2013年-CEPS欧洲政策研究中心_Performance_of_Long_132页_2mb

报告摘要

Summary of Performance of Long-Term Care Systems in Europe (ENEPRI Research Report No. 117, December 2012)

Core Content

This report evaluates the performance of long-term care (LTC) systems in four representative European countries: Germany, the Netherlands, Spain, and Poland. It is part of the ANCIEN project, which aims to understand the future of LTC for the elderly in Europe. The evaluation is based on a performance framework that includes four core criteria:

Quality of life of LTC users
Quality of care
Equity of LTC systems
Total burden of LTC (financial and informal caregiving)

The report also presents projections for LTC expenditures up to 2060, and discusses the implications of these findings for policy.

Main Views and Findings

Quality of Life and Care

The quality of life of LTC users is assessed using data from the Survey of Health, Ageing and Retirement in Europe (SHARE).
In Germany, older persons with limitations living at home have the highest probability of receiving help, while in Poland, this probability is the lowest.
The sufficiency of care is best ensured in Switzerland, Italy, and the Netherlands.
France has the most favourable indirectly observed properties of LTC systems.
Belgium and Switzerland are highlighted as countries where an older person who values all three aspects (quality of life, quality of care, and equity) might be best off.

Equity Analysis

Equity in LTC systems is evaluated based on horizontal (equal treatment of individuals) and vertical (equal treatment across different levels of need) dimensions.
The Dutch system scores highest on overall equity, followed by the German system.
Spain and Poland have less equitable systems.
Informal care plays a significant role in reducing equity in the German system due to the high burden on informal caregivers.
Poland has the lowest total burden of care, but scores lowest on quality of care and equity.
Spain has few extreme scores, indicating a more balanced system.

Financial Burden and Projections

Projections until 2060 show that public and private LTC expenditures are expected to more than double in all four countries, with some cases seeing a triple increase.
The Netherlands will spend the most on LTC.
The financial burden is influenced by public expenditures, private funding, and informal care.
The base scenario highlights the growing demand and increasing costs of LTC systems due to aging populations.

Policy Implications

The report discusses policy considerations in the final chapter, emphasizing the need for equitable and sustainable LTC systems.
Informal care is a critical component, but its high burden can affect equity and affordability.
Choice and accessibility are also important, with the Netherlands and Germany having better access to LTC services.
The overall evaluation of the four countries shows that the Dutch system has the highest scores across all four dimensions, except for total burden of care, where Poland performs better.

Key Information

Data Sources: SHARE database for quality of life and care experiences; various national and EU sources for financial data.
Methodology: Empirical models and projections based on previous ANCIEN work packages (WP2, WP3, WP6).
Comparative Analysis: The four representative countries are compared based on system characteristics, financial burden, and user experience.
Equity Considerations: Includes analysis of informal care, private income, social insurance, and taxation.
Future Outlook: The financial burden of LTC is expected to rise significantly due to aging populations, requiring policy adjustments to ensure affordability and sustainability.

Structure of the Report

Introduction: Sets the context and outlines the purpose of the report.
Performance Framework: Discusses the theoretical basis for evaluating LTC systems, including the WHO framework and the Open Method of Coordination.
Individual Outcome Measures: Focuses on the quality of life of LTC users.
Equity Analysis: Evaluates the horizontal and vertical equity of LTC systems in the four representative countries.
Expenditure Projections: Provides financial forecasts for LTC in the four countries.
Overall Evaluation: Summarizes the performance of the LTC systems across all four criteria.
Review and Conclusions: Discusses the concept of performance, key findings, and policy recommendations.

Conclusion

The report provides a comprehensive analysis of LTC systems in Europe, highlighting Germany and the Netherlands as having the best performance, particularly in equity and accessibility, while Poland and Spain lag behind in quality of care and equity. It underscores the importance of informal care in shaping LTC systems and the need for policy reforms to address financial sustainability and equity in the face of aging populations.