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How is formal long-term care organized – an European overview?

2012 Conference Presentation

(Inter)national systems EU

7 September 2012

How is formal long-term care organized – an European overview?

Markus Kraus, Institute for Advanced Studies, Vienna, Austria
Monika Riedel, Institute for Advanced Studies, Vienna, Austria


We investigate the organization and provision of long-term care for the elderly population in 21 member states of the European Union, thus including both old as well as new member states.

This investigation is based on a new collection of data on the provision of long-term care. We highlight several aspects of regulating long-term care systems, e.g. (1) which level of government is responsible for decision making and regulation for capacity-planning, (2) is quality assurance binding and (3) key stakeholders’ influence on the system. Furthermore, we analyzed how access to services is organized. We also elaborate on public and private provision of services, and on the possibility of persons in need of care to choose between different care providers or different settings of care.

Our investigation shows that in about half of the 21 countries analyzed the main responsibility for regulating LTC resides at the national level, while in the other half this responsibility usually is shared between central authorities and those at a lower level. This is true for institutional and home-based care. Furthermore, our findings show that the majority of the countries handle capacity-planning on both the centralized and decentralized levels. Only a few countries strictly delegate capacity-planning to the centralized level. We found quality assurance to be mandatory in institutional as well as in home-based care in all old EU member states in our sample, except in Austria and Finland. We further found that two of three LTC systems provide access to publicly financed LTC services without a means test. The use of meanstesting clusters neither geographically nor along the lines of traditional welfare models. Almost all European countries provide legal entitlement to LTC services. Notable exemptions are Austria, England and Romania.

Additionally, our investigation indicates that countries within our sample answer the question for the optimal (or at least, for the feasible) public-private mix in the provision of long-term care services quite differently. The Netherlands hold the most extreme position with virtually all long-term care services being provided by private enterprises. Also the German market for longterm care services is dominated by private enterprises in both settings of care, institutional and home-based. In general, private provision plays a larger role in the provision of home-based care than in institutional care. This especially seems to be true for new EU member states, most notably for Slovakia.

In our study we further analyzed the freedom of choice with focus on the choice between public and private providers as well as on the choice between benefits in cash and in kind. In almost all countries of our sample care recipients can choose their providers freely and in nine out of 21 countries both benefits in cash and in kind are available in institutional care, while in the other countries institutional care is provided in kind only.