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

Author

Listed:
  • 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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Suggested Citation

  • 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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    Cited by:

    1. Giuliano Resce & Raffaele Lagravinese & Elisa Benedetti & Sabrina Molinaro, 2019. "Income-related inequality in gambling: evidence from Italy," Review of Economics of the Household, Springer, vol. 17(4), pages 1107-1131, December.
    2. Viktoria Szenkurök & Daniela Weber & Marcel Bilger, 2025. "Informal and formal long-term care utilization and unmet needs in Europe: examining socioeconomic disparities and the role of social policies for older adults," International Journal of Health Economics and Management, Springer, vol. 25(1), pages 87-106, March.
    3. Ginevra Floridi & Ludovico Carrino & Karen Glaser & Candace Kemp, 2021. "Socioeconomic Inequalities in Home-Care Use Across Regional Long-term Care Systems in Europe [Demography of informal caregiving]," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 76(1), pages 121-132.
    4. Zhonghua Wang & Xue Yang & Mingsheng Chen, 2022. "Inequality and Associated Factors in Utilization of Long-Term Care Among Chinese Older People: Evidence from the Chinese Longitudinal Healthy Longevity Survey," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 160(2), pages 467-486, April.
    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).
    10. Ludovico Carrino & Cristina Elisa Orso & Giacomo Pasini, 2018. "Demand of long‐term care and benefit eligibility across European countries," Health Economics, John Wiley & Sons, Ltd., vol. 27(8), pages 1175-1188, August.
    11. Marianne Tenand & Pieter Bakx & Eddy van Doorslaer, 2020. "Equal long‐term care for equal needs with universal and comprehensive coverage? An assessment using Dutch administrative data," Health Economics, John Wiley & Sons, Ltd., vol. 29(4), pages 435-451, April.
    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. Joan Costa-Font & Cinzia Di Novi & Cristina Elisa Orso, 2025. "From Care Gaps to Mental Health Strain," DEM Working Papers Series 231, University of Pavia, Department of Economics and Management.
    14. 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).
    15. Stefania Ilinca & Ricardo Rodrigues & Stefan Fors & Eszter Zólyomi & Janet Jull & Johan Rehnberg & Afshin Vafaei & Susan Phillips, 2022. "Gender differences in access to community-based care: a longitudinal analysis of widowhood and living arrangements," European Journal of Ageing, Springer, vol. 19(4), pages 1339-1350, December.
    16. Bo Hu & Javiera Cartagena-Farias & Nicola Brimblecombe, 2022. "Functional disability and utilisation of long-term care in the older population in England: a dual trajectory analysis," European Journal of Ageing, Springer, vol. 19(4), pages 1363-1373, December.

    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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