Assessing Needs of Care in European Nations. ENEPRI Policy Brief No. 14, 28 December 2012

This Policy Brief presents the research questions, main results and policy implications and recommendations of the seven Work Packages that formed the basis of the ANCIEN research project, financed under the 7th EU Research Framework Programme of the European Commission. Carried out over a 44-month period and involving 20 partners from EU member states, the project principally concerns the future of long-term care (LTC) for the elderly in Europe and addresses two questions in particular: How will need, demand, supply and use of LTC develop? How do different systems of LTC perform

The Dutch system of long-term care

This document describes the Dutch system of long-term care (LTC) for the elderly. An overview of LTC policy is also given. This document is part of the first stage of the European project ANCIEN (Assessing Needs of Care in European Nations), commissioned by the European Commission under the Seventh Framework Programme (FP7). Since the first stage of the project aims to facilitate structured comparisons of the organisation of LTC for the elderly in different countries, comparable reports have been written for most other European countries (including new member states). Future analyses in subsequent work packages within the project will build on these country reports.

Modelling health care expenditures; overview of the literature and evidence from a panel time series model

The first purpose of this paper is to give an up to date overview of the literature on health care expenditures. Secondly, this paper contributes to the existing literature by investigating the impact of several factors on health care expenditures in an empirical analysis using an error-correction model. Health care expenditures in industrial countries have been growing rapidly over the past forty years. This rapid growth jeopardizes the sustainability of public budgets and causes an increasing interest in the determinants of health care expenditures. Additional to the 'usual suspects' for rising health care expenditures, we pay attention to a somewhat neglected driving factor, which is the increase in the relative price of health care compared to other goods and services. We find that the increasing price of health care helps to explain the increase in real health care expenditures. However, the use of health care in volume terms is negatively affected by the increasing price. This effect seems to be stronger in periods of cost containment policy. Consistent with most recent findings in the literature, we find that income and ageing are important drivers of health care expenditures.

Pharmaceutical promotion and GP prescription behaviour

The aim of this paper is to empirically analyse the responses by general practitioners to promotional activities for pharmaceuticals by pharmaceutical companies. Promotion can be beneficial for society as a means of providing information, but it can also be harmful in the sense that it lowers price sensitivity of doctors and it merely is a means of establishing market share, even when cheaper, therapeutically equivalent drugs are available. A model is estimated that includes interactions of promotion expenditures and prices and that explicitly exploits the panel structure of the data, allowing for drug specific effects and dynamic adjustments, or habit persistence. The data used are aggregate monthly GP prescriptions per drug together with monthly outlays on drug promotion for the period 1994-1999 for 11 therapeutic markets, covering more than half of the total prescription drug market in the Netherlands. Identification of price effects is obtained by the introduction of the Pharmaceutical Prices Act, which established that Dutch drugs prices became a weighted average of the prices in surrounding countries after June 1996. We conclude that, on average, GP drug price sensitivity is small, but adversely affected by promotion.

A Typology of Long-term Care Systems in Europe.

This report summarizes the main results of Work Package 1 of the research project ‘Assessing Needs of Care in European Nations’ (ANCIEN). This report aims at contributing to knowledge on long-tem care (LTC) system design features by developing a typology of LTC system models in EU countries, which are characterized by diverse arrangements for the provision of care/organization and financing. Its approach deviates from existing typologies in a number of ways: It intends to produce a complete portrait of LTC systems without restricting its attention to selected settings, such as ‘nursing homes’, ‘residential care/assisted living’ or ‘home care’. Focus is confined to LTC services rather than covering a broader range of social services. It outlines a typology on the provision of care/organization and financing. This differs from existing work, which concentrates on comparing design features, such as financing alone, building up a system for developing countries or providing lessons for one national system in particular for the Netherlands and the UK. It provides a typology of existing systems rather than an overview of theoretically available possibilities. Unlike the typologies we know of, we also cover new EU member states for which sufficient data could be obtained to enable inclusion in a typology: Bulgaria, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia and Slovenia. Finally, in deriving country clusters the report applies formal methods rather than pursuing a purely qualitative analysis. The limited availability of quantitative data, however, forced the authors to either restrict the number of variables and use more qualitative information, or reduce the number of countries to those with better availability of metric data. Therefore two approaches are presented, one for each kind of restriction. This quantitative approach again is in contrast to the existing typologies of known comprehensive LTC systems

A Typology of Long-term Care Systems in Europe.

This report summarizes the main results of Work Package 1 of the research project ‘Assessing Needs of Care in European Nations’ (ANCIEN). This report aims at contributing to knowledge on long-tem care (LTC) system design features by developing a typology of LTC system models in EU countries, which are characterized by diverse arrangements for the provision of care/organization and financing. Its approach deviates from existing typologies in a number of ways: It intends to produce a complete portrait of LTC systems without restricting its attention to selected settings, such as ‘nursing homes’, ‘residential care/assisted living’ or ‘home care’. Focus is confined to LTC services rather than covering a broader range of social services. It outlines a typology on the provision of care/organization and financing. This differs from existing work, which concentrates on comparing design features, such as financing alone, building up a system for developing countries or providing lessons for one national system in particular for the Netherlands and the UK. It provides a typology of existing systems rather than an overview of theoretically available possibilities. Unlike the typologies we know of, we also cover new EU member states for which sufficient data could be obtained to enable inclusion in a typology: Bulgaria, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia and Slovenia. Finally, in deriving country clusters the report applies formal methods rather than pursuing a purely qualitative analysis. The limited availability of quantitative data, however, forced the authors to either restrict the number of variables and use more qualitative information, or reduce the number of countries to those with better availability of metric data. Therefore two approaches are presented, one for each kind of restriction. This quantitative approach again is in contrast to the existing typologies of known comprehensive LTC systems

Sustainability of Long-term Care: Puzzling Tasks Ahead for Policy-Makers

Background: The sustainability of long-term care (LTC) is a prominent policy priority in many Western countries. LTC is one of the most pressing fiscal issues for the growing population of elderly people in the European Union (EU) Member States. Country recommendations regarding LTC are prominent under the EU’s European Semester. Methods: This paper examines challenges related to the financial- and organizational sustainability of LTC systems in the EU. We combined a targeted literature review and a descriptive selected country analysis of: (1) public- and private funding; (2) informal care and externalities; and (3) the possible role of technology in increasing productivity. Countries were selected via purposive sampling to establish a cohort of country cases covering the spectrum of differences in LTC systems: public spending, private funding, informal care use, informal care support, and cash benefits. Results: The aging of the population, the increasing gap between availability of informal care and demand for LTC, substantial market failures of private funding for LTC, and fiscal imbalances in some countries, have led to structural reforms and enduring pressures for LTC policy-makers across the EU. Our exploration of national policies illustrates different solutions that attempt to promote fairness while stimulating efficient delivery of services. Important steps must be taken to address the sustainability of LTC. First, countries should look deeper into the possibilities of complementing public- and private funding, as well as at addressing market failures of private funding. Second, informal care externalities with spill-over into neighboring policy areas, the labor force, and formal LTC workers, should be properly addressed. Thirdly, innovations in LTC services should be stimulated to increase productivity through technology and process innovations, and to reduce costs. Conclusion: The analysis shows why it is difficult for EU Member State governments to meet all their goals for sustainable LTC, given the demographic- and fiscal circumstances, and the complexities of LTC systems. It also shows the usefulness to learn from policy design and implementation of LTC policy in other countries, within and outside the EU. Researchers can contribute by studying conditions, under which the strategies explored might deliver solutions for policy-maker

Sustainability of Long-term Care: Puzzling Tasks Ahead for Policy-Makers

Abstract Background: The sustainability of long-term care (LTC) is a prominent policy priority in many Western countries. LTC is one of the most pressing fiscal issues for the growing population of elderly people in the European Union (EU) Member States. Country recommendations regarding LTC are prominent under the EU's European Semester. Methods: This paper examines challenges related to the financial-and organizational sustainability of LTC systems in the EU. We combined a targeted literature review and a descriptive selected country analysis of: (1) public-and private funding; (2) informal care and externalities; and (3) the possible role of technology in increasing productivity. Countries were selected via purposive sampling to establish a cohort of country cases covering the spectrum of differences in LTC systems: public spending, private funding, informal care use, informal care support, and cash benefits. Results: The aging of the population, the increasing gap between availability of informal care and demand for LTC, substantial market failures of private funding for LTC, and fiscal imbalances in some countries, have led to structural reforms and enduring pressures for LTC policy-makers across the EU. Our exploration of national policies illustrates different solutions that attempt to promote fairness while stimulating efficient delivery of services. Important steps must be taken to address the sustainability of LTC. First, countries should look deeper into the possibilities of complementing public-and private funding, as well as at addressing market failures of private funding. Second, informal care externalities with spill-over into neighboring policy areas, the labor force, and formal LTC workers, should be properly addressed. Thirdly, innovations in LTC services should be stimulated to increase productivity through technology and process innovations, and to reduce costs. Conclusion: The analysis shows why it is difficult for EU Member State governments to meet all their goals for sustainable LTC, given the demographic-and fiscal circumstances, and the complexities of LTC systems. It also shows the usefulness to learn from policy design and implementation of LTC policy in other countries, within and outside the EU. Researchers can contribute by studying conditions, under which the strategies explored might deliver solutions for policy-makers