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Can Europe still afford health and long-term care for its elderly?

Ageing is a slow-burning fuse with a strong impact both on public expenditures and the social mood, as shown by this week’s strike in the UK over pensions. The situation is particularly serious in terms of health and long-term care. Even more alarming is the financial burden on households looking after the elderly. Interview with Ms. Xenia Scheil-Adlung, Health Policy Coordinator at the ILO.

Analysis | 11 May 2012

Why has care for the elderly become such an issue?

Xenia Scheil-Adlung: The elderly are particularly at risk, as they are prone to ill health and disability conditions that need health and long-term care. Public health care provision constitutes – as a share of the gross domestic product (GDP) – the second largest expenditure item for the elderly after pension schemes – ranging between 5.5 and 8.5 per cent of GDP across European countries.

In the European Union, public health expenditure is projected to rise from 6.4 per cent of GDP in 2007 to 8.6 per cent in 2060, while expenditure on long-term care (LTC) could more than double between 2007 and 2050.

Who are the most vulnerable among the elderly?

Xenia Scheil-Adlung: The recent ILO study Can the European elderly afford the financial burden of health and long-term care? shows that expenditure for long-term care is higher for the poor than for the rich. Women and individuals living alone are at highest risk to pay for care out of their own pocket.

Do social systems provide adequate financial protection for the elderly?

Xenia Scheil-Adlung: European social protection systems show frequently severe gaps, particularly as regards long-term care coverage and benefits and in many countries they do not provide adequate protection for the elderly. Out of pocket payments (OOPs) for health care concern up to about 95 per cent of the elderly population. About 5 percent has to face such expenditures as a consequence of long-term care.

The economic consequences of such expenditures on households of the elderly in Europe may be severe. They constitute a threat to households’ financial sustainability and can become a source of impoverishment. In many cases we observe important income reductions and in some cases even financial ruin of households when costs for care exceed the total income of the elderly. Women and individuals living alone face an even higher risk with respect to OOPs.

It’s not only about money. What about the availability of services for the elderly?

Xenia Scheil-Adlung: The availability of services constitutes an important problem in most countries given the lack of skilled workers providing services to the elderly. The widespread shortage of the health and long-term care workforce could be addressed by improving the working conditions in the sector.

What are the prospects for the future?

Xenia Scheil-Adlung: Given demographic developments, the problems observed are likely to increase in the future. In order to meet the current and future needs of the elderly, and particularly of vulnerable groups among the elderly population, coverage providing access to adequate benefits should be universal. Further, more effective and efficient social protection systems for health and long-term care are desirable.

What can be done to improve the situation of the elderly?

Xenia Scheil-Adlung: First of all, more resources should be made available for the elderly, particularly to further develop long-term care schemes with a view to increase the scope of benefits, ensure affordability, availability and delivery of services and improve the quality of services in order to respond more adequately to the needs of elderly people.

Moreover, informal care should be facilitated by covering family carers in social protection systems and giving them compensation e.g. cash benefits and allowances.

How can we improve access for the poor and vulnerable elderly?

Xenia Scheil-Adlung: Addressing inequities in access to health and long – term care services of the elderly also requires an integrated policy concept within the broader social protection system. Creating synergies and better matching the interfaces of various schemes, e.g. old age pension and social assistance with health and long-term care schemes could help to eliminate the inequities observed. After all, receiving health and long-term care when in need are considered fundamental human rights which are highlighted in the ILO Social Security Convention No. 102.

Health care and long-term care in Europe

  • All countries have achieved near universal health care coverage. This is not case for long-term care (LTC).
  • Public expenditure on health care for the elderly ranges from 5.5 % to 8.5 % of GDP.
  • Public expenditure on LTC ranges from less than 0.5 % to 3.5 %.
  • Public health expenditure in EU countries is projected to rise from 6.4 % of GDP in 2007 to 8.6 % in 2060.
  • Expenditure on LTC could more than double between 2007 and 2050.
  • 95 % of the elderly make out of pocket payments for health and about 5 % for LTC.
  • Public expenditure for LTC is higher for the poor than for the rich.
  • Women and individuals living alone are at highest risk to make out pocket payments.
  • Governments are tackling shortages of health workers but not of LTC workers.
  • Informal caregivers make up most of the LTC workforce; many are family members (16.2 % in Italy.)
  • The proportion of foreign-born workers in home care exceeds that of local workers in most countries.