Catalan Long-Term Care system reaches the majority of age: What have we learned?

Abstract

Almost 20% of the Catalan population is aged 65 years or older. By 2050, this percentage is estimated to reach 29%. In addition, this population cohort is associated with the longest life expectancy among OECD countries, yet only half of the total life expectancy at 65 is expected to be healthy life expectancy (OECD, 2024). Far from healthy ageing, in 2021, around 66% of the Spanish elderly do not self-rate their health as good or very good, and 49% report limitations in carrying out activities of daily living. In this context, the Long-Term Care (LTC) system—representing the fourth pillar of the welfare state—is being consolidated, reaching the majority of age. The first goal of this communication is to present the main features of the system and compare and contrast it with European counterparts. Secondly, we aim to provide the main insights learned from a diverse range of system’s analyses. With respect to the financial sustainability of the Spanish LTCS, underfunding and suboptimal design has increased the burden on families through higher co-payments. Despite this limited capacity, it has been remarked on the significant economic impact through job creation. Regarding the effects of Spanish LTCS on beneficiaries and their families, the introduction of Spanish LTC has reduced hospitalizations, primarily driven by conditions that could be avoided if LTC is adequately provided. In addition, LTC benefits have reduced the level of savings, increased the supply of informal caregivers, caregivers’ wellbeing and the probability of early retirement among caregivers. Last but not least, research has also analysed the implementation and design of Spanish LTC. While navigating the system is not associated with socioeconomic horizontal inequity, access to different types of benefits (and their mode of provision) shows evidence of socioeconomic horizontal inequity. Furthermore, the COVID-19 pandemic has highlighted critical weaknesses in nursing home care, including underfunding and inadequate staffing, which have contributed to high fatality rates

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