The impact of income and household situation on the utilisation of long-term care - comparing Sweden (data from the SNAC study) and Japan (Handa) Mårten Lagergren Brussels, October 30th, 2008

The system of long-term care of the elderly in Sweden Social services are provided by the municipality in ordinary or special housing. Health care mainly provided by the country council. Financing by taxes. Social services are provided by the municipality in ordinary or special housing. Health care mainly provided by the country council. Financing by taxes. Many elderly live alone – but with help from their children Many elderly live alone – but with help from their children Principle of ‘Aging in place’ – support in order to be able to continue independent living Principle of ‘Aging in place’ – support in order to be able to continue independent living

The system of long-term care of the elderly in Japan National Long-Term Care Insurance system financed by premiums introduced in 2000 National Long-Term Care Insurance system financed by premiums introduced in 2000 Traditional emphasis on long-term care in hospitals – now more services in the community and in nursing homes Traditional emphasis on long-term care in hospitals – now more services in the community and in nursing homes Many elderly persons live with their children - emphasis on relief support Many elderly persons live with their children - emphasis on relief support

Long-term care activities in Sweden and Japan

Assessment of aged care needs in Sweden Informal assessment by care managers in the municipality Informal assessment by care managers in the municipality According to the law the entire life situation of the old person should be taken into consideration According to the law the entire life situation of the old person should be taken into consideration Detailed decision concerning type and amount of services Detailed decision concerning type and amount of services

Assessment of aged care needs in Japan Very formal assessment of needs through detailed questionnaire and computer calculation Very formal assessment of needs through detailed questionnaire and computer calculation According to law only personal dependency should form basis of decision According to law only personal dependency should form basis of decision

Allotment of services in Sweden Large differencies between municipalities when it comes to coverage and amount of allotted services Large differencies between municipalities when it comes to coverage and amount of allotted services Very low co-payments – average 4%. High uptake of allotted services Very low co-payments – average 4%. High uptake of allotted services Actually executed services may differ from decided Actually executed services may differ from decided

Allotment of services in Japan The assessment results in an allotted care level – actual content within that level is decided by the old person in co-operation with a care manager The assessment results in an allotted care level – actual content within that level is decided by the old person in co-operation with a care manager Fairly high co-payments (10%) result in relatively low uptake of services in relation to the allotted care level (40%) Fairly high co-payments (10%) result in relatively low uptake of services in relation to the allotted care level (40%)

Level of need and care time index

Cost limits per level of need and uptake percentage

Data set from Sweden Data set from Sweden Data collected in the SNAC study – care system part, Kungsholmen, Data collected in the SNAC study – care system part, Kungsholmen, Data include needs assessment variables and allotted services Data include needs assessment variables and allotted services Dataset contains 2676 observations Dataset contains 2676 observations

SNAC Swedish National study on Ageing and Care

SNAC The development of longitudinal area databases for monitoring and analysis of the system of long-term care for elderly persons in Sweden

SNAC - a four-centre individual-based longitudinal study intended to SNAC - a four-centre individual-based longitudinal study intended to describe the ageing process from different aspects  the development of health, functional and cognitive ability, social and economic situation etc., and describe the ageing process from different aspects  the development of health, functional and cognitive ability, social and economic situation etc., and monitor the total consumption of health and social care of the elderly population in the area. monitor the total consumption of health and social care of the elderly population in the area.

Four different areas  Five municipalities in Region Skåne (Eslöv, Hässleholm, Malmö, Osby, Ystad) (Eslöv, Hässleholm, Malmö, Osby, Ystad)  Karlskrona municipality in Blekinge  Karlskrona municipality in Blekinge  Kungsholmen district, Stockholm  Kungsholmen district, Stockholm  Municipality of Nordanstig  Municipality of Nordanstig All four areas follow the same design and use the same core protocol

Basic study design Population perspective Population perspective in order to describe the life situation of the elderly and the ageing process in order to describe the life situation of the elderly and the ageing process Care system perspective Care system perspective in order to describe the functioning of the system of health and social care for the elderly in relation to their needs in order to describe the functioning of the system of health and social care for the elderly in relation to their needs

Care system perspective Systematic, longitudinal, individual-based collection of data concerning the operations of the system of long-term care for the elderly Systematic, longitudinal, individual-based collection of data concerning the operations of the system of long-term care for the elderly All changes in the provision of long-term care by municipality or county council are recorded All changes in the provision of long-term care by municipality or county council are recorded The recording includes measures of dependency/ functional ability, housing and informal care and allotted services The recording includes measures of dependency/ functional ability, housing and informal care and allotted services

Data set from Japan Data collected in Handa municipality in connection to needs assessment in National Long-Term Care Insurance Data collected in Handa municipality in connection to needs assessment in National Long-Term Care Insurance Data include need assessment variables, allotted level of need (0 (support) and 1 – 5 ) and provided services Data include need assessment variables, allotted level of need (0 (support) and 1 – 5 ) and provided services

Comparability of data Swedish and Japanese datasets differ but contain essentially comparable information Swedish and Japanese datasets differ but contain essentially comparable information Sometimes combinations of variables or calibration is needed in order to achieve comparability Sometimes combinations of variables or calibration is needed in order to achieve comparability

Average age among recipients of care, per gender and total

Distribution on type of household – urban Sweden (Kungsholmen)

Distribution on type of household – rural Sweden (Nordanstig)

Distribution on type of household – recipients of LTC urban Sweden (Kungsholmen)

Distribution on type of household – recipients of LTC, rural Sweden (Nordanstig)

Recipients of LTC care – Sweden Distribution on income-groups per age- group and gender

Proportion with LTC services - single person households, Sweden (Kungsholmen)

Proportion with LTC services - co-habitating Sweden (Kungsholmen)

Average dependency (SNAC-index) per income-group - recipients of LTC, Kungsholmen

Average weekly hours of home help for recipients of LTC in the community per income group Sweden, Kungsholmen

Prop. of recipients of LTC in special accomodations per income group Sweden, Kungsholmen

Distribution on type of household for recipients of LTC – Japan (Handa)

Distribution on income-group per age- group and gender, Japan (Handa)

Distribution on income-groups per type of household, Japan (Handa)

Distribution on allotted level of need per type of household, Japan (Handa)

Distribution on level of need per income-group, Japan (Handa)

Uptake rate per age-group and gender, Japan (Handa)

Average up-take rate per age-group and gender, Japan (Handa)

Uptake rate per level of dependency (PADL-groups), Japan (Handa)

Average uptake rate per level of dependency (PADL-groups), Japan (Handa)

Uptake rate per level of need, Japan (Handa)

Average uptake rate per level of need Japan (Handa)

Uptake rate per income group, Japan (Handa)

Average uptake rate per income group Japan (Handa)

Uptake rate per type of household, Japan (Handa)

Average uptake rate per type of household, Japan (Handa)

Main conclusions Income does not seem to affect the provision of care in Sweden, but type of household makes a big difference when it comes to receiving services Income does not seem to affect the provision of care in Sweden, but type of household makes a big difference when it comes to receiving services Some differences between income groups in Sweden conc. type of LTC services Some differences between income groups in Sweden conc. type of LTC services In Japan allotted level of need in Japan is generally lower for single-living than co-habitating persons reflecting differences in possibility to cope In Japan allotted level of need in Japan is generally lower for single-living than co-habitating persons reflecting differences in possibility to cope Income and type of household affect uptake rate in Japan reflecting higher co-payments Income and type of household affect uptake rate in Japan reflecting higher co-payments

That´s all folks! Thanks for your attention