Catastrophic expenditures and impoverishment linked to out-of-pocket payments for long-term care services at home in Europe

Overview

In many countries in Europe individuals are frequently required to pay out of pocket (OOP) for long-term care (LTC) services received at home. OOP payments are contributions to the cost of care, whether made as copayments for using publicly subsidized services or as payments for privately provided services. This study of catastrophic expenditures in 14 countries in Europe found that in Denmark, Germany, Luxembourg, Sweden and Switzerland, around 25% to 30% of people aged 60 years and older who use LTC services at home are already poor before paying OOP for services – an indication that older adults using these services are less able to cope with even limited OOP payments. The study found that OOP payments may result in impoverishment or constitute a catastrophic expenditure for those using LTC services at home. In Greece, Italy and Spain, some 20% or more of those using these services at home experienced catastrophic spending after paying OOP for LTC services at home. In all countries, except the Netherlands and Spain, catastrophic expenditures are concentrated among poor households.