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

1. Introduction
Long-Term Care Use and Supply in Europe:
Projection Models and Results for Germany,
the Netherlands, Spain and Poland
ENEPRI Research Report No. 116/April 2012
Joanna Geerts, Peter Willemé and Esther Mot (eds) *
Sharp increases in the numbers of older persons and an improved survival of disabled older persons are
expected to cause an increase in the demand for and use of long-term care (LTC) in the coming decades
in all European countries. At the same time population ageing is likely to have a profound impact on the
future availability of both formal and informal caregivers. Generally, LTC systems in Europe consist of
a range of home and residential care services, and significant informal care, mainly provided by partners
and children. However, as work packages (WP) 1 and 3 of the ANCIEN project and other comparative
studies have demonstrated, European countries differ considerably in how they organise, finance and
allocate LTC. There is considerable variation not only in levels of formal and informal care use, but also
in how care use is related to disability, household composition, and other characteristics of older
persons. Supply side analyses of WP 3 have also shown large country differences in the prevalence of
informal caregiving and in formal care workforce participation rates. Furthermore, as has been shown in
WP2, current and predicted disability levels are much higher in some countries than in others. How
population ageing and other societal trends (e.g. changing living arrangements, higher female
employment rates) will affect future use and supply of formal and informal care is therefore likely to
differ considerably across European countries.
The aim of this report is to make projections of future use and supply of formal and informal care for
different LTC systems. Projections are made up to 2060 for four countries: Germany, the Netherlands,
Spain and Poland, using a standardised methodology. The countries were selected in WP 1 as
representative of clusters of countries with different LTC systems, based on four indicators of use and
financing of care: i) public LTC expenditure as a share of GDP and corrected for the share of persons
aged 65 and over, ii) private expenditure as a share of LTC spending, iii) the share of informal care users
among the 65+ population, and iv) support measures for informal caregivers (Kraus et al., 2010). The
typology of LTC systems is presented in Table 1.1 below.
Cluster 1, to which Germany belongs, consists of countries in which a low level of public spending is
combined with a modest share of private spending, high informal care use and high informal care
support. The Netherlands belongs to a cluster of Northern European countries characterized by high
public LTC spending, low private spending, low informal care use and high informal care support. Spain
and the other countries of cluster 3 share the profile of cluster 1 with regard to informal care use and
support, but have a much higher level of private responsibility and a somewhat higher level of public
spending. Poland is allocated to cluster 4, which is characterized by a small public sector involvement,
more private spending, high informal care provision but few supportive measures for informal
caregivers. Cluster 2 is ranked by Kraus et al. (2010) as the most attractive from the point of view of
older persons in need of care. Cluster 1 and 3 share second and third place, and cluster 4 is placed fourth
in the ranking.
* Joanna Geerts is researcher and Peter Willemé is health economist in the Social Security Research Group at the
Federal Planning Bureau (FPB); Esther Mot is senior researcher in the Netherlands Bureau for Economic Policy
Analysis (CPB).
Note: This report uses data from SHARE release 2.3.1, as of July 29th 2010. SHARE data collection in 2004-2007
was primarily funded by the European Commission through its 5th and 6th framework programmes (project
numbers QLK6-CT-2001- 00360; RII-CT- 2006-062193; CIT5-CT-2005-028857). Additional funding by the US
National Institute on Aging (grant numbers U01 AG09740-13S2; P01 AG005842; P01 AG08291; P30 AG12815;
Y1-AG-4553-01; OGHA 04-064; R21 AG025169) as well as by various national sources is gratefully
acknowledged (see http://www.share-project.org for a full list of funding institutions).
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