Home Sweet Home? Public Financing and Inequalities in the Use of Home Care Services in Europe

33 Pages Posted: 11 Jun 2015

See all articles by Vincenzo Carrieri

Vincenzo Carrieri

CSEF - University of Naples Federico II

Cinzia Di Novi

Ca Foscari University of Venice

Cristina Orso

Ca Foscari University of Venice - Dipartimento di Economia

Date Written: June 8, 2015

Abstract

Income-related inequalities in health care access have been found in several European countries but little is known about the extent of inequalities in the provision of Long Term Care services (LTC). This paper fills this gap: it addresses equity issues related to the provision of home care services across three macro-areas in Europe which are highly heterogeneous in terms of the degree of public financing of LTC and the strength and the social value of family ties. Using cross-country comparative micro-data from SHARE (Survey of Health, Ageing and Retirement in Europe) survey, we estimate and decompose an Erreygers concentration index of the use of both paid domestic help (“unskilled” care) and personal nursing care (“skilled” care), measuring the contribution of income, needs and non-needs factors to overall inequality. We base the decomposition on a bivariate probit model which takes into account the reciprocal interaction between formal and informal home care use. We find evidence of high horizontal inequity in the use of unskilled home care in areas where public financing of LTC is relatively low (Southern Europe) while moderate inequalities emerges in areas where public-private mix of financing is more balanced (Continental Europe). At the same time, we do not detect inequity in Northern Europe characterized by high public spending on universal services equitable for all, including LTC public coverage. In all areas, informal care has been found to be a substitute for paid unskilled care among the poor and this contributes to further skewing the distribution of the use of formal care services towards the rich.

Keywords: inequality, long term care, home care, Europe

JEL Classification: I11, I14

Suggested Citation

Carrieri, Vincenzo and Di Novi, Cinzia and Orso, Cristina, Home Sweet Home? Public Financing and Inequalities in the Use of Home Care Services in Europe (June 8, 2015). University Ca' Foscari of Venice, Dept. of Economics Research Paper Series No. 14/WP/2015, Available at SSRN: https://ssrn.com/abstract=2616610 or http://dx.doi.org/10.2139/ssrn.2616610

Vincenzo Carrieri

CSEF - University of Naples Federico II ( email )

Via John Paul II, 132
Fisciano (SA), 84084
Italy

Cinzia Di Novi (Contact Author)

Ca Foscari University of Venice ( email )

Dorsoduro 3246
Venezia, 30123
Italy

Cristina Orso

Ca Foscari University of Venice - Dipartimento di Economia ( email )

Cannaregio 873
Venice, 30121
Italy

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