Abstract

In order to provide users with increased choice and to support informal care and thus cope with population ageing a number of countries have introduced cash-for-care schemes in their long-term care (LTC) systems. By providing incentives for the internalisation of care provision by the family, cash-for-care schemes could potentially impact the takeup of care services.

We aim to investigate whether (1) there are socio-economic inequalities in the use of formal home care services by older people across European countries after controlling for health; and (2) how public policies, i.e. the option for cash over in-kind benefits, may explain differences between countries. Given that de-regulated cash benefits tend to favour the take up of informal care, the hypothesis under test here is that countries which provide support through cash benefits may induce greater socio-economic differences in the use of care services. The analysis is based on data from SHARE (Survey of Health, Ageing, and Retirement in Europe).

Unlike previous research, which relied on a dichotomous measurement of use of care services, we aim to provide a more comprehensive picture of care services use by accounting for intensity, i.e. number of hours of care. Based on multinomial logistic regression, an index of horizontal inequity was calculated for intensity of home care services for individual countries. Results show that use of home care services measured by the number of care hours, is indeed concentrated on those with lower income across countries.

However, once we control for differences in health status, marked socio-economic differences in the use of home care between country clusters become evident, with older people of lower socioeconomic conditions (SEC) reporting lower use of home care services in countries providing deregulated cash benefits. In an extended model a larger set of variables such as use and intensity of informal care is included. In this extended model it is only in the cluster of countries relying on in-kind benefits that older people of lower SEC report higher probability of use of home care services. The option for cash for care seems to impact the use of care services differently across socioeconomic groups. Previous research has shown that differences in the informal/formal care mix between countries vary according to specific public policies, namely the option for cash over in-kind services. The results presented here highlight that public policies do not affect the use of care services homogeneously within countries and across different socio-economic groups. From a policy perspective this means that potential consequences in terms of equitable use of services should be taken into account when opting for cash-for-care solutions so that the option to take up informal care corresponds to the actual choice of households rather than the outcome of a reduction in the available set of choices, especially for lower SEC groups. Over reliance on informal care by people of lower SEC could have far reaching consequences in terms of equity and social mobility if, for example, informal carers are not able to remain in gainful employment.

Slides