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A Comparative Analysis of LTC Systems in Terms of Inclusiveness

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Abstract

In Chap. 4, using micro-data from SHARE (the Survey of Health Ageing and Retirement in Europe) and ELSA (the English Longitudinal Study on Ageing), we estimate the potential coverage of each specific LTC programme, disentangling the differences between countries’ coverage rates in terms of population and regulation effects. More precisely, by applying each regulation on the standard population of SHARE and ELSA, we generate a set of comparable “directly adjusted” eligibility rates (i.e., the share of the standard population that would be covered by each programme). Furthermore, we perform a pair-wise comparison of programmes’ inclusiveness through a counterfactual analysis (indirect adjustment), i.e., simulating the adoption of a region’s regulation on another region’s population.

Keywords

  • SHARE ELSA data
  • Counterfactual analysis
  • International comparison
  • Standard population
  • Adjusted eligibility rates

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Fig. 4.1
Fig. 4.2
Fig. 4.3
Fig. 4.4

Notes

  1. 1.

    https://g2aging.org

  2. 2.

    All the SHARE questions are worded in order to be comparable across countries.

  3. 3.

    Thirteen tasks are included in all the SHARE and ELSA waves: (i) dressing, including putting on shoes and socks; (ii) walking across a room; (iii) bathing or showering; (iv) eating, such as cutting up one’s food; (v) getting in and out of bed; (vi) using the toilet, including getting up and down; (vii) using a map to determine how to get around in a strange place; (vii) preparing a hot meal; (ix) shopping or buying groceries; (x) making telephone calls; (xi) taking medicines, following medical prescriptions; (xii) doing work around the house or garden; and (xiii) managing money, such as paying bills and keeping track of expenses. SHARE wave 6 includes also: (xiv) Leaving the house independently and accessing transportation services; (xv) Doing personal laundry. An additional question covers the dependency over urinary incontinence, or the involuntary loss of urine, in all of the ELSA waves as well as in SHARE waves 1–4, while the item is missing from wave 5, and included in wave 6 through a question about the use of incontinence pads. ELSA includes a question on faecal incontinence, as well as on two further tasks as “Recognising when you are in physical danger” and “Communication (speech, hearing or eyesight)”.

  4. 4.

    The tasks covered are: (i) walking 100 meters (yards in ELSA); (ii) sitting for about two hours; (iii) getting up from a chair after sitting for long periods; (iv) climbing several flights of stairs without resting; (v) climbing one flight of stairs without resting; (vi) stooping, kneeling, or crouching; (vii) reaching or extending your arms above shoulder level; (viii) pulling or pushing large objects like a living room chair; (ix) lifting or carrying weights over 10 pounds/5 kilos, like a heavy bag of groceries 10; (x) picking up a small coin from a table.

  5. 5.

    If P j  = N j then n p,j  = 1 for every p.

  6. 6.

    Although this crude rate is computed for all the LTC programmes implemented in a country, programme-specific coverage -rates can be calculated in a similar way.

  7. 7.

    Similar concerns are expressed by Bonsang (2009) and Balia and Brau (2013). Reliability of self-reported health-conditions is investigated in Bound (1991), Baker, Stabile, and Deri (2004), Dwyer and Mitchell (1999), LaPlante (2010). A cross-survey comparison between HRS, SHARE and ELSA is performed in Chan et al. (2012).

  8. 8.

    We cannot use estimate crude rates for the England LTC legislation before 2015, since the reviewed eligibility rules were not yet implemented.

  9. 9.

    As discussed in Carrino and Orso (2015), there are situations of failure in take-up (i.e., individuals who do not make use of formal home-care while being eligible) or excessive take-up (i.e., individuals who report receiving care, despite failing eligibility ). There are at least two reasons, besides measurement error, for observing this pattern: first, formal-care, as it is asked in SHARE, includes privately-paid care not publicly provided. Second, the eligibility index is based on main home -care programmes regulated at national or regional level, yet not also on municipal-level, since the exact municipality of residence is not available in SHARE due to non-disclosure policies.

  10. 10.

    The difference between the inclusiveness rates for Flanders and Wallonia.

  11. 11.

    From a resources-oriented perspective, receiving an additional allowance from the Flemish government can affect individual behaviour. Our interest is to look at whether individuals are covered under a specific regime in the status quo.

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Brugiavini, A., Carrino, L., Orso, C.E., Pasini, G. (2017). A Comparative Analysis of LTC Systems in Terms of Inclusiveness. In: Vulnerability and Long-term Care in Europe. Palgrave Pivot, Cham. https://doi.org/10.1007/978-3-319-68969-2_4

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  • DOI: https://doi.org/10.1007/978-3-319-68969-2_4

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