Social protection for dependency in old age in the 15 EU Member States and Norway


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Synthesis Report commissioned by the European Commission and the Belgian Minister of Social Affairs
Social protection and social security



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Social protection for
dependency in old age
in the 15 EU Member States and Norway
Employment & social affairs
European Commission Social protection for dependency
in old age in the 15 EU Member States
and Norway
Synthesis report commissioned by the European Commission and the
Belgian Minister of Social Affairs
Jozef Pacolet - Ria Bouten - Hilde Lanoye - Katia Versieck
Higher Institute of Labour Studies - Catholic University of Leuven
Employment & social affairs
Social security and social integration
European Commission
Directorate-General for Employment, Industrial Relations
and Social Affairs
Manuscript completed in 1998 The information used in this comparative report is to a large extent based on national reports for which
the national contributors have the complete responsibility.
The comparisons, the analysis and the conclusions presented in this report remain the responsibility
of the authors of the Comparative Study. The research has been conducted by independent researchers
and does not engage the authorities that commissioned the project.
A great deal of additional information on the European Union is available on the Internet.
It can be accessed through the Europa server (
Cataloguing data can be found at the end of this publication.
Luxembourg: Office for Official Publications of the European Communities, 1999
ISBN 92-828-6428-6
© European Communities, 1999
Reproduction is authorised provided the source is acknowledged.
Printed in Italy
The publication of this report, which summarises a large comparative study on
social protection for dependent elderly persons in the European Union and Nor­
way, forms part of the European Cornmission's efforts to raise awareness and
stimulate the debate about the challenges that an ageing population will pose for
social protection systems in the field of long-term care.
The European Commission's Communication on Modernising and Improving Social
Protection in the European Union (COM(97)102) identified the need for Member
States to consider adapting their health and social care systems to meet the needs
of an ageing population. The fourth pillar of the Employment Guidelines emphasises
the need for adequate provision of good quality care for older people in order to
support the entry and continued participation of women and men in the labour
All Member States will have to face the challenge of providing an adequate, effi­
cient and cost- effective response to the rising demand for care services in the
context of demographic changes. Although responses will need to reflect differ­
ences in existing provisions and the specific intensity and timing of rising
demands, policy makers will have many problems in common. Closer collabora­
tion and the sharing of experiences at Community level can therefore help Mem­
ber States in their search for adequate ways of addressing the long-term care
This report provides us with the first analytical overview of the layout of existing
dependency provisions and of recent policy debates about how to secure ample
protection for the frail among the elderly and I hope it will stimulate a policy
debate at European level on long-term care for the elderly during this, the 1999
United Nations Year for Older Persons, and coming years.
Allan Larsson
Director General DG V Table of contents
List of figures
List of tables 11
Introduction and acknowledgements 13
17 Summary
Chapter 1/ Methodology of international comparison of social protection
of dependent older persons 31
1. Research methodology 31
1.1 International overview
1.2 Typology of the elderly population2
1.3 Casestudies
2. Definition of dependency and the need for social protection 33
2.1 Definition ofy
2.2 Risks7
2.3 Some theoretical concepts relating to the organisation of the care 38
3. Some macro-assessment of the risk 39
Chapter 2/ Number of dependent older persons 41 Table of contents
Chapter 3/ Some macro-observations regarding social protection of
dependent older persons 49
1. Income protection 50
2. Other elements of income support: cash benefits and allowances 52
3. HealthCare8
4. Summary of the macro-characteristics of the social protection systems 59
Chapter 4/ The variety, scope and coverage of health and social services
for the elderly: the welfare pluralism 67
1. Variety 6
2. Availability 73
3. Affordability8
4. The fading borderline between housing provision and services 82
4.1 Elements of social protection and the special situation of housing
costs 8
4.2 Adapted housing and support services for the elderly 8
4.3 Relation with services for the elderly 86
4.4 Unbundling of housing and care in theory and integrated services
in practice7
4.5 Housing and care: one continuum8
4.6g as a means of financing care9
Chapter 5/ Differences in treatment of similar categories of need 91
1. Methodology 9
1.1 Physical dimension2
1.2 Mentaln
1.3 Economic dimension
1.4 Socialn and living situation 93
1.5 Age
1.6 Gender4
2. Cross-country comparisons: differences and similarities in
social protection 9
2.1 Differences and similarities in average costs and financing of care 9
2.1.1 Old age homes and nursing homes 95 Table of contents 7
2.1.2 General hospitals 98
2.1.3 District nursing, general practitioners and pharmaceuticals 99
2.1.4 Home help 100
2.1.5 Meals-on-wheels1
2.2 Differences and similarities in the organisation of care 102
2.2.1 Formal versus informal care
2.2.2 In kinds in cash care3
2.2.3 Universal systems versus selective systems4
Chapter 6/ Debate on long-term care insurance 105
1. Present situation of social protection of the elderly and discussion
for change: an overview of the main characteristics of each country 10
2. Main characteristics of the political discussion on present and future
old age protection. Context of changing welfare states 108
3. Changing needs 109
4. Covered costs 11
5. Institutional arrangements for long-term (old age) care within
(or beyond?) the existing systems of social protection 120
6. Common tendencies in the European project8
Chapter 7/ Some theoretical and policy conclusions 131
1. The place of social insurance 13
2. The social protection systems have reached maturity3
3. Conclusions for the EU project5
Annexes 141
Annex 1 / List of institutions of national correspondents responsible
for national reports3
Annex 2 / List of invited experts for consultation on the project 14
Annex 3 / Availability and relative importance of a selected list of
services for the elderly 147 Table of contents
Bibliography 153
Publications - Social Protection for Dependency in Old Age in the EU
and Norway7
I. National reports
II. European comparative report9
III. European synthesis report 15