Content area
Full text
1. Introduction
As a growing number of older people in Europe find themselves in need of support, the policy relevance of long-term care (LTC) organization has considerably increased [1]. Despite the attention afforded to the increasing share of frail older people and the high costs associated with it, two aspects have been mostly overlooked in the literature: the issue of how equitable the use of LTC is and how this might vary between countries in Europe [2,3]. This stands in contrast with health care, for which a wide body of literature attesting to a socio-economic gradient in the use of different forms of health care has accumulated [4,5,6,7]. The gap is all the more remarkable as LTC in Europe is characterized by a wider diversity in terms of both allocation of public resources and the breadth and depth of coverage than health care [8,9]. The present study contributes to addressing this shortcoming by exploring the existence of inequalities in the use of LTC among community-dwelling older people in Europe and by comparing the results between European countries. Two main research questions are addressed. Firstly, what is the evidence of inequality and horizontal inequity by socio-economic status (SES) in the use of LTC at home across European countries. Secondly, which socio-economic factors drive inequality and inequity in use of LTC in different European countries. In addressing the second research question, we discuss the categorization of different factors driving inequalities into legitimate or illegitimate sources of variation in LTC use. We find that home-based care utilization is higher among lower income individuals in most European countries and that health needs and the structure of the household are its main drivers. Differences in use are almost entirely explained by differential care needs-i.e., we do not find evidence of horizontal inequity, but these results are sensitive to the categorization of household structures as legitimate rather than illegitimate sources of variation.
Previous work on LTC use has usually assumed that because older people of lower SES have on average poorer health [10], they would be the most likely users of LTC services. There is, however, a dearth of empirical evidence attesting to this situation and it is often limited to single country studies. What is more, the disparate results do...