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2012 Conference Presentation

(Inter)national systems GermanyPolandSpainThe Netherlands

7 September 2012

Long-term care systems and horizontal and vertical equity: Germany, the Netherlands, Spain and Poland

Adelina Comas-Herera, London School of Economics, United Kingdom


This paper examines the different features that form long-term care systems and discusses how they can be expected to perform in terms of horizontal and vertical equity.

The approach used involves looking both at how resources are raised to fund care and how they are allocated. The care systems of Germany, the Netherlands, Spain and Poland (chosen as representatives of the clusters identified by the ANCIEN project) are examined to see how the presence and relative importance of the different features of the care system are likely to affect the overall equity of the system.

Of the four countries, the Netherlands performs highly in terms of equity, both horizontal and vertical. Germany’s system performs well on horizontal equity but less so on vertical equity. The Spanish system has recently introduced new features that can potentially increase the equity of the system, but in practice this is hampered by regional variations and rationing. The Polish system is characterised by a small formal care sector and universal care-related cash benefits to everyone over 75 which does not perform well in terms of vertical equity.


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