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Consumer Direction and Choice in Long-Term Care for Older Persons, Including Payments for Informal Care: How Can it Help Improve Care Outcomes, Employment and Fiscal Sustainability?


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  • Jens Lundsgaard


As the number of older persons in need of long-term care increases, efforts to support older persons remaining in their home are intensified in most OECD countries. In this context of ageing in place, there is a movement towards allowing more individual choice for older persons receiving publicly funded long-term care at home. Having more flexibility in terms of how to receive care can increase the older person’s self-determination and that of his/her informal care givers. Having a choice among alternative care providers can empower older persons as consumers and may help strengthen the role of households in the care-management process. Choice can also help address quality aspects that are difficult to quantify but easy to experience for users, such as the personal interaction between the older person and the care giver. Le nombre de personnes âgées en perte d’autonomie augmentant, les efforts à leur intention destinés à leur permettre de continuer à vivre chez elles s’intensifient, dans la plupart des pays de l’OCDE. Dans cette logique du maintien à domicile, la tendance est à donner une liberté de choix de plus en plus grande aux personnes âgées qui bénéficient, chez elles, d’une aide et de services financés sur fonds publics. En acceptant plus de flexibilité dans les modalités de déploiement de la prestation on peut renforcer la capacité de décision de la personne âgée et des aidants informels. Le fait de donner à la personne âgée la liberté de choix entre différents prestataires peut lui conférer un certain poids en tant que consommateur, et cela peut contribuer à renforcer le rôle des ménages dans le processus de gestion de la prise en charge. La faculté de choisir peut aussi aider à prendre en compte les aspects qualitatifs, qui sont difficiles à mesurer mais très importants pour l’utilisateur, comme la qualité des échanges entre la personne âgée et la personne qui s’occupe d’elle.

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Bibliographic Info

Paper provided by OECD Publishing in its series OECD Health Working Papers with number 20.

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Date of creation: 11 May 2005
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Handle: RePEc:oec:elsaad:20-en

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Cited by:
  1. Bolin, K. & Lindgren, B. & Lundborg, P., 2008. "Your next of kin or your own career?: Caring and working among the 50+ of Europe," Journal of Health Economics, Elsevier, vol. 27(3), pages 718-738, May.
  2. Melanie Arntz & Stephan L. Thomsen, 2010. "Are Personal Budgets a Financially Sound Reform Option for the German Long-Term Care Insurance?," Journal of Economics and Statistics (Jahrbuecher fuer Nationaloekonomie und Statistik), Justus-Liebig University Giessen, Department of Statistics and Economics, vol. 230(4), pages 378-402, August.
  3. Bartosz Przywara & Núria Diez Guardia & Etienne Sail, 2010. "Future Long-term Care Needs and Public Expenditure in the EU Member States," CESifo DICE Report, Ifo Institute for Economic Research at the University of Munich, vol. 8(2), pages 3-12, 07.
  4. Leigh, Andrew, 2010. "Informal care and labor market participation," Labour Economics, Elsevier, vol. 17(1), pages 140-149, January.
  5. Arntz, Melanie & Thomsen, Stephan L., 2008. "Reforming Home Care Provision in Germany: Evidence from a Social Experiment," ZEW Discussion Papers 08-114, ZEW - Zentrum für Europäische Wirtschaftsforschung / Center for European Economic Research.
  6. Arntz, Melanie & Thomsen, Stephan L., 2008. "Crowding out Informal Care? Evidence from a Social Experiment in Germany," ZEW Discussion Papers 08-113, ZEW - Zentrum für Europäische Wirtschaftsforschung / Center for European Economic Research.
  7. Rodríguez Cabrero, Gregorio, 2007. "El marco institucional de la protección social de la dependencia en España/," Estudios de Economía Aplicada, Estudios de Economía Aplicada, vol. 25, pages 341-372, Abril.
  8. Lilly, Meredith B. & Laporte, Audrey & Coyte, Peter C., 2010. "Do they care too much to work? The influence of caregiving intensity on the labour force participation of unpaid caregivers in Canada," Journal of Health Economics, Elsevier, vol. 29(6), pages 895-903, December.


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