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2022 Conference Presentation

8 September 2022

Financing long-term care in Europe: reflections on age-related differences in preferences and expectations for LTC financing models

Cassandra Simmons , European Centre for Social Welfare Policy & Research , Austria

Stefania Ilinca, European Centre for Social Welfare Policy & Research, WHO Regional Office for Europe
Selma Kadi, European Centre for Social Welfare Policy & Research, WHO Regional Office for Europe
Adelina Comas-Herrera, Care Policy and Evaluation Centre, London School of Economics and Political Science


Introduction: Demographic and social change alongside mounting pressure on working age individuals to finance current long-term care (LTC) systems have raised the issue of intergenerational equity and how LTC systems should sustainably be financed in the future.

Objectives: The aims of this paper are twofold: 1) to explore whether there are age-related differences in the expectations and preferences for LTC financing design in European countries; and 2) to discern whether these preferences have changed over time.

Material & Methods: Based on data collected online as part of the InCARE survey (September 2021 to March 2022) on attitudes, expectations and experiences with LTC, we investigate how expectations and preferences for LTC financing arrangements vary across age groups (18-29, 30-59, 60-90) in Europe using bivariate and multivariate analysis. We further compare InCARE survey data to the 2007 Eurobarometer 67.3 (from which the InCARE survey was modelled), to discern whether preferences for LTC financing have changed over time across age groups.

Results: The findings suggest that support for LTC insurance schemes remains high across all age groups, while support for the use of assets to pay for care is low, particularly among younger individuals. The expectation that children should hold some financial responsibility for their parents’ care if necessary has decreased collectively across age groups over time. While most individuals expect to afford care through a combination of self and public-financing, views regarding the ideal cost-sharing arrangement between the state and care users diverge by age. Younger individuals are more likely to support cost arrangements covered entirely by the state, while support for means-tested cost-sharing arrangements is highest among the oldest age group.

Conclusions: These findings make the case for considering public attitudes in the design of LTC financing systems and emphasize the need to consider shifting preferences within the broader conversation on LTC system financing and sustainability. Despite concerns surrounding intergenerational equity of LTC financing, these findings suggest that younger adults subscribe to the concept of intergenerational solidarity, both in terms of filial responsibilities and the allocation of public resources, more so than older adults who have higher support for ability-to-pay approaches.

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