Who gets what and how much care in old age in Europe’s welfare states? A cross-national analysis of the impact of social inequality on long-term care reception
Erwin Stoltz | University of Salzburg, University of Graz
In comparison to other acknowledged social risks, care dependency in old age is less cushioned by public social protection and can be associated with substantial costs for clients and their family members. Despite these characteristics and the fact that public care provision varies enormously across Europe, the link between social policies, social inequality and care outcomes is underresearched. This paper circles around the question (1) whether there is a social gradient (by education, income or familial social capital) concerning both the amount and type of long-term care elderly receive in Europe and, (2) whether this social gradient varies between different welfare state policies concerning long-term care. To answer this question, we first analyse 15 European LTC-systems on the country-level, differentiated by the level of necessary resource-input in order to obtain suitable long-term care. Additionally, we derive five types of LTC systems via robust hierarchal and k-means cluster analysis. We then use this macro-level information on both the country level and the level of country-clusters alongside micro-level data from the Survey of Health, Ageing and Retirement (SHARE). We first compare the results of simple logistic regression analysis across the five different country clusters and use, secondly, a hierarchical-logisticregression framework with both restricted maximum likelihood and MCMC estimators in order to receive valid results with varying intercepts and slopes for each country. Results show substantially different social gradients in care reception due to contextual effects of welfare state structures for different kinds of social resources. It shows, for example, that both economic and educational resource-dependency in obtaining formal care is highest in Southern and Central Eastern European countries. Policy implications of this cross-national comparative study include lessons about how vertical and horizontal differentiation in care reception are linked to specific social policies and how changed public welfare characteristics can decrease the level of social inequality in the area of long-term care.