Abstract

Against the background of an ageing population and increasing pressure to transform care systems in Europe, the aim of this article is to uncover existing country-specific heterogeneities in the utilization of cash-for-care benefits and to measure the causal effect on the reception of home-based long-term care (LTC) services.

To investigate the influence of public care benefits and insurance on the use of formal and informal care by family and non-family members living in or outside the household, a panel data approach using microdata from the Survey of Health, Ageing and Retirement in Europe (SHARE) is adopted. The survey was conducted over the course of eight different waves, with the fieldwork of the first wave completed in 2004 for a total of 11 European countries. Based on similarity in terms of eligibility thresholds and choice restrictions, the sample is restricted to a selection of European countries (Austria, Belgium, France, Germany) where mixed use of care, i.e. a combination of informal and formal home care, is relatively widespread.

Traditionally characterized by a familistic approach to elderly care, the chosen countries have developed different LTC policy measures and evolved towards a mixed model, combining public measures and family care. Yet, the nature of public benefits and overall structure of the care system is different, for example in terms of the responsibility of the regional authorities and the federal government. The spectrum of institutional arrangements ranges from a compulsory insurance-based system in Germany and federal care allowances (Bundespflegegeld') in Austria, to more regionally fragmented institutional arrangements in Belgium (until 2014) or France, in which law a legal obligation for families to care for their older parents is specified. It must be emphasized that after the 6th state reform in Belgium (2014), the transfer of competencies resulted in a shared ownership of regulation, organization and financing of home and residential care for older adults, health care and social care between the federal level and the federated entities.

Preliminary results based on a cross-sectional analysis of the most recent wave in SHARE (8th Wave) suggest that the availability of cash benefits significantly reduces unmet needs, and is even stronger associated with the use of a combination of informal and formal home care. However, since little is known about the causal pathways of this relationship and in order to be able to account for changes in policy over time, a panel regression model with fixed effects (FE) is applied in the next step. Empirical results of this analysis are thought to be presented at this year's International Conference on Evidence-based Policy in Long-term Care.

The expected results of this analysis are of particular policy relevance, as long-term care financing schemes are increasingly challenged due to ongoing demographic and societal change.

Slides