Typology of LTC systems based on system characteristics Markus Kraus Monika Riedel, Gerald Röhrling, Thomas Czypionka, Andreas Goltz International Conference on Evidence-based Policy in Long-term Care 8th – 11th of September 2010, London

Outline Introduction Data collection Method Variables Results

Introduction The typology was derived in context of the ANCIEN research project, which is financed under the 7th Research Framework Programme of the European Commission and from the Austrian Federal Ministry of Science and Research. It includes 20 partner institutions from EU member states such as CEPS, CPB, DIW, FPB, IHS, LSE and is organized in 7 work packages. It started in January 2009 and will last 44 months. The objective of the project is:  to review the long-term care (LTC) systems in EU member states,  to assess the actual and future numbers of elderly care-dependent people in selected countries and  to develop a methodology for comprehensive analysis of actual and future LTC needs and provision across European countries, including the potential role of technology and policies on maintaining and improving quality The objective of WP 1 is to portray long-term care systems in light of provision of care and financing and to derive a typology of LTC systems.

Why another typology, or: What is new in our approach to characterize LTC systems? We know typologies of welfare systems, typologies of health care systems, perhaps systems of setting-specific provision of care, but hardly any typology of LTC provision in Europe.  LTC is different from health care, so a different typology seems appropriate  Welfare typologies usually concentrate on countries other than Eastern Europe – we are interested in a comprehensive European typology Existing typologies usually rely more on qualitative information and appropriate methods. We succeeded in using a formal approach.

Data collection - literature review Literature review to identify relevant typologies, indicators, variables Literaturhinweis von Prof Schneider eingetroffen?

Data collection – questionnaire, problems Questionnaire was designed and sent to the national experts. It was organized in several blocks of questions focussing on macrostructure, funding and financing, informal care, formal institutional care, formal home based care and policy issues. Availability and comparability of quantitative data is rather limited, even when cooperating with national experts. This is particularly true when for more detailed or setting-specific information was asked. Derived typology: focuses on system characteristics  it relies on qualitative information describing national systems of LTC provision and uses this information after transformation into ordinal variables thus, we can cover Western as well Eastern European countries

Method (1) Procedure to derive the typology was as follows:  Allocate variables to one of two groups, one describing the organizational depth and one the financial generosity of LTC systems, and recode all variables with ordinal values.  Rationale behind coding: „Which system characteristic is more preferable from the patient‘s point of view?“  Most preferable option was coded „3“, least preferable option was coded „1“.  By summing up the organization variables one gets an index in which countries with high values could be interpreted as countries with high degree of patient friendliness and vice versa.

Method (2)  By summing up the funding variables one gets an index where countries with high values could be interpreted as countries with high degree of patient friendliness and vice versa.  Formal cluster analysis with SPSS K means clustering algorithm based on the two indices.

Variables (1) The selection of variables is a crucial part when designing a typology. We identified six variables describing the organization and two variables characterizing the financing of LTC systems: Organizational depth: Means-tested access Entitlement Indicator for: How easy is access to publicly financed LTC for (prospective) recipients of care? Availability of cash benefits Choice of provider  Indicator for: How much freedom of choice is there for recipients of care? Sechs Variable klingt vielleicht wenig gemessen am Aufwand. Dh im gesprochenen würd ich drauf hinweisen dass das wegen verschiedener Settings usw mehr Info ist als es am ersten Blick aussieht

Variables (2) Quality assurance Integration / coordination of care  Indicator for: How technically developed is the management of the care systems? Financial generosity: Cost sharing Public expenditures as share of GDP  Indicator for: Financial generosity of LTC systems

Results (1) Source: own compilation

Results (2) Western countries tend to have LTC-systems with a higher degree of patient friendliness. Organizational depth: there is NO clear distinction between Western and Eastern European countries. Only Lithuania, Poland, Romania, and to a lesser degree Hungary are lacking behind in this matter. Financial generosity: a gap between Western and Eastern European countries can be observed. Western European countries tend to be more generous to care recipients than Eastern European countries. A Scandinavian, Continental and Mediterranean country group cannot be exactly identified but there is some degree of compatibility to this classification.

Results (3) The Eastern European countries do not form a cluster by themselves. Though sharing the feature of low spending on LTC, they differ widely with regard to organizational aspects. Not even the Baltic States are altogether in one cluster. They are spread over three clusters. Slovakia and the Czech Republic, however, are in the same cluster.

Thank you for your attention!

Contact Markus Kraus Institute for Advanced Studies (IHS) Stumpergasse 56 A- 1060 Vienna Phone: +43 1/59991 141 E-Mail: kraus@ihs.ac.at

LTC system characteristics by country Source: own compilation