Aging Clinical and Experimental Research

, Volume 28, Issue 1, pp 147–158 | Cite as

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

  • Mårten LagergrenEmail author
  • Cecilia Fagerström
  • Britt-Marie Sjölund
  • Johan Berglund
  • Laura Fratiglioni
  • Eva Nordell
  • Eva von Strauss
  • Anders Wimo
  • Sölve Elmståhl
Original Article


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.


Urban/rural differences Long-term care Older people Public care Eldercare Target efficiency 



The Swedish National study on Aging and Care, SNAC, ( 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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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Mårten Lagergren
    • 1
    Email author
  • Cecilia Fagerström
    • 2
  • Britt-Marie Sjölund
    • 4
  • Johan Berglund
    • 2
  • Laura Fratiglioni
    • 1
    • 4
  • Eva Nordell
    • 3
  • Eva von Strauss
    • 4
    • 6
  • Anders Wimo
    • 4
    • 5
  • Sölve Elmståhl
    • 3
  1. 1.Stockholm Gerontology Research CenterStockholmSweden
  2. 2.Blekinge Institute of TechnologyKarlskronaSweden
  3. 3.Division of Geriatric Medicine, Department of Health SciencesLund University and Skåne University HospitalMalmöSweden
  4. 4.Department of Neurobiology, Aging Research Center, Care Sciences and SocietyKarolinska Institutet and Stockholm UniversitySolnaSweden
  5. 5.Department of Neurobiology, Alzheimer´s Disease Research Center, Care Sciences and SocietyKarolinska InstitutetSolnaSweden
  6. 6.The Non-Profit Organization for the Red Cross Hospital and Red Cross University CollegeStockholmSweden

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