Friday, May 11, 2012

[EQ] Can the European elderly afford the financial burden of health and long-term care?

Can the European elderly afford the financial burden of health and long-term care?

Assessing impacts and policy implications

Xenia Scheil-Adlung, Jacopo Bonan

ESS Paper N° 31 Global Campaign on Social Security and Coverage for All
International Labour Organization 2012

Available online PDF file [50p.] at:

This research report assesses the financial impact of private health and long-term care expenditure on households of the elderly, in particular, the impact of out-of-pocket payments at the time of service delivery and related policy implications.

“…….Receiving health and long-term care when in need and adequate social health protection from related financial impacts are considered fundamental human rights, which are highlighted in the Social Security (Minimum Standards) Convention, 1952 (No 102).

The elderly are particularly at risk, as they are prone to ill health and disability conditions that necessitate health care and long-term care LTC. However, social protection systems in the countries observed do not provide adequate protection for the elderly:

·         Out-of-pocket payments for health care concern on average about 70 per cent of the elderly population; about 5 per cent have to face Out-of-pocket payments and expenditures as a consequence of long-term care LTC.

·         Economic consequences of such expenditures on households may be severe and constitute a threat to their financial sustainability and bring about impoverishment.

·         The impact of related private expenditure for long-term care LTC is higher for the poor than for the rich, and some social groups – such as women and individuals living alone – are at a higher risk of Out-of-pocket payments.

·         The availability of services constitutes an important problem in most countries given the lack of skilled workers providing services to the elderly.

Given demographic developments, the problems observed are likely to increase in the future. In order to meet the current and future needs of the elderly, and particularly vulnerable groups among them, population coverage should be universal and more effective; efficient social health protection systems are also desirable.

This requires, in particular, that more resources should be made available for the elderly, especially to further develop long-term care LTC schemes with a view to: increasing the scope of benefits;  ensuring the affordability, availability and delivery of services; and improving the quality of services in order to respond more adequately to needs.

Furthermore, measures should be envisaged to facilitate the delivery of informal car by covering family carers in social protection systems and providing compensation, e.g. cash benefits and allowances. In addition, the widespread shortage of the health and long-term care LTC workforce needs to be addressed by creating decent working conditions.

Addressing inequities in the elderly population’s access to health and long-term care LTC services also requires an integrated policy approach within the broader social protection system. Raising the national social protection floor has the potential to reduce the social and economic vulnerability of the elderly. In addition to guaranteeing access to needed health and long-term care LTC services, it would focus on income support and financial protection. As a result, synergies of benefits from various schemes – e.g. old-age pension, social assistance and health care –would help to address the inequities observed…..”


1._ Introduction

2._ European social protection systems aimed at alleviating the financial burden of health and long-term care: Key characteristics

2.1._ Public expenditure investments in health and long-term care

2.2._ Coverage and financing mechanisms

2.3._ Extent of benefit packages and financial protection

2.4._ Availability and quality of services: the role of the workforce

3._ Assessing the burden of private health and long-term care expenditure on the elderly

4._ Who are the most vulnerable among the elderly?

5._ Assessment of the findings and policy implications

5.1._ Closing gaps in coverage and financial protection

5.2._ Addressing deficits in the availability of services

5.3._ Achieving equitable access for the most vulnerable

6._ Summary and conclusions




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