Article: Unequal but equitable: an analysis of variations in old-age care in Sweden

This study aimed to investigate whether contraction in services has led to inequitable service levels or simply large local variations. Previous attempts to explain service variations with aggregate, municipal level data have failed. We link representative Swedish data from 3,267 individuals aged 65 and older in 2002-2003 with coverage rates of public Home Help services in the 288 municipalities in which they reside. What past attempts have masked is that needs also vary substantially between municipalities; needs being defined as old people who live alone need help with their activities of daily living (ADL). Once these local individual level variations are incorporated, municipal differences in public Home Help coverage largely vanish. Multivariate analyses confirm that advanced age, inability to perform ADL and solitary living are the major determinants of Home Help use. Variations in local supply have no association with individual use of public Home Help. These services are unequal but hence yet deemed to be reasonably equitable.

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References

1.

Berg S, Branch L, Doyle A, Sundstrom G . Local variations in old age care in the welfare state: the case of Sweden. Health Policy. 1993; 24(2):175-86. DOI: 10.1016/0168-8510(93)90033-l. View

2.

Davey A, Femia E, Shea D, Zarit S, Sundstrom G, Berg S . How many elders receive assistance? A cross-national comparison. J Aging Health. 2000; 11(2):199-220. DOI: 10.1177/089826439901100204. View

3.

Muramatsu N, Campbell R . State expenditures on home and community based services and use of formal and informal personal assistance: a multilevel analysis. J Health Soc Behav. 2002; 43(1):107-24. View

4.

Sundstrom G, Johansson L, Hassing L . The shifting balance of long-term care in Sweden. Gerontologist. 2002; 42(3):350-5. DOI: 10.1093/geront/42.3.350. View

5.

Egleston B, Rudberg M, Brody J . Prior living arrangements and nursing home resident admission ADL characteristics: a study of two states. J Gerontol B Psychol Sci Soc Sci. 2002; 54(4):S202-6. DOI: 10.1093/geronb/54b.4.s202. View

6.

Shea D, Davey A, Femia E, Zarit S, Sundstrom G, Berg S . Exploring assistance in Sweden and the United States. Gerontologist. 2003; 43(5):712-21. DOI: 10.1093/geront/43.5.712. View

7.

Meinow B, Kareholt I, Lagergren M . According to need? Predicting the amount of municipal home help allocated to elderly recipients in an urban area of Sweden. Health Soc Care Community. 2005; 13(4):366-77. DOI: 10.1111/j.1365-2524.2005.00570.x. View

8.

Young H, Grundy E, Kalogirou S . Who cares? Geographic variation in unpaid caregiving in England and Wales: evidence from the 2001 census. Popul Trends. 2005; (120):23-34. View

9.

Li L . Longitudinal changes in the amount of informal care among publicly paid home care recipients. Gerontologist. 2005; 45(4):465-73. DOI: 10.1093/geront/45.4.465. View

10.

Davey A, Femia E, Zarit S, Shea D, Sundstrom G, Berg S . Life on the edge: patterns of formal and informal help to older adults in the United States and Sweden. J Gerontol B Psychol Sci Soc Sci. 2005; 60(5):S281-8. PMC: 2925266. DOI: 10.1093/geronb/60.5.s281. View

11.

Johansson L, Sundstrom G . Policies and practices in support of family caregivers - filial obligations redefined in Sweden. J Aging Soc Policy. 2006; 18(3-4):7-26. DOI: 10.1300/J031v18n03_02. View

12.

Daatland S, Lowenstein A . Intergenerational solidarity and the family-welfare state balance. Eur J Ageing. 2017; 2(3):174-182. PMC: 5546341. DOI: 10.1007/s10433-005-0001-1. View

Unequal but Equitable: an Analysis of Variations in Old-age Care in Sweden