Working Paper 07-10 - The Belgian long-term care system

This report describes the organization of the Belgian long‐term care system. It can be characterized as a mixed system with extensive public care provision and substantial support from informal care mainly within the family. While the current volume and quality of services appears to be adequate, the future increase in the number of dependent elderly persons over the next two decades as a result of demographic ageing can be expected to become a serious challenge, both in terms of required formal and informal care capacity and financially.Belgium, Dependent elderly population, Health care system, Long-term care

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

Projections of use and supply of long-term care in Europe: Policy implications. ENEPRI Policy Brief No. 12, 12 April 2012

Projections of use and supply of formal and informal care carried out in Work Package 6 of the ANCIEN project show that if current patterns of care use and supply prevail, supply of care is likely to fall behind demand. This paper discusses the key policy implications of these findings. Meeting the required care capacity poses multifarious challenges for European welfare states, namely: how to limit the growing burden of LTC expenditure on social security or government budgets, especially in countries that rely heavily on formal care, and how to avoid an increased informal caregiver burden, while at the same time ensuring adequate care for disabled older persons. Technological advances could help close the care gap, by reducing the need for care and boosting the productivity of formal and informal care workers, or by lessening the need for care. As it is impossible to assess whether these efficiency gains will suffice to bridge the care gap, policies should anticipate an increasing care burden and plan accordingly for how to deal with its consequences

The Long-term Care System for the Elderly in Belgium.

This report describes the organisation of the Belgian long-term care system. It can be characterised as a mixed system, with extensive public care provision and the substantial support of informal care provided mainly within the family. While the current volume and quality of services appears to be adequate, the future increase in the number of dependent elderly persons over the next two decades as a result of demographic ageing can be expected to become a serious challenge, in terms of both the required formal and informal care capacity and financing

Unobserved Heterogeneity in the Productivity Distribution and Gains From Trade

A correct parametric approximation of the productivity distribution is essential to calculate Gains From Trade (GFT) in heterogeneous firms models. This paper argues that heterogeneity in productivity is best captured by Finite Mixture Models (FMMs). FMMs build on the existence of unobserved subpopulations in the data. As such, they are generally consistent with models of firm dynamics differing between groups of firms and allow for a very flexible distribution fit. We find FMMs to increase this fit by more than 70% compared to currently considered distributions. A GFT exercise with Portuguese data reveals that only FMMs approximate the ‘true gains’ reasonably well

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

Performance of Long-Term Care Systems in Europe. ENEPRI Research Report No. 117, 21 December 2012

This report evaluates the performance of long-term care (LTC) systems in Europe, with a special emphasis on four countries that were selected in Work Package 1 of the ANCIEN project as representative of different LTC systems: Germany, the Netherlands, Spain and Poland. Based on a performance framework, we use the following four core criteria for the evaluation: the quality of life of LTC users, the quality of care, equity of LTC systems and the total burden of LTC (consisting of the financial burden and the burden of informal caregiving). The quality of life is analysed by studying the experience of LTC users in 13 European countries, using data from the Survey of Health, Ageing and Retirement in Europe (SHARE). Older persons with limitations living at home have the highest probability of receiving help (formal or informal) in Germany and the lowest in Poland. Given that help is available, the sufficiency of the help is best ensured in Switzerland, Italy and the Netherlands. The indirectly observed properties of the LTC system are most favourable in France. An older person who considers all three aspects important might be best off living in Belgium or Switzerland. The horizontal and vertical equity of LTC systems are analysed for the four representative countries. The Dutch system scores highest on overall equity, followed by the German system. The Spanish and Polish systems are both less equitable than the Dutch and German systems. To show how ageing may affect the financial burden of LTC, projections until 2060 are given for LTC expenditures for the four representative countries. Under the base scenario, for all four countries the proportions of GDP spent on public and private LTC are projected to more than double between 2010 and 2060, and even treble in some cases. The projections also highlight the large differences in LTC expenditures between the four countries. The Netherlands spends by far the most on LTC. Furthermore, the report presents information for a number of European countries on quality of care, the burden of informal caregiving and other aspects of performance. The LTC systems for the four representative countries are evaluated using the four core criteria. The Dutch system has the highest scores on all four dimensions except the total burden of care, where it has the second-best score after Poland. The German system has somewhat lower scores than the Dutch on all four dimensions. The relatively large role for informal care lowers the equity of the German system. The Polish system excels in having a low total burden of care, but it scores lowest on quality of care and equity. The Spanish system has few extreme scores. Policy implications are discussed in the last chapter of this report and in the Policy Brief based on this report

Statistical Appendices to “Performance of Long-Term Care Systems in Europe”. ENEPRI Research Report 117A, 21 December 2012

This document provides statistical appendices underpinning the research presented in ENEPRI Research Report No. 117, “Performance of Long-Term Care Systems in Europe”, December 2012. Esther Mot is Senior Researcher in the Netherlands Bureau for Economic Policy Analysis (CPB) and Riemer Faber is researcher at CPB. Joanna Geerts is researcher and Peter Willemé is health economist in the Social Security Research Group at the Federal Planning Bureau (FPB)

How European Nations Care for Their Elderly: A new typology of long-term care systems. ENEPRI Policy Brief No. 7, August 2011

Expected future demographic and societal shifts have put the improvement of quality and efficiency of long-term-care (LTC) systems on the agenda of virtually every EU member state, last but not least in order to support its long-term financial sustainability. Research to support the reform process, however, suffers from the scarcity of reliable and comparable data to work with, and the extent to which the process can be generalised is further complicated by large differences in the design of national LTC systems. Work Package 1 of the ANCIEN (Assessing Needs for Care in European Nations) project collected data on national LTC systems in 21 European countries and produced national reports describing the structure of these systems. The collected material allowed the project team to derive a typology of LTC systems in European countries, or more specifically: to derive one typology of organisation and financing of care, and another typology focusing on use and financing of care. Unlike existing typologies, the ANCIEN typologies focus on LTC rather than a broader definition of social, health or welfare services, and include old as well as new EU member states. Furthermore, the ambitious data collection process allowed the project team to apply formal methods in deriving the typology, which is another novelty in this field. The creation of empirically founded system ‘types’ should serve to make research in this field more easily generalisable within groups of this typology and thus to improve the efficiency of further research on LTC