2015年-CEPS欧洲政策研究中心_Performance_of_Long_14页_708kb

Summary of the Performance of Long-Term Care Systems in Europe

Core Content

This policy brief evaluates the performance of long-term care (LTC) systems in four European countries: Germany, the Netherlands, Spain, and Poland. The evaluation is based on a set of performance criteria, including the quality of life of LTC users, quality of care, total burden of care (financial and informal), equity, and choice. The findings highlight the complexity of LTC systems and the trade-offs between different performance dimensions.

Main Performance Criteria and Key Findings

1. Quality of Life of LTC Users

• The Netherlands scores highest in the probability of receiving help and the sufficiency of help.
• France has the most favourable unobserved properties (e.g., dignity and control over daily life).
• Germany leads in the probability of receiving help, but its scores on sufficiency and unobserved properties are lower.
• Poland scores low on all aspects except unobserved properties, where it performs medium-high.
• Spain scores low or medium-low on all aspects, partly due to recent LTC reforms and budget cuts.

2. Quality of Care

• The Eurobarometer 67.3 survey provides a general measure of care quality, with scores ranging from 1 (very bad) to 4 (very good).
• France, Sweden, Austria, and the Netherlands have relatively high quality scores for both home care and nursing homes.
• Poland and Italy score the lowest in both categories.
• Spain has moderate scores but has not fully implemented its reforms, which may have improved equity.

3. Total Burden of Care

• The total burden includes both financial and informal caregiving costs.
• The Netherlands has the second-best performance in total burden after Poland, which has the lowest burden due to a combination of low usage rates and high informal care availability.
• Germany and Spain are expected to face high future burdens due to their aging populations and higher demand for care.
• Poland has a small formal care sector and universal cash benefits for those over 75, which affects its overall burden profile.

4. Equity of the LTC System

• Equity is assessed in terms of horizontal (equal treatment for similar individuals) and vertical (different treatment for different needs).
• The Netherlands excels in both horizontal and vertical equity.
• Germany performs well in horizontal equity but poorly in vertical equity due to strict eligibility criteria.
• Poland and Spain have lower equity in resource allocation, with Poland’s system being particularly regressive due to its reliance on informal care and universal benefits.

5. Choice

• The choice dimension includes provider selection and availability of cash benefits.
• All four countries have equal choice scores, so it is not used to differentiate them in the final evaluation.

Overall Evaluation

• The Netherlands has the highest overall performance in terms of quality of life, quality of care, and equity.
• Germany performs well in quality of life but has lower scores on other dimensions.
• Poland has the lowest total burden but scores poorly on quality of care and equity.
• Spain has moderate scores across all criteria but is affected by recent reforms and economic constraints.
• Standardised performance scores show the Netherlands leading in all dimensions except total burden, where it ranks second after Poland.

Key Policy Implications

• The performance of LTC systems is a multidimensional concept that requires considering various aspects such as quality, burden, and equity.
• Informal caregiving significantly impacts the total burden of care and should not be overlooked in policy design.
• State involvement in funding and organisation plays a crucial role in system fairness and effectiveness.
• Private funding and the role of informal care influence both public expenditure and system equity.
• International research into relative preferences for performance criteria could improve the weighting of dimensions in overall evaluations.

Conclusion

The evaluation highlights the importance of balancing quality of care, burden, and equity in LTC systems. While the Netherlands stands out for its comprehensive and equitable system, Poland and Spain face significant challenges in terms of quality and equity. The German system prioritises access but lacks in equity. Future LTC policies should consider the interplay between these dimensions to ensure sustainable and fair care systems.