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Can the European elderly afford the financial burden of health and long-term care? Assessing impacts and policy implications

dianagosalvez Diana Gosálvez Prados last modified 14/05/2012 12:45

This research report assesses the financial impact of private health and long-term care expenditure on households of the elderly, in particular, the impact of out-of-pocket payments at the time of service delivery and related policy implications.

Scheil-Adlung X, Bonan J. Can the European elderly afford the financial burden of health and long-term care?  Assessing impacts and policy implications. Geneva: International Labour Ofiice; 2012. Available at: http://www.social-protection.org/gimi/gess/RessFileDownload.do?ressourceId=30228



The elderly are particularly at risk, as they are prone to ill health and disability conditions that necessitate health care and long-term care LTC. However, social protection systems in the countries observed do not provide adequate protection for the elderly:

  • Out-of-pocket payments for health care concern on average about 70 per cent of the elderly population; about 5 per cent have to face Out-of-pocket payments and expenditures as a consequence of long-term care LTC.
  • Economic consequences of such expenditures on households may be severe and constitute a threat to their financial sustainability and bring about impoverishment.
  • The impact of related private expenditure for long-term care LTC is higher for the poor than for the rich, and some social groups – such as women and individuals living alone – are at a higher risk of Out-of-pocket payments.
  • The availability of services constitutes an important problem in most countries given the lack of skilled workers providing services to the elderly.

Given demographic developments, the problems observed are likely to increase in the future. In order to meet the current and future needs of the elderly, and particularly vulnerable groups among them, population coverage should be universal and more effective; efficient social health protection systems are also desirable.

This requires, in particular, that more resources should be made available for the elderly, especially to further develop long-term care LTC schemes with a view to: increasing the scope of benefits;  ensuring the affordability, availability and delivery of services; and improving the quality of services in order to respond more adequately to needs.

Furthermore, measures should be envisaged to facilitate the delivery of informal car by covering family carers in social protection systems and providing compensation, e.g. cash benefits and allowances. In addition, the widespread shortage of the health and long-term care LTC workforce needs to be addressed by creating decent working conditions.

Scheil-Adlung X, Bonan J.

Chapter 9: Socioeconomic implications Collaborative document