European Commission's agenda on long-term care and healthy ageing

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1 European Commission's agenda on long-term care and healthy ageing AIM seminar on LTC and healthy ageing 24 June 2015, Liège Sven Matzke Team Leader: Health and long-term care DG Employment, Social Affairs and Inclusion Unit D.3: Social Protection Social Europe

2 How EU supports Member States EU law: coordination of social security Economic governance - European Semester European Structural and Investment Funds Policy coordination: Open Method of Coordination Mutual learning: European Innovation Partnership on Active and Healthy Ageing Research: Horizon 2020, EaSI, Health Programme, Joint Programming Initiatives (Alzheimer, more years better life) 2 Social Europe

3 Ageing Report Social Europe

4 The European Semester Health CSRs LTC CSRs LTC CSRs for AT, DE, NL and LU were dropped. AT: Strengthen measures to increase the labour market participation of older workers and women, including by improving the provision of childcare and LTC services. SI: By end of 2015 adopt a healthcare and long-term care reform. 4 Social Europe

5 Open Method of Coordination Common objectives for long-term care: Guarantee access for all to adequate long-term care and ensure that the need for care does not lead to poverty and financial dependency Promote quality in LTC, notably by establishing quality standards Ensure that adequate and high-quality LTC remains sustainable Related activities with the Social Protection Committee: Reporting and mutual learning (peer reviews) Agree on common indicators 5 Social Europe

6 Challenges faced by LTC systems Growing demand for LTC (almost tripling of people aged 80+) A dwindling supply of potential carers The quality challenge The financing challenge How to close the gap between the need for and the supply of LTC? Social Europe 6

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8 Country profiles of EU Member States Proposals for future actions Key messages adopted by EPSCO Council in June 2014 o o o 2014 Joint SPC/EC Report There are solid equity and efficiency reasons for MSs to establish adequate social protection for LTC needs There is a need to clarify the common objective of adequate social protection against LTC dependency MSs should move from a reactive to increasingly proactive policy approaches Social Europe 8

9 From reactive to proactive strategies Preventing people from becoming dependent Early detection of frailty Strengthening rehabilitation and re-enablement Promote independent living through age-friendly environments and use of technology Raise the efficiency of care services Better integrate health and social care services Enhance the support to informal carers and sustain the LTC workforce 9 Social Europe

10 The EIP on Active and Healthy Ageing approach +2 Healthy Life Years by 2020 Triple win for Europe - A stakeholder-led, cross sectorial, collaboration initiative for research, innovation & intervention. - Launched 2012 as part of Europe 2020 Strategy. health & quality of life of European citizens Sustainable & efficient care systems growth & expansion of EU ( industry - Reach a critical mass for action by pooling EU resources/ expertise & recognising innovation/ excellence. SIX AREAS OF INTERVENTION A1. Adherence to treatment A2. Preventing falls A3. Frailty & cognitive decline B3. Integrated care C2. Independent Living D4. Age-friendly environments TWO STREAMS FOR ACTION Action Groups Reference Sites

11 Building up EIP AHA scale and critical mass 1,000 regions & municipalities > 500 commitments 1 billion euro mobilised 3,000 partners & 300 leading organisations 30 mio citizens, >2 mio patients Marketplace >72,500 visits >1,240 registered users 11

12 The EIP on AHA results and follow-up Evidence Priorities for EU funding Framework conditions Scaling-up strategy c c EIPonAHA achievements: Good practices Commitments Collaborative work Health programme Horizon 2020 IMI Joint Action on Frailty Preparatory action on healthy diets Better interoperability of ICT services and systems Public Innovation procurement Scaling up local successes to other regions or Member States European Scaling-up strategy set up by the EC and the EIPonAHA partners

13 Network on quality and cost-effectiveness in LTC and dependency prevention Network should gather evidence on cost-effectiveness of measures in the areas of prevention, rehabilitation, measures promoting independent living and care delivery. The deliverables of the network could take the form of guidelines, manuals or toolkits targeted to policy makers. Commission provides a grant of a maximum of Action should start around Sept/Oct 2015 Social Europe 13

14 Towards a definition of adequate social protection against LTC needs LTC clearly a major social risk - Costs can be much higher than for health care Yet, very different approach than to health care - Few universal systems, benefits often means-tested, strong reliance on families and informal carers Or should social protection against LTC needs be rather modelled on child care? - Families as primary providers, state only intervenes when families fail; some support for reconciliation and compensation for carers lost earnings (and pension rights) 14 Social Europe

15 Open questions What is the right model for social protection against LTC needs? Respective roles of individuals (as potential users of LTC), families and the state To what extent should we expect individuals to use their own income and assets to pay for LTC? Need to protect partners, but heirs? Which services and in which quality should be guaranteed? Regardless of who (individuals, families, state) has the primary responsibility for LTC Social Europe 15

16 Addressing the lack of evidence Lack of comparable data allowing for assessment across EU LTC needs Extent of social protection Social, employment and economic impact of LTC needs Quality of LTC Cost-effectiveness of different approaches to LTC needs Difficult to develop common indicators at this stage Work on better evidence in progress Improvements in EU surveys Specific research, notably on cost-effectiveness Joint project with OECD on typical cases Social Europe 16

17 We need to consider the breadth and depth of coverage Not covered: individuals meet part of the cost Depth What % of the cost is covered? Costs covered by system Not covered: ineligible people and services outside the scope of the system Breadth What services / needs are included? Who is eligible?

18 Defining equivalent means is easy enough, but needs are more difficult Universal entitlement with fixed levels of benefit e.g. Germany Fully means-tested safety net system e.g. United Kingdom 20 th percentile Median 80 th percentile Define typical cases to map levels of need between systems

19 The cost of packages of care The cost of services for different levels of need, as a proportion of GDP per head Home care services are expensive (relative to GDP) in the Netherlands and Slovenia Residential care is expensive in Finland and the Netherlands Home care services are cheap in the Czech Republic How can we explain these differences, and are they plausible?

20 More expensive means less affordable to older people with care needs Cost of care as a proportion of disposable income for older people Median income Home care services very unaffordable in Slovenia, but residential care is relatively cheap does this look right? Services also unaffordable in the Netherlands. Residential care unaffordable in Finland and Netherlands.

21 More expensive means less affordable to older people with care needs Cost of care as a proportion of disposable income for older people Low income Home care services very unaffordable in Slovenia, but residential care is relatively cheap does this look right? Services also unaffordable in the Netherlands. Residential care unaffordable in Finland and Netherlands.

22 Coverage ratios The proportion of the cost of care covered by collective schemes Median income

23 Out-of-pocket costs relative to income Before social protection Median income

24 Out-of-pocket costs relative to income After social protection Median income

25 Out-of pocket costs as a % of disposable income in the Netherlands Before social protection After social protection (low assets) Netherlands key facts Public spending on LTC = 3.5% of GDP This is one of the highest levels of spending in the world Public coverage via universal LTC insurance High levels of qualifications of staff e.g. geriatricians based in many care homes After social protection (high assets)

26 Out-of pocket costs as a % of disposable income in Slovenia Before social protection After social protection Slovenia key facts Public spending on LTC = 0.8% of GDP

27 THANK YOU FOR YOUR ATTENTION 27 Social Europe