elderly People of Post‐Soviet Ukraine: Medical, Social, and Economic Challenges, “Journal of the American Geriatrics Society” 2005; 53 (12): 2216‒2220.

15. Tolstokorova A.V., Gender Implications of Care Migration for the Operation of Care Diamond in Ukraine, “Diversities” 2013; 15 (1): 37‒50.

16. Small B.H., Siewert G.A., Porrazzo J., Evaluating Long- Term Health Care Options for the Elderly in Albania, 2015, https://digitalcommons.wpi.edu/iqp-all/3338/ (accessed: 10.08.2019).

17. Barker K.K., Bosco C., Oandasan I.F., Factors in implementing interprofessional education and collaborative practice initiatives: Findings from key informant interviews, “Journal of Interprofessional Care” 2005; 19 (supl.): 166‒176.

18. Christmas C., Kravet S.J., Durso S.C., Wright S.M., Clinical excellence in academia: Perspectives from masterful academic clinicians, Paper presented at the Mayo Clinic Proceedings, 2008, https://www.sciencedirect.com/science/article/abs/pii/S0025619611606010 (accessed: 10.08.2019).

19. Kiffin-Petersen S., Murphy S.A., Soutar G., The problemsolving service worker: Appraisal mechanisms and positive affective experiences during customer interactions, “Human Relations” 2012; 65 (9): 1179‒1206.

20. King N., Brooks J.M., Template analysis for business and management students, Sage, London 2016.

21. Pfau-Effinger B., Culture and welfare state policies: Reflections on a complex interrelation, “Journal of Social Policy” 2005; 34 (1): 3‒20.

22. European Commission, Joint Report on Health Care and Long-Term Care Systems & Fiscal Sustainability, Vol. 1, European Commission, Brussels 2016, https://publications.europa.eu/en/publication-detail/-/publication/d6042a45-b535-11e6-9e3c-01aa75ed71a1/language-en (accessed: 10.08.2019).

23. Coleman E.A., Falling through the cracks: Challenges and opportunities for improving transitional care for persons with continuous complex care needs, “Journal of the American Geriatrics Society” 2003; 51 (4): 549‒555.

24. Lau J.Y.C., Wong E.L.Y., Chung R.Y., Law S.C., Threapleton D., Kiang N.,..., Yeoh E.K., Collaborate across silos: Perceived barriers to integration of care for the elderly from the perspectives of service providers, “The International Journal of Health Planning and Management” 2018; 33 (3): e768‒e780.

25. Uittenbroek R.J., Kremer H.P., Spoorenberg S.L., Reijneveld S.A., Wynia K., Integrated care for older adults improves perceived quality of care: results of a randomized controlled trial of embrace, “Journal of General Internal Medicine” 2017; 32 (5): 516‒523.

26. Marcotte L., Kirtane J., Lynn J., McKethan A., Integrating health information technology to achieve seamless care transitions, “Journal of Patient Safety” 2015; 11 (4): 185‒190.

27. Da Roit B., Le Bihan B., Similar and yet so different: Cashfor‐ care in six European countries’ long‐term care policies, “The Milbank Quarterly” 2010; 88 (3): 286‒309.

28. Challis D., Chesterman J., Luckett R., Stewart K., Care management in social and primary health care: The Gateshead Community Care Scheme, Routledge, Abingdon, UK 2018.

29. Arentshorst M.E., Kloet R.R., Peine A., Intergenerational Housing: The Case of Humanitas Netherlands, “Journal of Housing For the Elderly” 2019; 33 (3): 244‒256.

30. Tinker A., Ginn J., Ribe E., Assisted living platform: The long term care revolution. A study of innovatory models to support older people with disabilities in the Netherlands, King’s College London, London 2013, https://www.ifa-fiv. org/wp-content/uploads/2013/11/HLIN-Report-LTC-Revolution.pdf (accessed: 10.08.2019).

31. Chen L., Evans T., Anand S., Boufford J.I., Brown H., Chowdhury M.,..., Elzinga G., Human resources for health: Overcoming the crisis, “The Lancet” 2004; 364 (9449): 1984‒1990.

32. Daly T., Armstrong P., Liminal and invisible long-term care labor: Precarity in the face of austerity, “Journal of Industrial Relations” 2016; 58 (4): 473‒490.

33. Greve B., Long-term care for the elderly in Europe: Development and prospects, Routledge, Abingdon, UK 2016,.

34. Costa‐Font J., Courbage C., Swartz K., Financing longterm care: ex ante, ex post or both? “Health Economics” 2015; 24: 45‒57, https://onlinelibrary.wiley.com/doi/abs/10.1002/hec.3152 (accessed: 10.08.2019).

35. Vabo S.I., Actors and governance arrangements in longterm care for older people, in: Y. Kazepov, Rescaling Social Policies towards Multilevel Governance in Europe, Routledge, Abingdon, UK 2017: 343‒363.

36. Barlow J., Roehrich J., Wright S., Europe sees mixed results from public-private partnerships for building and managing health care facilities and services, “Health Affairs” 2013; 32 (1): 146‒154.

37. Costa-Font J., Courbage C., Long-Term Care Insurance: Partnership or Crowding Out?, in: J. Costa-Font, C. Courbage, Financing Long-Term Care in Europe, Palgrave Macmillan, London 2012: 91‒100.

38. Hussein S., Manthorpe J., An international review of the long-term care workforce: Policies and shortages, “Journal of Aging & Social Policy” 2005; 17 (4): 75‒94.

39. Aiken L.H., Sloane D.M., Bruyneel L., Van den Heede K., Sermeus W., Consortium, R. c., Nurses’ reports of working conditions and hospital quality of care in 12 countries in Europe, “International Journal of Nursing Studies” 2013; 50 (2): 143‒153.

40. Hollinger-Smith L., Ortigara A., Changing culture: Creating a long-term impact for a quality long-term care workforce, “Alzheimer’s Care Today” 2004; 5 (1): 60‒70.

41. Jecker N.S., Chin J.J.L., Justice and global care chains: Lessons from Singapore, “Developing World Bioethics” 2018; 19 (3): 155‒168.

42. Georgiou A., Marks A., Braithwaite J., Westbrook J.I., Gaps, disconnections, and discontinuities ‒ the role of information exchange in the delivery of quality long-term care, “The Gerontologist” 2012; 53 (5): 770‒779.

43. van der Haak C.S., Mileski M., Alaytsev V., Carol E., Williams A., Adoption factors associated with electronic health record among long-term care facilities: A systematic review, “BMJ Open” 2015; 5 (1): e006615.

44. Čaić M., Odekerken-Schröder G., Mahr D., Service robots: Value co-creation and co-destruction in elderly care networks, “Journal of Service Management” 2018; 29 (2): 178‒205.

45. van der Haak M., Wolff A.C., Brandner R., Drings P., Wannenmacher M., Wetter T., Data security and protection in cross-institutional electronic patient records, “International Journal of Medical Informatics” 2003; 70 (2‒3): 117‒130.

46. Fernandez S., Rainey H.G., Managing successful organizational change in the public sector, in: R.F. Durant, J.R.S. Durant, Debating Public Administration, Routledge, Abingdon, UK 2017: 7‒26.

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