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
2
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.
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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.
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Data collection - literature review

Literature review to identify relevant typologies, indicators, variables
Topic
Literature Sources
Entitlement
WHO 2003,
Da Roit, Le Bihan, Österle 2007
Financing: tax (Beveridge) /
insurance contribution (Bismarck)
Pacolet et al. 1999, WHO 2003, Pommer et al. 2007
Target: poor / non-poor,
Income testing
WHO 2003, Pommer et al. 2007,
Da Roit, Le Bihan, Österle 2007
Family support as a criterion
WHO 2003
Flexibility of criteria,
e.g. assessment process
WHO 2003,
Da Roit, Le Bihan, Österle 2007
Level of benefits,
e.g. level of cash allowance
WHO 2003,
Da Roit, Le Bihan, Österle 2007
Coverage by disabilities
WHO 2003
Cash benefits
WHO 2003
Informal carer: time provided, time
off-work, subsidies
Bettio, Plantenga 2004
(De-)Centralization of legislation,
implementation and financing
Glendenning et al. 2004,
Da Roit, Le Bihan, Österle 2007
Capacities for formal care
Pacolet et al. 1999,
Pommer et al. 2007
Take-up of care by care settings
Pommer et al. 2007,
Da Roit, Le Bihan, Österle 2007
5
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
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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.
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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.
𝑂𝑟𝑔𝑎𝑛𝑖𝑧𝑎𝑡𝑖𝑜𝑛 𝑑𝑒𝑝𝑡ℎ: 𝑋𝑖 =
𝐹𝑖𝑛𝑎𝑛𝑐𝑖𝑎𝑙 𝑔𝑒𝑛𝑒𝑟𝑜𝑠𝑖𝑡𝑦: 𝑌𝑖 =
𝑛
𝑗 =1 𝑂𝑗𝑖 ,
𝑚
𝑘=1 𝐹𝑘𝑖 ,
𝑖 = 1, … ,21,
𝑖 = 1, … ,21,
where 𝑖 indexes the 21 countries of our data set, 𝑂𝑗 are the organizational variables and 𝐹𝑘 are the
financial variables.
 Formal cluster analysis with SPSS K means clustering algorithm
based on the two indices.
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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:
o Means-tested access
o Entitlement
 Indicator for: How easy is access to publicly financed LTC for
(prospective) recipients of care?
o Availability of cash benefits
o Choice of provider
 Indicator for: How much freedom of choice is there for
recipients of care?
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Variables (2)
o Quality assurance
o Integration / coordination of care
 Indicator for: How technically developed is the management
of the care systems?

Financial generosity:
o Cost sharing
o Public expenditures as share of GDP
 Indicator for: Financial generosity of LTC systems
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Results (1)
Source: own compilation
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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.
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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.
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Thank you for your attention!
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Contact
Markus Kraus
Institute for Advanced Studies (IHS)
Stumpergasse 56
A- 1060 Vienna
Phone: +43 1/59991 141
E-Mail: [email protected]
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LTC system characteristics by country
Countries
Organizational depth
Means tested
access
Entitlement
Cash benefits
Xi
Quality
assurance
Choice
Integration
Financing generosity
Cost sharing
Public
expenditures
Yi
Austria
3
1
3
3
1
3
14
1
3
4
Belgium
3
3
3
3
3
3
18
2
4
6
Bulgaria
3
3
1
3
3
2
15
1
1
2
Czech Republic
3
3
2
3
2
2
15
1
1
2
Denmark
3
3
1
2
3
3
15
3
4
7
England
1
2
3
3
3
2
14
2
2
4
Estonia
3
3
3
3
3
2
17
1
1
2
Finland
3
3
3
1
1
3
14
1
4
5
France
3
3
2
3
3
2
16
2
3
5
Germany
3
3
2
3
3
2
16
3
2
5
Hungary
3
3
1
3
2
1
13
2
1
3
Italy
1
3
3
2
3
2
14
2
4
6
Latvia
1
3
2
3
2
3
14
3
1
4
Lithuania
1
3
2
3
1
2
12
1
2
3
Netherlands
3
3
2
3
3
2
16
1
5
6
Poland
1
3
2
3
1
2
12
1
1
2
Portugal
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Romania
2
1
1
3
3
1
11
2
1
3
Slovakia
3
3
2
3
3
2
16
2
1
3
Slovenia
3
3
3
3
1
2
15
2
3
5
Spain
1
3
3
2
3
2
14
2
2
4
Sweden
3
3
1
3
3
3
16
1
5
6
Source: own compilation
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