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Open AccessFeature PaperArticle

Fairness and Eligibility to Long-Term Care: An Analysis of the Factors Driving Inequality and Inequity in the Use of Home Care for Older Europeans

1
European Centre for Social Welfare Policy and Research, 1090 Vienna, Austria
2
Austrian Public Health Institute, 1010 Vienna, Austria
*
Author to whom correspondence should be addressed.
Academic Editors: Ingrid Darmann-Finck, Heinz Rothgang and Hajo Zeeb
Int. J. Environ. Res. Public Health 2017, 14(10), 1224; https://doi.org/10.3390/ijerph14101224
Received: 31 August 2017 / Revised: 22 September 2017 / Accepted: 2 October 2017 / Published: 14 October 2017
(This article belongs to the Special Issue Key Issues in Current Health Research: Ageing–Health–Equity)
In contrast with the case of health care, distributional fairness of long-term care (LTC) services in Europe has received limited attention. Given the increased relevance of LTC in the social policy agenda it is timely to evaluate the evidence on inequality and horizontal inequity by socio-economic status (SES) in the use of LTC and to identify the socio-economic factors that drive them. We address both aspects and reflect on the sensitivity of inequity estimates to adopting different definitions of legitimate drivers of care need. Using Survey of Health, Ageing and Retirement in Europe (SHARE)data collected in 2013, we analyse differences in home care utilization between community-dwelling Europeans in nine countries. We present concentration indexes and horizontal inequity indexes for each country and results from a decomposition analysis across income, care needs, household structures, education achievement and regional characteristics. We find pro-poor inequality in home care utilization but little evidence of inequity when accounting for differential care needs. Household characteristics are an important contributor to inequality, while education and geographic locations hold less explanatory power. We discuss the findings in light of the normative assumptions surrounding different definitions of need in LTC and the possible regressive implications of policies that make household structures an eligibility criterion to access services. View Full-Text
Keywords: long-term care; home care services; inequality; decomposition; equity in use long-term care; home care services; inequality; decomposition; equity in use
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Ilinca, S.; Rodrigues, R.; Schmidt, A.E. Fairness and Eligibility to Long-Term Care: An Analysis of the Factors Driving Inequality and Inequity in the Use of Home Care for Older Europeans. Int. J. Environ. Res. Public Health 2017, 14, 1224.

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