long-term care use and supply in europe: projections for germany ...

LONG-TERM CARE USE AND SUPPLY IN EUROPE | 39
composition is assumed. For the Netherlands, projections have been obtained from Statistics
Netherlands for the 2011-2060 period, by five year intervals. For Germany, projections of household
composition have been used for the projections of home care use only, as household composition was
not included in the residential care model (see 4.3.4a). To the best of our knowledge, no household
composition projections are available for Spain and Poland.
Projected trends in household composition of the older populations differ for males and females (see
Table A4.1 and Table A4.2 in Appendix), in great part due to changes in the differentials in life
expectancy between males and females. In Germany, the shares of single persons are projected to
decrease among females between 2010 and 2050 in all age categories, while among males the shares of
single persons are projected to increase. In the Netherlands, the shares of single persons are projected to
rise substantially among males between 2010 and 2060, particularly at younger ages. At older ages, the
shares of single persons will slightly decrease initially. Among females the share of single persons is
projected to decrease between 2010 and 2060 for the 75-79, 80-84 and 85+ age categories. At younger
ages, the share of single persons is projected to slightly increase, after an initial decrease.
4.3.3 Educational level projections
Projections of the older population by age, gender and educational level have been made by the
International Institute for Applied Systems Analysis (IIASA) for many countries, including Germany,
the Netherlands and Spain (see Kc et al. (2010) for more details). For the ‘better education’ scenario,
IIASA projections under the ‘fast track’ scenario for the 2010-2050 period have been used. After 2050,
no further change in educational level is assumed. For Poland, no educational level projections have
been used, as data on care use by educational level was not available (see section 4.3.4).
The educational level of the older population is generally projected to increase (see Table A4.3 to Table
A4.5 in Appendix for details of the educational level projections). In Germany, where very few older
persons are in the lowest educational category in 2010, the shares of persons in the lowest category are
projected to increase slightly over the projection period.
While in all three countries base year educational levels are lower for women than for men, the
educational level of women is projected to increase faster than that of men, resulting in decreased gender
gaps in future years. In Spain, the educational level of women is projected to surpass that of men.
4.3.4 Care use models
a. Residential care models
For the Netherlands and Spain logit models have been estimated to examine the determinants of
institutionalisation, using national cross-sectional microdata representative for the population of persons
aged 65 years and over (see Chapter 2 for a detailed description of the residential care models). Using
the results of the logit models, predicted probabilities of residential care use have been calculated by
combinations of age category, gender, ADL disability level, household composition, educational level
and cognitive functioning (significant variables only), keeping income and number of chronic
conditions (if significant) at their mean values (cell means). For the Netherlands, data of the Aanvullend
Voorzieningengebruik Onderzoek 2007 (AVO, Research into supplementary use of Services) and the
Onderzoek naar Ouderen in Instellingen 2008 (OII, Research on older persons in institutions) have been
used to estimate the residential care model. For Spain, the Encuesta de Discapacidad, Autonomia
Personal y Situaciones de Dependencia (EDAD, Survey on disability, independence and dependency)
has been used.
Due to the unavailability of micro level data for Germany and Poland, no logit models have been
estimated for these countries. Instead, prevalences of institutionalisation by age, gender and disability
have been calculated. For Germany data from the Long-term Care Insurance scheme (Statistisches
Bundesamt, 2009) have been used. Data for Poland have been obtained by gathering information from a
number of sources with the help of CASE (Golinowska & Sowa, 2011) and of Etienne Sail from DG