The impact of income and household situation on the utilisation of long-term care - comparing Sweden (data from the SNAC study) and Japan (Handa)

1
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

2
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.
• 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

3
The system of long-term care of the elderly in
Japan

• 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
• Many elderly persons live with their children
  -emphasis on relief support

4
Long-term care activities in Sweden and Japan
5
Assessment of aged care needs in Sweden

• 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
• Detailed decision concerning type and amount of
  services

6
Assessment of aged care needs in Japan

• Very formal assessment of needs through detailed
  questionnaire and computer calculation
• According to law only personal dependency should
  form basis of decision

7
Allotment of services in Sweden

• 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
• Actually executed services may differ from
  decided

8
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
• Fairly high co-payments (10) result in
  relatively low uptake of services in relation to
  the allotted care level (40)

9
Level of need and care time index
10
Cost limits per level of need and uptake
percentage
11
Data set from Sweden

• Data collected in the SNAC study care system
  part, Kungsholmen, 2002 -2005
• Data include needs assessment variables and
  allotted services
• Dataset contains 2676 observations

12
SNAC

• Swedish National study on Ageing and Care

13
SNAC

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

14
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
•  monitor the total consumption of health and
  social care of the elderly population in the
  area.

15
Four different areas

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

16
Basic study design

• Population perspective
• in order to describe the life situation of
  the elderly and the ageing process
• 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

17
Care system perspective

• 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
• The recording includes measures of dependency/
  functional ability, housing and informal care and
  allotted services

18
Data set from Japan

• 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

19
Comparability of data

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

20
Average age among recipients of care, per
gender and total
21
Distribution on type of household urban Sweden
(Kungsholmen)
22
Distribution on type of household rural Sweden
(Nordanstig)
23
Distribution on type of household recipients of
LTC urban Sweden (Kungsholmen)
24
Distribution on type of household recipients of
LTC, rural Sweden (Nordanstig)
25
Recipients of LTC care Sweden Distribution on
income-groups per age-group and gender

26
Proportion with LTC services - single person
households, Sweden (Kungsholmen)
27
Proportion with LTC services - co-habitating
Sweden (Kungsholmen)
28
Average dependency (SNAC-index) per
income-group- recipients of LTC, Kungsholmen
29
Average weekly hours of home help for recipients
of LTC in the community per income groupSweden,
Kungsholmen
30
Prop. of recipients of LTC in special
accomodations per income group Sweden,
Kungsholmen
31
Distribution on type of household for recipients
of LTC Japan (Handa)
32
Distribution on income-group per age-group and
gender, Japan (Handa)
33
Distribution on income-groups per type of
household, Japan (Handa)
34
Distribution on allotted level of need per type
of household, Japan (Handa)
35
Distribution on level of need per income-group,
Japan (Handa)
36
Uptake rate per age-group and gender, Japan
(Handa)
37
Average up-take rate per age-group and gender,
Japan (Handa)
38
Uptake rate per level of dependency
(PADL-groups), Japan (Handa)
39
Average uptake rate per level of dependency
(PADL-groups), Japan (Handa)
40
Uptake rate per level of need, Japan (Handa)
41
Average uptake rate per level of need Japan
(Handa)
42
Uptake rate per income group, Japan (Handa)
43
Average uptake rate per income group Japan (Handa)
44
Uptake rate per type of household, Japan (Handa)
45
Average uptake rate per type of household, Japan
(Handa)
46
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
• 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
• Income and type of household affect uptake rate
  in Japan reflecting higher co-payments

47
Thats all folks! Thanks for your
attention