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

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

Almost 20% of the Catalan population is aged 65 years or older (Departament de Drets Socials, 2023). 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 aging, around 66% of the Catalan elderly do not self-rate their health as good or very good, and 50% report limitations in carrying out daily activities as of 2021 (OECD, 2024).

In this context, the Long-Term Care (LTC) system—representing the fourth pillar of the welfare state—is being consolidated after more than 15 years of implementation. 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 evaluations. Using administrative records of the Catalan LTC system, we have learned about the equity and impact of LTC benefits on the health of LTC beneficiaries.

In terms of horizontal inequity, cash subsidies provided to compensate informal care costs are disproportionately distributed to the financially better-off, while the use of care services is concentrated among the worse-off. Additionally, we identify inequity in the form of provision. With respect to the effects of LTC on the use of healthcare, receiving LTC benefits is estimated to reduce unscheduled primary care visits by 44% and has no significant effect on scheduled visits. It also reduces the probability of avoidable hospital admissions by 66%. When comparing home-care settings with institutional care, no significant differences are found in the probability of hospitalization.