Angrisani Marco, Regalado José Carlos Ortega, Hashiguchi Tiago Cravo Oliveira
USC Center for Economic and Social Research, University of Southern California, Los Angeles, CA, United States.
Health Division, Directorate for Employment, Labour and Social Affairs, Organisation for Economic Co-operation and Development, Paris, France.
EClinicalMedicine. 2022 Jun 25;50:101503. doi: 10.1016/j.eclinm.2022.101503. eCollection 2022 Aug.
Empirical evidence informing policies aiming at ensuring affordability of long-term care (LTC) costs is limited. Combining system-level with individual-level data, we quantify the burden of out-of-pocket costs of LTC services on households in 13 European countries and the USA and explore how social protection systems impact affordability of care.
In this observational study, we use harmonised data from the Health and Retirement Study (HRS), collected between 2012 and 2016, and from the Survey of Health, Ageing and Retirement in Europe, collected between 2013 and 2017. We assess the severity of LTC needs of older adults (65+) on the basis of self-reported limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs). We classify countries' social protection systems in terms of affordability and progressivity using information obtained from country officials. We examine variation in individual-level out-of-pocket LTC costs by social protection systems' affordability and progressivity.
Out-of-pocket LTC costs are heterogeneous across countries and increase with individuals' needs. In countries where LTC is more affordable and social protection systems less progressive, older adults incur significantly lower levels of LTC costs. Within Europe, not only are costs lower where systems are characterized by higher affordability and lower progressivity, but they also represent a lower share of households' disposable income.
Our findings indicate that the social protection systems significantly affect the level of out-of-pocket costs faced and reported by older adults with LTC needs as well as the share of their income that is devoted to pay for care.
We received funding from the National Institute on Aging (grant number R01 AG030153). The OECD programme of work on ageing and long-term care is partly funded by the European Union.
有助于制定旨在确保长期护理（LTC）费用可负担性政策的实证证据有限。我们将系统层面数据与个人层面数据相结合，量化了13个欧洲国家和美国长期护理服务自付费用对家庭造成的负担，并探讨了社会保护系统如何影响护理的可负担性。
在这项观察性研究中，我们使用了来自健康与退休研究（HRS）（2012年至2016年收集）以及欧洲健康、老龄化与退休调查（2013年至2017年收集）的统一数据。我们根据自我报告的日常生活活动（ADL）和工具性日常生活活动（IADL）受限情况，评估老年人（65岁及以上）长期护理需求的严重程度。我们利用从各国官员处获得的信息，从可负担性和累进性方面对各国的社会保护系统进行分类。我们研究了社会保护系统的可负担性和累进性对个人层面长期护理自付费用的影响。
长期护理自付费用在各国之间存在差异，并随着个人需求的增加而增加。在长期护理更具可负担性且社会保护系统累进性较低的国家，老年人的长期护理费用显著较低。在欧洲内部，不仅在社会保护系统具有较高可负担性和较低累进性的地方费用较低，而且这些费用在家庭可支配收入中所占的比例也较低。
我们的研究结果表明，社会保护系统显著影响有长期护理需求的老年人面临和报告的自付费用水平，以及用于支付护理费用的收入份额。
我们获得了美国国立衰老研究所的资助（资助编号R01 AG030153）。经合组织关于老龄化和长期护理的工作方案部分由欧盟资助。
