European Journal of Ageing

, Volume 3, Issue 1, pp 34–40 | Cite as

Unequal but equitable: an analysis of variations in old-age care in Sweden

  • Adam Davey
  • Lennarth Johansson
  • Bo Malmberg
  • Gerdt Sundström
Original Investigation


This study aimed to investigate whether contraction in services has led to inequitable service levels or simply large local variations. Previous attempts to explain service variations with aggregate, municipal level data have failed. We link representative Swedish data from 3,267 individuals aged 65 and older in 2002–2003 with coverage rates of public Home Help services in the 288 municipalities in which they reside. What past attempts have masked is that needs also vary substantially between municipalities; needs being defined as old people who live alone and need help with their activities of daily living (ADL). Once these local individual level variations are incorporated, municipal differences in public Home Help coverage largely vanish. Multivariate analyses confirm that advanced age, inability to perform ADL and solitary living are the major determinants of Home Help use. Variations in local supply have no association with individual use of public Home Help. These services are unequal but hence yet deemed to be reasonably equitable.


Home Help Services Needs Equity Regional variability 



This work was partially supported by a grant from the National Institute on Aging (R03AG023301).


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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Adam Davey
    • 1
  • Lennarth Johansson
    • 2
  • Bo Malmberg
    • 3
  • Gerdt Sundström
    • 3
  1. 1.Polisher Research InstituteNorth WalesUSA
  2. 2.SocialstyrelsenStockholmSweden
  3. 3.Institute of Gerontology, School of Health SciencesJönköping UniversityJönköpingSweden

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