Μακροχρόνια φροντίδα σε γηράσκουσες κοινωνίες : διερεύνηση της ζήτησης, προσφοράς και μεθόδων χρηματοδότησης
Long-term care in aging societies : exploring demand, supply and modes of finance
Βάλβης, Ζαφείριος - Δημήτριος
Valvis, Zafiris - Dimitris
KeywordsΜακροχρόνια φροντίδα ; Γήρανση ; Οικονομικές προβολές ; Μέγεθος πληθυσμού σε ανάγκη φροντίδας ; Συγκριτική ανάλυση ευρωπαϊκών χωρών ; Ερμηνευτικές μεταβλητές δεικτών μακροχρόνιας φροντίδας ; Δημόσιες πολιτικές
The current thesis is divided into four parts. In the first part, and in particular in chapter 1, the conceptual framework of the thematic field Long-term Care of the older adults is set, 'long-term care' is defined and organizational models, public policies of European countries and demographic data are presented with the aim of understanding the wider context in which the subject of this work is included, not only at a scientific level but also at a social and public policy level. Chapter 2 presents the methodological approach, in particular the data, the definitions and the measurements used, as well as the methodology followed. Data from the Survey of Health, Aging and Retirement in Europe (SHARE) were used for 17 European countries (Sweden, Denmark, Germany, Austria, France, Belgium, Luxembourg, Switzerland, Italy, Spain, Greece, Portugal, Czech Republic, Poland, Slovenia , Estonia, Croatia) and Israel. A descriptive statistical analysis of four long-term care indicators is performed for a 95% confidence interval, with the results weighted to the total population of each country and displayed in bar diagrams, Venn diagrams and scatter plots. Probit regression analyzes are then carried out in order to determine the degree of influence of selected independent variables on the probability of someone being in need of care, on the probability of receiving no care at all, on the probability of receiving only professional care, as well as on the probability that the care provided covers the needs. In the second part, a comparative analysis is carried out between the 18 countries. The analysis focuses on four main statistical indicators: i) the Care need indicator, ii) the Care gap indicator, iii) the Care mix indicator and iv) the Care satisfaction indicator. The second Part is developed in four distinct Chapters. In the first of these (chapter 3) a new categorization of levels of care needs is proposed, as a lack of a uniform approach at the European level was found. In chapter 4, a comparative analysis of the above four indicators is made for all people aged 65+ who need personal care (difficulty with at least one basic activity of daily living, ADL) per country. The fifth chapter examines the above four indicators taking into account also those who need care/assistance only with functional activities of daily living (iADL), while chapter 6 examines whether formal and informal care work as complements or substitutes. The third Part focuses on what is happening in Greece. First, the methodological approach is presented (chapter 7) and further data from the SHARE survey are analyzed on who provides long-term care for the elderly in Greece. Then, the role of informal-non-professional care in relation to professional care, as well as the correlation of care receipt with parameters such as household composition, financial wealth, age or having children are analyzed (Chapters 8 and 9). Then, the various forms of long-term care services provision that exist in Greece and their financing are presented, while unpublished administrative data, collected in the context of this thesis regarding the number of older adults who receive care services from organized structures (public or private) and the related public expenditures, are also presented. Also we present the results of the primary research carried out by the author of the current thesis to a specialized audience (focus group) in the context of the project entitled "Social Protection Innovative Investment in Long-Term Care (SPRINT)" financed by Horizon 2020 under the auspices of the Center of Research at the University of Piraeus (Chapter 10). The third Part concludes by projecting needs for home long-term care services for older adults by the year 2070 (Chapter 11) based on the demographic and macroeconomic assumptions of the Aging Working Group (AWG) Reports. Finally, in the fourth Part the overall conclusions and key findings of the previous chapters are presented (Chapter 12) and five axes for long-term care policies are proposed (Chapter 13), combining the quantitative findings of the previous chapters with the qualitative findings of the "focus group" research on a specialized audience and also taking into account the practices of other countries. The five proposed policy design axes for long-term care for older adults are: i) Creation of an integrated institutional framework that systematizes different levels and types of services provided based on the severity of needs and sets clear criteria for beneficiaries of public long-term care services, ii) Governance System - Systematic and structured recording and quality monitoring of services provided, iii) Strengthening and systematizing financing of public long-term care programs, iv) Incentives for the development of private long-term care insurance, for the development of private long-term care services and for the fight against undeclared work and v) Informal carers/family support. The aim of this thesis is to be an instrument for planning public policies and services for the long-term care of older adults.