The use of the international
definition of long-term care
at the national level
Mateja Nagode, Social Protection Institute of the Republic of
Slovenia
Stane Marn, Statistical Office of the Republic of Slovenia
Anita Jacović, Statistical Office of the Republic of Slovenia
Eva Zver, Institute of Macroeconomic Analysis and Development
Statistical Days,
Radenci, 12–13 November 2012
STRUCTURE OF THE PRESENTATION
• Importance of data on long-term care (LTC) and reasons
for establishing an interinstitutional working group
• Definition of LTC in the System of Health Accounts
(OECD, WHO and EUROSTAT)
• Components of LTC
• Criteria for delimitation between LTC health and social
care
• Cooperation in the OECD feasibility study on LTC
expenditure
• Interinstitutonal working group: Analysis of availability
of data on LTC expenditure and receipts
PRESSURES ON LTC ARE EXPECTED TO
GROW (Colombo et al. 2011)
Radenci, 12. - 13. november 2012
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DEFINITION OF LONG-TERM CARE
______________________________________
organisation and provision of health and social services to
people who due to reduced level of independence and ability
to live independently need permanent help in performing
daily activities
dependence on help can be the result of physical or
psychological limitations the result of which is inability to
independently perform:
activities of daily living (ADL)
instrumental activities of daily living (IADL)
LTC HAS NOT YET BEEN
SYSTEMATICALLY REGULATED
Pension and Disability Insurance Act
Social Security Act
Social Security Benefits Act
Rights Enforcement from Public Funds Act
Parental Care and Family Benefits Act
Mentally and Physically Handicapped Persons Act
Health Care and Health Insurance Act
War Disabled Act
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IMPORTANCE OF SYSTEMATIC DATA COLLECTION
• Establishment of interinstitutional working group on
LTC:
–
–
–
–
–
–
–
–
–
–
Social Protection Institute of the Republic of Slovenia
Statistical Office of Republic of Slovenia
Ministry of Labour, Family and Social Affairs
Slovenian Community of Social Institutions
National Institute of Public Health
Pension an Disability Insurance Institute
Institute of Macroeconomic Analysis and Development
Ministry of Health
Institute for Economic Research
Health Insurance Institute of Slovenia
OBJECTIVES OF THE WORKING GROUP
ON LTC
• to examine national and international requests for
information in the field of LTC;
• to identify and define the contents of LTC - in terms of
national legislation and from the perspective of
international recommendations
• to identify and define the available data sources
• to determine the competences between the institutions to
provide data
• to prepare methodological solutions
• to participate in the LTC regulation of recording data on
LTC;
• to participate in the publication of relevant data on LTC
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COMPONENTS OF LONG-TERM CARE
- health part (HC. 3)
• Medical or nursing care – permanent help to dependent persons in
alleviating pain and suffering, taking medicine; included are minor surgery,
dressing of wounds, family counselling, emotional and spiritual support:
- prevention of deterioration of fragile state of health
- treatment of chronic disease – deterioration of the state of health
- much rehabilitation for establishing basic functionality
- helping mentally disabled, prevention of deterioration, preserving basic
functionality
• Personal care services – permanent help to dependent persons in
performing basic activities of daily living (ADL): feeding, bathing, washing,
dressing, getting in and out of bed, getting to and from the toilet,
managing incontinence
• - included: assistance in kind and in cash (for informal (family) personal
care)
COMPONENTS OF LONG-TERM CARE
- social part (HCR. 1)
• Assistance services – permanent help in performing
activities of daily living (ADL) such as shopping, laundry,
cooking, managing finances, using the telephone, transport
for people with health problems, functional limitations or
• Other social care services – activities whose primary purpose
is social and leisure
- included:
assistance in kind and in cash
- excluded: sickness, disability benefits, special schooling
expenditure and vocational rehabilitation, expenditure for
other social services for people combating loneliness, etc.
DELIMITATION BETWEEN LONG-TERM HEALTH
CARE SERVICES (HC. 3) and LONG-TERM SOCIAL
SERVICES (HCR. 1)
____________________________________________
The delimitation is a critical point of international comparability
of health expenditure due to:
differences in institutional organisation of financing and implementing longterm services
differences in health and social statistics (different definitions of LTC;
different coverage based either on the principal activity of the provider
or the mode of financing)
differences in data availability (problem of out-of-pocket expenditure, problem
of complex institutions)
APPROACHES TO THE DELIMITATION OF LONG-TERM HEALTH
AND SOCIAL CARE
1)
Functional approach
•
By type of services
Expenditure related to help in activities of daily living (ADL) belong to long-term health care
Expenditure related to help in instrumental activities of daily living (IADL) belong to longterm social care
2)
3)
Institutional approach
•
By the principal activity of the provider
•
By financing and regulations (from health funds or from social security funds)
•
By the qualification of the personnel performing the service (only health personnel
can perform services of long-term health care)
By the health status of the recipient
•
Long-term health care expenditure covers total expenditure for people who need
help in activities of daily living - ADL (including IADL, if the recipient needs help in
ADL)
Overview of expenditure and receipts in Slovenia
(part)
Service
providers
Expenditure
Available data
- ZZZS database
Homes
for
elderly
- SSZS: annual
reports for the
Ministry of Labour,
Family and Social
Affairs
- ZPIZ: Allowance
for assistance and
attendance (estimate)
Centres
for Care
and
Training
- ZZZS database
- Ministry of Labour,
Family and Social
Affairs
Receipts
Note
Available data
Note
- SSZS: Homes for
elderly (annual
reports for the
Ministry of Labour,
Family and Social
Affairs
Exclusion of
double
counting:
recipients of
allowance for
assistence and
attendance
(Breakdown of
recipients by gender
and five-year age
groups)
- SURS: Centres for
Care and Training
(SOC-VDC/L)
(Breakdown of
recipients by gender
and five-year age
groups)
Exclusion of
double
counting:
recipients of
allowance for
assistance and
attendance
Results of the analysis of data
sources for LTC
• Data on LTC expenditure do not include:
-
long-term day care in Centres for Care and Training, fewer than 16 hours
loss of income
personal assistance and group homes organised by NGOs
meals on wheels
• Main problems in data on recipients of LTC:
– Missing data (psychiatric hospitals, community nursing, sheltered
housing)
– Missing data by five-year age groups
– Overlapping of recipients of services and allowances
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Results of feasibility tests
LTC accounting and its impact on data reporting (Source: OECD 2012)
Issues for clarification
(Vir: OECD 2012)
INSTEAD OF CONCLUSION
• Successful interinstitutional work
• Identification of requests for data in the field
of LTC (national and international)
• Identification of competences between the
institutions to provide data
• Improving data collections (for example age
groups)
• Need for further interinstitutional
collaboration
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