2012年-CEPS欧洲政策研究中心_Determinants_of_the_Probability_of_Obtaining_Formal_and_Informal_Long_31页_1mb

报告摘要

Summary of "Determinants of the Probability of Obtaining Formal and Informal Long-Term Care in European Countries"

Core Content

This report explores the patterns of utilisation and the determinants of demand for formal and informal long-term care (LTC) in European countries, focusing on four clusters identified in the ANCIEN project. It analyses the factors influencing the probability of receiving LTC, including demographic, health-related, and socio-economic variables, and highlights how different LTC systems across Europe shape care provision.

Main Viewpoints

Differences in LTC Utilisation: There are significant variations in LTC utilisation across European countries, influenced by their social protection models, traditions, and institutional frameworks.
Formal vs. Informal Care: In countries with a Scandinavian model (e.g., the Netherlands), formal care is more prevalent, and informal care is less prominent. In contrast, Mediterranean countries (e.g., Spain) rely heavily on informal care provided by family members.
Continental Europe Model: Countries like Germany and France exhibit a mixed model, where both formal and informal care are used, with a stronger emphasis on formal care due to public policy and institutional support.
Eastern and New Member States: Poland and Italy, part of Cluster 4, show a high reliance on informal care and low public provision of LTC. The data for formal care in Poland is limited due to coding errors in the SHARE dataset.

Key Information

1. Countries and Clusters Analyzed

Cluster 1: Belgium, the Czech Republic, Germany, Slovakia
Cluster 2: Denmark, the Netherlands, Sweden
Cluster 3: Austria, France, Spain
Cluster 4: Hungary, Italy, Poland
Selected Countries for Analysis: Germany, the Netherlands, Spain, and Poland (with Italy as a substitute for Poland due to data constraints).

2. Data Used

SHARE Dataset (Wave 2, 2006): The primary data source, which includes information on LTC utilisation among the elderly (aged 50+).
Limitations: The dataset has constraints, such as limited coverage of formal care in Poland and a focus on home-based care over institutional care. Additionally, informal care is underrepresented in the data due to low response rates.

3. Model and Methodology

A logit model was used to estimate the probability of receiving LTC.
The model includes variables such as demographic characteristics (age, gender, education), family situation (living with a partner, children), health status (limitations in ADLs/IADLs), and financial factors (reported income).
Calibrated weights were applied to ensure representative descriptive statistics for both respondents and non-respondents.

4. Utilisation of LTC

Formal Care: Most prevalent in the Netherlands (around 16%), followed by Germany, Spain, and Italy. It mainly includes home-based care and nursing care.
Informal Care: Dominant in Mediterranean and Eastern European countries, especially in Spain and Poland. It includes care from family members, friends, and neighbours.
Combined Care: Some countries, like the Netherlands and Germany, show a combination of formal and informal care, with a higher share of formal care in the Netherlands.

5. Determinants of LTC Utilisation

Demographic Factors: Age and population ageing are important determinants. Older populations (especially over 85) are more likely to require LTC.
Health Status: Limitations in ADLs (Activities of Daily Living) and IADLs (Instrumental Activities of Daily Living) are strong indicators of LTC need.
Family Structure: Living with a partner or children increases the likelihood of receiving informal care.
Socio-Economic Factors: Financial resources and income levels influence the ability to access formal care services.
Public Policy: Countries with strong public LTC systems (like the Netherlands) have higher formal care utilisation, while those with limited public support (like Poland) rely more on informal care.

6. Country-Specific Insights

Netherlands: High public spending, strong institutional care, and a Scandinavian-style model. Formal care is frequently used, and informal care is marginal.
Germany: Mixed public–private and formal–informal care. Public policy supports informal care, and formal care is increasingly used for the elderly over 80.
Spain: Dominated by informal care, with a recent shift towards public support. However, the informal care sector remains large.
Poland: Limited formal care data due to coding errors. Informal care is the main source, and public support is minimal.
Italy: Similar to Poland in terms of LTC provision, with a strong informal care sector and limited public care. Formal care is fragmented between health and social systems.

7. Conclusion

The availability and type of LTC vary significantly across European countries due to differences in social protection models, traditions, and public policy.
Informal care is more common in Mediterranean and Eastern European countries, while formal care is more prevalent in the Netherlands and Germany.
Data limitations affect the accuracy of formal care estimates in some countries, particularly Poland, where the dataset is unreliable.
Cluster analysis helps in understanding the patterns of LTC provision and the determinants of care utilisation across different regions.

Figures and Tables Overview

Figure 1: Age distribution of the population across countries and clusters.
Figure 2: Share of the population with limitations in ADLs/IADLs.
Figure 3: Share of respondents receiving formal and informal care.
Figure 4: Formal care obtained by age.
Figure 5: Shares of different types of formal care.
Figure 6: Formal care obtained by limitations in ADLs/IADLs.
Figure 7: Shares of different types of informal care.
Figure 8 and 9: Informal care by age, type of care, and country clusters.
Figure 10: Informal care by limitations in ADLs/IADLs and type of care.
Table 1: Observations by country and cluster.
Table 2: Comparison of countries in cluster analysis and multivariate analysis.
Table 3: Probability of obtaining formal care by country.
Table 4: Pooled multivariate analysis of formal care.
Table 5 and 6: Probability of receiving informal care.
Table 7 and 8: Pooled multivariate analysis of informal care.

Final Notes

The analysis does not consider the supply side of LTC (availability of services) or legal regulations.
The Scandinavian model is characterised by high public responsibility and institutional care.
The Mediterranean model is dominated by family-based informal care.
The Continental model includes a mixed approach with both formal and informal care.
The Eastern and New Member States (Cluster 4) show a high dependence on informal care and limited public provision.