Which European model for elderly care? Equity and cost-effectiveness in home based care in three European countries

Long term care for the elderly is growing apace in developed economies. As growth is forcing change in existing production and delivery systems of elderly care services, the question arises as to how different systems compare in terms of cost-effectiveness, equity or quality. Based on an in depth survey carried out in Denmark, Ireland and Italy – the GALCA survey - this articles compares prevailing arrangements of home based long-term care in these three countries, focussing on the overall cost-effectiveness of the provisions as well as on employment equity for the care workers. The first set of comparisons is between alternative types of provisions within each country, and the results suggests that home based care is generally, although not consistently, more cost-effective than care within institutions. The second set of comparisons is between the average provision package in the different countries and suggests that, whereas the Italian and the Danish systems are the most cost effective, the Danish system is more equitable, overall. The results for cost-effectiveness for Italy are partly explained by progressive replacement of unpaid family carers with low cost immigrant workers directly employed by the families and often cohabiting with the elderly (the immigrant-in the family-model). This new model of long term care is spreading across Southern Europe and raises complex issues of equity and sustainability from an employment perspective.