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Inequity in long-term care use and unmet need: two sides of the same coin

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  • García-Gómez, Pilar
  • Hernández-Quevedo, Cristina
  • Jiménez-Rubio, Dolores
  • Oliva-Moreno, Juan

Abstract

We investigate the determinants of several LTC services and unmet need using data from a representative sample of the non-institutionalised disabled population in Spain in 2008. We measure the level of horizontal inequity and compare results using self-reported versus a more objective indicator of unmet needs. Evidence suggests that after controlling for a wide set of need variables, there is not an equitable distribution of use and unmet need of LTC services in Spain; formal services are concentrated among the better-off, while intensive informal care is concentrated among the worst-off. The distribution of unmet needs for LTC services depends on the service considered and on whether we focus on subjective or objective measures. In 2008, only individuals with the highest dependency level had universal coverage. Our results show that inequities in most LTC services and unmet needs among this group either remain or even increase for formal services.

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  • García-Gómez, Pilar & Hernández-Quevedo, Cristina & Jiménez-Rubio, Dolores & Oliva-Moreno, Juan, 2015. "Inequity in long-term care use and unmet need: two sides of the same coin," LSE Research Online Documents on Economics 60789, London School of Economics and Political Science, LSE Library.
    • Handle: RePEc:ehl:lserod:60789
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    Cited by:

    1. Hu, Bo, 2020. "Trajectories of informal care intensity among the oldest-old Chinese," Social Science & Medicine, Elsevier, vol. 266(C).
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    3. Röttger, Julia & Blümel, Miriam & Köppen, Julia & Busse, Reinhard, 2016. "Forgone care among chronically ill patients in Germany—Results from a cross-sectional survey with 15,565 individuals," Health Policy, Elsevier, vol. 120(2), pages 170-178.
    4. Raúl Pozo-Rubio & Román Mínguez-Salido & Isabel Pardo-García & Francisco Escribano-Sotos, 2019. "Catastrophic long-term care expenditure: associated socio-demographic and economic factors," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(5), pages 691-701, July.
    5. Innes, Hanna Mac & Walsh, Kieran & Österberg, Torun, 2021. "The inverse care law and the significance of income for utilization of longterm care services in a Nordic welfare state," Social Science & Medicine, Elsevier, vol. 282(C).
    6. Øystein Hernæs & Snorre Kverndokk & Simen Markussen & Henning Øien, 2023. "When Health Trumps Money: Economic Incentives and Health Equity in the Provision of Nursing Homes," CESifo Working Paper Series 10359, CESifo.
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    8. Hernæs, Øystein & Kverndokk, Snorre & Markussen, Simen & Øien, Henning, 2023. "When health trumps money: Economic incentives and health equity in the public provision of nursing homes in Norway," Social Science & Medicine, Elsevier, vol. 333(C).
    9. 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.
    10. Pilar (P.) Garcia-Gomez & Helena M Hernandez-Pizarro & Guillem Lopez-Casasnovas & Joaquim Vidiella-Martin, 2019. "Unravelling Hidden Inequities in a Universal Public Long-Term Care System," Tinbergen Institute Discussion Papers 19-011/V, Tinbergen Institute.
    11. Scheil-Adlung, Xenia., 2015. "Long-term care protection for older persons : a review of coverage deficits in 46 countries," ILO Working Papers 994886493402676, International Labour Organization.
    12. Pulok, Mohammad Habibullah & van Gool, Kees & Hall, Jane, 2020. "Horizontal inequity in the utilisation of healthcare services in Australia," Health Policy, Elsevier, vol. 124(11), pages 1263-1271.
    13. 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.
    14. 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.
    15. Daisy Duell & Xander Koolman & France Portrait, 2017. "Practice variation in the Dutch long‐term care and the role of supply‐sensitive care: Is access to the Dutch long‐term care equitable?," Health Economics, John Wiley & Sons, Ltd., vol. 26(12), pages 1728-1742, December.
    16. Aristides dos Santos, Anderson Moreira & Perelman, Julian & Jacinto, Paulo de Andrade & Tejada, Cesar Augusto Oviedo & Barros, Aluísio J.D. & Bertoldi, Andréa D. & Matijasevich, Alicia & Santos, Iná S, 2019. "Income-related inequality and inequity in children’s health care: A longitudinal analysis using data from Brazil," Social Science & Medicine, Elsevier, vol. 224(C), pages 127-137.
    17. Zhu, Yumei & Österle, August, 2017. "Rural-urban disparities in unmet long-term care needs in China: The role of the hukou status," Social Science & Medicine, Elsevier, vol. 191(C), pages 30-37.
    18. Waitzberg, Ruth & Schmidt, Andrea E. & Blümel, Miriam & Penneau, Anne & Farmakas, Antonis & Ljungvall, Åsa & Barbabella, Francesco & Augusto, Gonçalo Figueiredo & Marchildon, Gregory P. & Saunes, Ingr, 2020. "Mapping variability in allocation of Long-Term Care funds across payer agencies in OECD countries," Health Policy, Elsevier, vol. 124(5), pages 491-500.
    19. Amadeo Fuenmayor & Rafael Granell & María Angeles Tortosa, 2016. "Quasi-markets Targets and the Evaluation of Nursing-home Funding in the Valencian Region," Hacienda Pública Española / Review of Public Economics, IEF, vol. 216(1), pages 13-38, March.
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    21. Carla Blázquez-Fernández & David Cantarero-Prieto & Patricio Pérez-González, 2018. "Unmet health care needs among the working-age population. Evidence from the great recession in Spain," Working Papers. Collection B: Regional and sectoral economics 1806, Universidade de Vigo, GEN - Governance and Economics research Network.
    22. Iparraguirre, Jose Luis, 2020. "Reductions in local government spending on community-based social care and unmet social care needs of older people in England," The Journal of the Economics of Ageing, Elsevier, vol. 17(C).
    23. Peña-Longobardo, Luz María & Oliva-Moreno, Juan & García-Armesto, Sandra & Hernández-Quevedo, Cristina, 2016. "The Spanish long-term care system in transition: Ten years since the 2006 Dependency Act," Health Policy, Elsevier, vol. 120(10), pages 1177-1182.

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    More about this item

    Keywords

    Disability; Equity in utilisation; Dependency; Long-term care; Unmet need;
    All these keywords.

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs
    • J14 - Labor and Demographic Economics - - Demographic Economics - - - Economics of the Elderly; Economics of the Handicapped; Non-Labor Market Discrimination

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