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Horizontal and vertical targeting: a population-based comparison of public eldercare services in urban and rural areas of Sweden

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Abstract

The concepts of target efficiency can be used to assess the extent to which service provision is in line with the needs of the population. Horizontal target efficiency denotes the extent to which those deemed to need a service receive it and vertical target efficiency is the corresponding extent to which those who receive services actually need them. The aim of this study was to assess the target efficiency of the Swedish eldercare system and to establish whether target efficiencies differ in different geographical areas such as large urban, midsize urban and rural areas. Vertical efficiency was measured by studying those people who received eldercare services and was expressed as a percentage of those who received services who were functionally dependent. To measure horizontal target efficiency, data collected at baseline in the longitudinal population study SNAC (Swedish National study on Aging and Care) during the years 2001–2004 were used. The horizontal efficiency was calculated as the percentage of functionally dependent persons who received services. Functional dependency was measured as having difficulty with instrumental activities of daily living (IADL) and/or personal activities of daily living (PADL). Services included long-term municipal eldercare services (LTC). Horizontal target efficiency for the public LTC system was reasonably high in all three geographical areas, when using dependency in PADL as the measure of need (70–90 %), but efficiency was lower when the less restrictive measure of IADL dependency was used (40–50 %). In both cases, the target efficiency was markedly higher in the large urban and the rural areas than in the midsize urban areas. Vertical target efficiency showed the same pattern—it was almost 100 % in all areas for IADL dependency, but only 50–60 % for PADL dependency. Household composition differed in the areas studied as did the way public long-term care was provided to people living alone as compared to those co-habiting.

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Notes

  1. Vertical target efficiency could have been calculated using only care recipients. However, we chose to use the same sample for calculating both horizontal and vertical target efficiency.

  2. “Low income” was defined as belonging to the lowest tertile of incomes derived from employment, pension and capital among the Swedish population 65 years and older. This corresponds to less than 138,000 SEK per year (15 000 €).

  3. In this context, immigrant is defined as being born outside the Nordic countries.

  4. Maximum number 5; for cognitive impairment and mobility disability 3.

  5. The municipalities are those that participate in the SNAC study. These municipalities were not chosen for being typical representatives of their type of geographical area, but rather for fulfilling other criteria—being willing and capable of participating being the most important.

References

  1. Lagergren M (2002) The systems of care for frail elderly persons: The case of Sweden. Aging Clin Exp Res 14:252–257

    Article  PubMed  Google Scholar 

  2. Trydegard GB (2000) Tradition, change and variation. Past and present trends in public old-age care. Stockholm studies of Social Work 16. Stockholm University, Department for Social Work: Stockholm

  3. Trydegard G-B, Thorslund M (2010) One uniform welfare state or a multitude of welfare municipalities? The evolution of local variation in Swedish eldercare. Soc Policy Admin 44:495–511

    Article  Google Scholar 

  4. Davies B, Challis D (1986) Matching resources to needs. Gower publishing company, Aldershot

    Google Scholar 

  5. Komisar HL, Feder J, Kasper JD (2005) Unmet long-term care needs: an analysis of Medicare-Medicaid dual eligibles. Inquiry 42:171–182

    PubMed  Google Scholar 

  6. Tennstedt S, McKinlay J, Kasten L (1994) Unmet needs among disabled elders: a problem in access to community long term care. Soc Sci Med 38:915–924

    Article  CAS  PubMed  Google Scholar 

  7. Williams J, Lyons B, Rowland D (1997) Unmet long-term care needs of elderly people in the community: a review of literature. Home Health Care Services 16:93–117

    Article  CAS  Google Scholar 

  8. Savla J, Davey A, Sundström G et al (2008) Home help services in Sweden: responsiveness to changing demographics and needs. Eur J Ageing 5:47–55

    Article  Google Scholar 

  9. Davey A, Johansson L, Malmberg B et al (2006) Unequal but equitable: an analysis of variations in old-age care in Sweden. Eur J Ageing 3:34–40

    Article  Google Scholar 

  10. Forbes DA, Stewart N, Morgan D et al (2003) Individual determinants of home-care nursing and housework assistance. Can J Nurs Res 35:14–36

    PubMed  Google Scholar 

  11. Frederiks CMA, teWierik MJM, van Rossum HJL et al (1992) Why do elderly people seek professional home care? J Commun Health 7:131–141

    Article  Google Scholar 

  12. Houde SC (1998) Predictors of elders´ and family caregivers´ use of formal home services. Res Nurs Health 21:533–543

    Article  CAS  PubMed  Google Scholar 

  13. Stoddart H, Whitley E, Harvey I et al (2002) What determines the use of home care services by elderly people? Health Soc Care Comm 10:348–360

    Article  Google Scholar 

  14. Tennstedt SL, Crawford S, McKinlay JB (1993) Determining the pattern of community care: is coresidence more important than caregiving relationship? J Gerontol 48:74–83

    Article  Google Scholar 

  15. Lagergren M, Kurube N (2014) Comparing long-term care recipients in rural and urban municipalities in Japan and Sweden. J Aging Soc Policy 26:1–14

    Article  Google Scholar 

  16. Lagergren M, Fratiglioni L, Hallberg IR et al (2004) A longitudinal study integrating population, care and social services data. The Swedish National study on Aging and Care. Aging Clin Exp Res 16:158–168

    Article  PubMed  Google Scholar 

  17. Anttonen A (2005) Empowering social policy: the role of social care services in modern welfare states. In: Kangas O, Palme J (eds) Social policy and economic development in the Nordic countries. UNRISD, New York

    Google Scholar 

  18. Campbell J, Shinmei M (2010) Jichitai to kaigohoken gyosei, in Nichibei LTCI Kenkyukai (ed) Zaitakukaigo ni okeru koureisha to kazoku. Toshi to chiho no hikakuchosa bunseki. [In Japanese: Local government and long-term care administration, in Japan/US LTCI Research group (ed) Elderly people and family in in-home care: Urban/rural comparative analysis]. Minerva, Kyoto, pp. 36–58

  19. Kodama H, Izumo Y, Takahashi R et al (2009) Family relationships of self-care-dependent older people and institutionalized rate to nursing home. Geriatr Gerontol Int 9:320–325

    Article  PubMed  Google Scholar 

  20. Dong X, Simon M (2010) Health and aging in a Chinese population: urban and rural disparities. Geriatr Gerontol Int 10:85–93

    Article  PubMed  Google Scholar 

  21. Katz S, Ford AB, Moskowitz RW, Jackson BA et al (1963) Studies of illness in the aged. J Amer Med Associ 185:914–919

    Article  CAS  Google Scholar 

  22. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”, A practical method for grading the cognitive state of patients for the clinician. J Psychiat Res 12(3):189–198

    Article  CAS  PubMed  Google Scholar 

  23. Montgomery SA, Asberg M (1979) A new depression scale designed to be sensitive to change. Brit J Psychiat 134:382–389

    Article  CAS  PubMed  Google Scholar 

  24. Larsson K, Thorslund M (2002) Does gender matter? Differences in patterns of informal support and formal services in a Swedish urban elderly population. Res Aging 24:308–326

    Article  Google Scholar 

  25. Szebehely M (1998) Changing divisions of carework: caring for children and frail elderly people in Sweden. In: Lewis J (ed) Gender, social care and welfare state restructuring in Europe. Ashgate, Aldershot, pp 257–283

    Google Scholar 

  26. Lagergren M, Sjölund BM, Fagerström C et al (2014) Horizontal and vertical targeting efficiency—a comparison between users and non-users of public long-term care in Sweden. Ageing Soc 34(4):700–719

    Article  Google Scholar 

  27. Ekström H, Dahlin-Ivanoff S, Elmståhl C (2008) Restriction in social participation and lower life satisfaction among fractured in pain. Arch Gerontol Geriat 46:409–424

    Article  Google Scholar 

  28. Guralnik JM, Ferrucci L, Balfour JL et al (2001) Progressive versus catastrophic loss of the ability to walk: implications for the prevention of mobility loss. J Am Geriatr Soc 49:1463–1470

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The Swedish National study on Aging and Care, SNAC, (http://www.snac.org) is financially supported by the Ministry of Health and Social Affairs, Sweden and the participating county councils, municipalities and university departments. We are grateful to the participants, the participating counties and municipalities.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

Ethical permission for the study was obtained from the ethical committees of the Karolinska Institute (KI dnr 00-446) and University of Lund (LU dnr 650-00 and LU 744-00, respectively).

Informed consent

Ethical aspects of the SNAC study including the question of informed consent have been described in Lagergren et al. [26].

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Authors and Affiliations

  1. Stockholm Gerontology Research Center, Stockholm, Sweden

    Mårten Lagergren & Laura Fratiglioni

  2. Blekinge Institute of Technology, Karlskrona, Sweden

    Cecilia Fagerström & Johan Berglund

  3. Division of Geriatric Medicine, Department of Health Sciences, Lund University and Skåne University Hospital, Malmö, Sweden

    Eva Nordell & Sölve Elmståhl

  4. Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden

    Britt-Marie Sjölund, Laura Fratiglioni, Eva von Strauss & Anders Wimo

  5. Department of Neurobiology, Alzheimer´s Disease Research Center, Care Sciences and Society, Karolinska Institutet, Solna, Sweden

    Anders Wimo

  6. The Non-Profit Organization for the Red Cross Hospital and Red Cross University College, Stockholm, Sweden

    Eva von Strauss

Authors
  1. Mårten Lagergren
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  2. Cecilia Fagerström
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  3. Britt-Marie Sjölund
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  4. Johan Berglund
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  5. Laura Fratiglioni
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  6. Eva Nordell
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  7. Eva von Strauss
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  8. Anders Wimo
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  9. Sölve Elmståhl
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Corresponding author

Correspondence to Mårten Lagergren.

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Lagergren, M., Fagerström, C., Sjölund, BM. et al. Horizontal and vertical targeting: a population-based comparison of public eldercare services in urban and rural areas of Sweden. Aging Clin Exp Res 28, 147–158 (2016). https://doi.org/10.1007/s40520-015-0369-5

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  • DOI: https://doi.org/10.1007/s40520-015-0369-5

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