Combining choice, quality and equity in care for the elderly
Newsletter 2009-1
Publication date : 2009-06-05
The
number of Europeans aged 80-plus is expected to rise by 174% between 2004 and
2050. Assuming that disability-free life expectancy increases in line with
overall expectancy, the number of dependent people, needing help with daily
activities and personal care, would rise by 31% over the same period. While
family members currently provide a substantial amount of care to the elderly, the
capacity of younger generations to provide day-today support for older
relatives is far from guaranteed. The
development of formal care services is thus essential and market mechanisms are
increasingly advocated within the EU on the grounds that they improve choice,
thereby raising quality and cutting costs. However,
there is no strong evidence of this causal link. In fact, the growth of
individualised service purchasing could generate substantial new transaction
costs and reduce economies of scale. What’s more, if increased choice is to
lead to bettervalue services, people need to be capable of making informed decisions.
Here, public authorities should play a part. Indeed, choice delegates risk, as
well as benefits, to individual disabled and older people, who may choose types
of services that deliver suboptimal outcomes. During
the Peer Review hosted by the Danish government last April with a view to
examining how new policy options and instruments can contribute to improved
long-term care for the elderly, Member States emphasised the benefits of choice
in terms of quality and diversity. However, it was pointed out that choice remains
a luxury in many countries, where merely ensuring adequate services is a challenge. It
was further questioned to what extent local government should be channelling
public resources into private profit. Regulation
was considered crucial to protecting vulnerable people, considering the
emergence of private for profit providers. At the same time, it was stressed
that over-regulation can result in overly high costs and fewer providers.
Top-down regulatory systems need to be complemented by citizens’ contributions,
namely via schemes such as the Danish complaints system, which could be
transferable to other countries. Good
relations between central and local government, and appropriate funding for local
authorities, were also highlighted as important factors, given the growing
trend towards decentralisation in most countries. The Danish equalisation
grants from central to local government were viewed as a useful and transferable
mechanism that can serve to target poorer and rural municipalities. Lastly,
participants stressed that in an increasingly service- focused EU economy, social
and long-term care services have considerable potential for creating new employment
and, therefore, for contributing to the Lisbon strategy. In turn, the
involvement of younger pensioners in the voluntary sector could provide
solutions to shortages in preschool services for working mothers, etc. What’s
more, the strain on healthcare resources could be smaller than expected, as
people are not only living longer, but also becoming healthier. Lessons learned
