ESS Paper N 31.doc
21
4.1.2. Long-term care
In contrast to OOP for health care, in most countries, a greater number of poor elderly households incur OOP expenditure for LTC than rich households figure 16 In addition,
wide differences between poor and rich are registered in countries such as Belgium, Netherlands and Sweden, where around 20 per cent of the poor households are concerned
as compared to less than 5 per cent of the rich households.
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Furthermore, the severity of the impact of OOP expenditure for LTC on households’ income is much higher for the poor than for the rich. Levels above 10 per cent of the poor
household income are registered in Greece 12.6 per cent, Italy 10.6 per cent, Netherlands 10.9 per cent, Spain 12 per cent, Sweden 11.2 per cent and partly France
9.9 per cent, whereas the levels of expenditure for the richer group range between 0.2 per cent in France to 3.4 per cent in Sweden figure 17.
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15 20
25
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22
ESS Paper N 31.doc
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4.2. Incidence and extent of out-of-pocket payments with increasing age
An age-related analysis of incidence and OOP seems to be crucial when assessing the vulnerability of the elderly given:
• the increasing need for health and LTC care among the oldest cohorts Lafortune,
2007; and •
the decline of disposable income with age OECD, 2011, which contributes towards sharpening the impact of OOP expenditures and increasing the risk of
impoverishment as people get older.
When evaluating OOP expenditure as a share of income by age, a measure of both expenditure and income at individual level is needed. In order to obtain comparable data
on OOP expenditure across countries, we propose a measure that is relative to income – as in the previous analysis. We assume resource pooling at household level and account for
household size by creating household per capita income.
7
The prevalence of OOP in different population cohorts and the severity of such direct payments for those incurring
the expenditures will be analysed both for health and LTC expenditure.
7
We divide household total gross income by the number of members in the household.
0.00 2.00
4.00 6.00
8.00 10.00
12.00
1st 5th
1st 5th
1st 5th
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Austria Belgium
France Germany
Greece Italy
Netherlands Spain
Sweden Switzerland
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ESS Paper N 31.doc
23
4.2.1. Health care
Within all countries observed the share of households experiencing OOP expenditure for health care stays at similar levels and does not to change significantly with age figure 18
– with the exception of Spain. In Spain, the likelihood of experiencing OOP expenditures for health care decreases beyond age 64 significantly. This might be due to specific
regulations exempting pensioners from OOP, for instance medicines SSAISSA, 2010.
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The amount spent by elderly households on direct health care increases with age in most European countries figure 19. The share of OOP spent by the elderly is highest for those
aged 80+ and reaches peaks of up to about 7 per cent of household income in countries such as Belgium and Greece where – as shown in figure 18 – more than 90 per cent of all
elderly households experiencing OOP are concerned.
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=
;
7 ?24 27? 0
:
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