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Home Sweet Home? Public Financing and Inequalities in the Use of Home Care Services in Europe

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  • Joan Costa‐Font
  • Edward C. Norton
  • Luigi Siciliani
  • Vincenzo Carrieri
  • Cinzia Di Novi
  • Cristina Elisa Orso

Abstract

Income-related inequalities in health care access have been found in several European countries but little is known about the extent of inequalities in the provision of Long Term Care services (LTC). This paper fills this gap: it addresses equity issues related to the provision of home care services across three macro-areas in Europe which are highly heterogeneous in terms of the degree of public financing of LTC and the strength and the social value of family ties. Using cross-country comparative micro-data from SHARE (Survey of Health, Ageing and Retirement in Europe) survey, we estimate and decompose an Erreygers concentration index of the use of both paid domestic help (�unskilled� care) and personal nursing care (�skilled� care), measuring the contribution of income, needs and non-needs factors to overall inequality. We base the decomposition on a bivariate probit model which takes into account the reciprocal interaction between formal and informal home care use. We find evidence of high horizontal inequity in the use of unskilled home care in areas where public financing of LTC is relatively low (Southern Europe) while moderate inequalities emerges in areas where public-private mix of financing is more balanced (Continental Europe). At the same time, we do not detect inequity in Northern Europe characterized by high public spending on universal services equitable for all, including LTC public coverage. In all areas, informal care has been found to be a substitute for paid unskilled care among the poor and this contributes to further skewing the distribution of the use of formal care services towards the rich.
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  • Joan Costa‐Font & Edward C. Norton & Luigi Siciliani & Vincenzo Carrieri & Cinzia Di Novi & Cristina Elisa Orso, 2017. "Home Sweet Home? Public Financing and Inequalities in the Use of Home Care Services in Europe," Fiscal Studies, Institute for Fiscal Studies, vol. 38, pages 445-468, September.
    • Handle: RePEc:ifs:fistud:v:38:y:2017:i::p:445-468
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    1. Carrieri, Vincenzo & Wuebker, Ansgar, 2013. "Assessing inequalities in preventive care use in Europe," Health Policy, Elsevier, vol. 113(3), pages 247-257.
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    5. Ginevra Floridi & Nekehia T Quashie & Karen Glaser & Martina Brand, 2022. "Partner Care Arrangements and Well-Being in Mid- and Later Life: The Role of Gender Across Care Contexts [Societal and individual determinants of medical care utilization in the United States]," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 77(2), pages 435-445.
    6. Carnazza, Giovanni & Liberati, Paolo & Resce, Giuliano, 2023. "Income-related unmet needs in the European countries," Socio-Economic Planning Sciences, Elsevier, vol. 87(PA).
    7. Bertin, Giovanni & Carrino, Ludovico & Pantalone, Marta, 2021. "Do standard classifications still represent European welfare typologies? Novel evidence from studies on health and social care," Social Science & Medicine, Elsevier, vol. 281(C).
    8. Maja Matanic Vautmans & Marijana Oreb & Sasa Drezgic, 2023. "Socioeconomic inequality in the use of long-term care for the elderly in Europe," Public Sector Economics, Institute of Public Finance, vol. 47(2), pages 149-176.
    9. Vidiella-Martin, Joaquim & Hernández-Pizarro, Helena M. & García-Gómez, Pilar & López-Casasnovas, Guillem, 2024. "Unravelling hidden inequities in a universal public long-term care system," The Journal of the Economics of Ageing, Elsevier, vol. 29(C).
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    12. Marianne Tenand & Pieter Bakx & Eddy van Doorslaer, 2020. "Eligibility or use? Disentangling the sources of horizontal inequity in home care receipt in the Netherlands," Health Economics, John Wiley & Sons, Ltd., vol. 29(10), pages 1161-1179, October.
    13. Hu, Bo & Brimblecombe, Nicola & Cartagena-Farias, Javiera & Silva-Ribeiro, Wagner, 2025. "Projected costs of long-term care for older people in England: The impacts of housing quality improvements," Health Policy, Elsevier, vol. 152(C).
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    More about this item

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality

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