Yuki Murakami (OESO) - De meerwaarde van ouderenzorg in België: een profielschets in Europees perspectief

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  • Low care needs 43 hours /month

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  • 1. Yuki Murakami (OESO) De meerwaarde van ouderenzorg in België: een profielschets in Europees perspectief
  • 2. LONG-TERM CARE FOR OLDER PEOPLE Conference Voka Health Community 30th September, 2013 Yuki MURAKAMI OECD ECONOMIC VALUE AND EFFICIENCY
  • 3. • Disability numbers mainly predicted by demographic ageing, not risk factors • How LTC is organised in OECD? • How will this impact on choice of care settings, unit labour cost and hence expenditure? • What options are there to gain efficiency? Topics of discussions
  • 4. Steep rise in the share of over 80 years old 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 EU-27 Japan OECD Key Emerging Countries1 World 1. Emerging economies include Brazil, China, India, Indonesia and South Africa. Source: OECD Historical Population Data and Projections Database, 2013.
  • 5. Pop over 80 years + in Belgium will be double by 2050 Source: OECD Historical Population Data and Projections Database, 2013. 0 5 10 15 20 Turkey South Africa India Indonesia Mexico Israel Russian Fed. Brazil Estonia Chile Hungary China United States Australia Ireland Slovak Rep. Luxembourg Iceland Norway Denmark Poland Belgium Sweden Canada OECD33 United Kingdom Czech Rep. Greece New Zealand Slovenia Portugal France Finland Netherlands Austria Switzerland Italy Korea Germany Spain Japan % 2010 2050
  • 6. Old-age dependency ratio is increasing 0% 5% 10% 15% 20% 25% 30% OECD EU (27) world Source: OECD Labour Force and Demographic Database, 2010. World population projection estimates based on UN World Population Prospects, 1950-2050 (2006 Revision)
  • 7. Limitations of daily activities increase with age Limitations in daily activities, population 65-74 and 75 years and over, 2011 Norway Sweden Denmark Iceland Luxembourg Switzerland Ireland United Kingdom Czech Rep. France Belgium Netherlands Spain Greece OECD (25) Finland Austria Poland Italy Turkey Germany Hungary Portugal Slovenia Estonia Slovak Rep. Source: Eurostat Database 2013. 0 20 40 60 80 Limited to some extent Limited strongly % of population aged 75 years and over 020406080 Limited to some extent Limited strongly % of population aged 65-74 years
  • 8. What do these demographic trends mean? • Not uniform sign of disability compression • Multiple co-morbidities • Preference for home and independent living • Demand for responsive, patient-centred services • Diverse user groups with different needs (e.g., Alzheimer; young disabled) Demand for more and better formal care Pressure on LTC workforce and financing • LTC workers will account for a larger share of a shrinking workforce • Pressure on financing of the welfare state especially if levies on labour income • Economic and financial crisis
  • 9. 0 4 8 12 16 20 24 28 32 36 Social protection Health Education Economic affairs General public services (excluding interest) Interest* Public order and safety Defence Recreation; culture and religion Housing and community amenities Environment protection 2007 2010 Source: OECD Fiscal Consolidation Survey 2012. Health and LTC: the 2nd largest area of government spending Structure of general government expenditures, 2007 & 2010 (% of total expenditures)
  • 10. Source: OECD calculations and 2009 Ageing Report, European Union, LTC expenditure is projected to at least double by 2050 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0% 9.0% 10.0% United States Germany EU-OECD Belgium Japan Norway Netherlands Public LTC Expenditure as a Share of GDP 2007 2050 (Low) 2050 (High)
  • 11. Belgium’s public LTC spending higher than OECD average Note: The OECD average only includes the 11 countries that report health and social LTC. Source: OECD Health Statistics 2013 0.0 3.7 3.6 2.4 2.4 2.1 2.0 1.8 1.8 1.7 1.6 1.5 1.4 1.3 1.2 1.2 1.0 1.0 0.7 0.6 0.6 0.5 0.4 0.3 0.2 0.2 0.2 0 1 2 3 4 Total Social LTC% of GDP
  • 12. -1.1% -1.1% 2.2% 2.4% 2.6% 3.1% 3.1% 3.1% 3.8% 3.8% 4.5% 4.6% 4.7% 4.8% 4.8% 5.1% 5.4% 5.5% 6.8% 6.9% 9.1% 12.5% 14.4% 43.9% -10% 0% 10% 20% 30% 40% 50% Hungary Iceland Sweden Germany Denmark Netherlands Canada United States Finland Slovenia Switzerland Austria France Spain OECD22 New Zealand Poland Norway Belgium Czech Republic Estonia Japan Portugal Korea A Average annual growth rate 8.7 4.0 4.0 2.6 4.7 -4.0 4.9 3.9 4.1 8.1 11.6 6.0 1.7 1.7 3.2 3.1 -1.6 8.2 3.5 4.3 16.6 8.0 7.6 7.3 6.9 6.5 6.4 6.4 5.0 4.8 4.5 3.7 3.1 3.1 2.5 2.2 1.9 1.8 1.3 1.0 -10 0 10 20 Korea Estonia Spain Switzerland Japan France Finland Norway New Zealand OECD19 Belgium Poland Austria Germany Sweden Canada Denmark Hungary Czech Republic Netherlands Slovenia Average annual growth rate (%) Institution LTC Home LTC Annual growth rate in LTC public expenditure 2005-11 Annual growth rate of public LTC institution and home care expenditure 2005-2011 Source: OECD Health Statistics 2013, LTC spending growing more in home care
  • 13. OECD countries at different stages of developing of formal LTC workforce supply 1. In New Zealand, Sweden, Spain and the Slovak Republic, it is not possible to distinguish LTC workers in institutions and at home. Source: OECD Health Statistics 2013 12.2 6.5 9.6 6.5 0.7 6.4 5.7 4.5 3.6 0.6 1.5 3.9 4.4 4.3 2.7 1.5 0.9 3.0 2.8 2.5 1.6 1.4 1.6 1.6 1.1 5.6 2.3 4.4 9.3 2.9 2.5 2.8 3.2 5.9 4 1.4 1.3 1.7 2.2 0.8 1.0 0 2 4 6 8 10 12 14 Home Institutions% of population aged 65 years and over Institutions + Home
  • 14. Greater staffing challenges in home care? 2.0 4.7 4.7 5.2 8.0 12.9 14.5 19.6 33.1 39.2 2.0 3.4 1.3 2.2 1.3 1.2 2.3 2.4 1.8 9.2 2.2 0 5 10 15 20 25 30 35 40 Users per FTE home care Users per FTE institutional care Higher ratio of LTC users per Full-Time Equivalent (FTE) worker in home care than in institutions Source: OECD (2011), Help Wanted? Providing and Paying for Long-Term Care, based on OECD Health Data 2010
  • 15. Employment opportunities in LTC? 50 100 150 200 250 2000 2002 2004 2006 2008 2010 Japan Long-term care Total employment Index (2000=100) 90 100 110 120 130 140 150 2001 2003 2005 2007 2009 2011 Germany Long-term care Total employment Index (2001=100) 90 100 110 120 130 2000 2002 2004 2006 2008 2010 Denmark Long-term care Total employment Index (2000=100) 90 100 110 120 130 2003 2005 2007 2009 2011 Norway Long-term care Total employment Index (2003=100) Source: OECD Health Statistics 2013 Trends in long-term care employment and total employment, selected OECD countries, 2000-11 (or nearest year)
  • 16. Services related to activities of daily living (help with feeding, bathing, mobility) Universal coverage within a single programme: – Tax-funded Nordic system; – Social LTC insurance in Jap, Kor, NL, Lux, Ger); – as part of health system in Belgium MMeans-tested systems – (England social-care system; US: Medicaid) Mixed schemes: – Parallel universal benefits (Scotland, Italy) – Progressive universal benefits (Israel, France, Austria, Australia) – Mix universal & means- tested (NK, Canada, Greece)
  • 17.  Basing funding on a wider basis as employee contributions (Japan, Belgium, Luxembourg, Netherlands);  Better distribute the force between generations (the retired pay an LTC insurance premium in Germany and Japan);  Introduce elements of pre-financing: the creation of a financial reserve (eg, private insurance, Luxembourg);  Private insurance with automatic enrollment (Singapore). Financing Long-term care
  • 18. Long-term care insurance model in Japan • Universal care insurance • Who benefits? Elderly dependents over 65 years of age or over 40 years with a disease related to aging (eg, Alzheimer's) • Financing: 25% income tax and 25% local taxes, 50% dependence insurance contribution paid by people over 40 years • Local variation in individual contributions, because the costs of services vary between locations. • Individual participation in labor costs being modest increase • Control over payments to providers can keep costs even though Japan has a institutionalization rate high
  • 19. Accommodation costs and restore facility Funding through participation related to individual resources (Australia, Nordic countries, Ireland) Funding through social assistance, reserved for the poorest (Belgium, Germany, It aly)
  • 20. In all countries, a portion of the cost is borne by individuals • Maximum public contribution capped (eg, Germany, Austria (1), Italy), the public contribution may depend on resources (APA France, Austria (2), Australia); • "Stay-in-charge" leveled according to individual resources (EUR 180 per month in Sweden, 1 800 EUR Netherlands); • Co-payment based on the cost of services (Japan 10% Korea, 20% in institutions, 15% at home).
  • 21. Help users to mobilize their resources to pay part of the costs  Buying bonds or shares of accommodation and other devices interest-free loan (Australia) structures;  Public measures to defer payment of the stay in the institution (Ireland, United States, England)  Private products (reverse mortgage, associants devices and life insurance care insurance)
  • 22. • Policy on expenses related to the level of income and / or severity of dependence • Define the level of dependency trigger coverage as resources (Korea); Direct care benefits to those who need it most
  • 23. • Enlargement towards universal coverage (Korea, Spain, Czech Republic); • ... But better targeted support to the most significant risks (Austria, Czech Republic, Sweden, the Netherlands); • Innovative solutions: – Public-private partnerships (United States - Medicaid, under discussion in England); – Voluntary insurance + automatic subscription (Singapore). • Reforms based on user choice: – Cash benefits (United States and several European countries); – "Vouchers" / check (Nordic countries). Four directions of reforms
  • 24. Irrespective of financing model, moving towards universal LTC benefits is desirable on access and affordability grounds…
  • 25. … the cost associated with high-care need can account for more than 60% of seniors’ disposable income, including for those from relative high income deciles Low care needs High care needs Share of adjusted disposable income for individuals 65 years and over in different income deciles, mid-2000s Source: OECD Secretariat calculation based on the OECD Income Distribution and Poverty Database (www.oecd.org/els/social/inequality).
  • 26. Quo vadis, long-term care? The only way to square the circle of higher demand, higher use, higher expectations and higher cost is by improving value for money. Three avenues to explore: – Allocative efficiency: optimising care settings, care coordination across pathways – Behavioural efficiency: incentives for providers (e.g., payment; competition) and users (e.g., prevention) – Technical efficiency: assessing cost & benefits of technology to help managing work processes, reduce errors, improve productivity
  • 27. • OECD (2013), A Good Time in Old Age? Measuring and Ensuring Quality of Long-Term Care • OECD (2011), Help Wanted? Providing and Paying for Long-Term Care, Paris • OECD (2010), Value for Money in Health Spending • www.oecd.org/health/longtermcare Yuki Murakami: yuki.murakami@oecd.org Thank you!!