Organizing Eldercare
The Danish Case in a Comparative
Perspective
Morten Balle Hansen, Professor, PhD
Department of Political Science,
Aalborg University Denmark
mbh@dps.aau.dk
No. 1
Outline
1. Introduction
2. Some Global Trends
3. Global variation in organizing eldercare
4. The Danish (Nordic) Case
5. Key facts Danish Long Term Care
6. Discussion: Advantages and disadvantages Danish
system
No. 2
Some Global Trends
• From a purely demographical point of view, since the 1970s,
the need for elder service on a global scale has grown and will
continue to grow over the next decades
• The percentage of the world’s population which is 60 years
old or older has increased from 8 % in 1970 to 10% in 2000
and is expected to reach 15 % in 2025 and 22 % in 2050
(Mirkin & Weinberger 2001, 37-38)
• Claim: How a society choose to organize its eldercare
increasingly determines its success in the global economy
No. 3
Global variations in Organizing Eldercare I
Family and state
• Traditionally the family has taking care of the elderly
• In all countries the family and informal social networks continues to play a
significant role
• In many countries however – and increasingly in the past decades – the
state has taken over a lot of this responsibility – especially in the Northern
part of Europe
• This is also shown in judicial terms:
• In the Nordic countries and the Netherlands the state is legally
responsible for taking care of the elderly
• In the southern part of Europe the family (defined in various ways) is
legally responsible
• The change tends to covary with women participation rates in the labor
market
No. 4
Global variations in Organizing Eldercare II
Financing eldercare: Who pays?
• Taxes (Denmark)
• Taxes and user payment: (Other Nordic countries, Austria,
etc.)
• Insurance (public) and user payment: (Netherlands, Germany,
etc.)
• Either taxes (low income groups) or private insurance (high
income groups) and user payment: (France, USA, etc.)
• Family or non-profit (e.g. church) charity organizations
No. 5
Global variations in Organizing Eldercare III
Organizing eldercare: Who controls and organizes the
eldercare?
• Public: Municipalities (Denmark, other Nordic countries, UK)
• Public: Local health boards (Ireland)
• Public: representatives for AWBZ (Netherlands)
• Public: other kinds of public sector organizing
• Public and private: (Belgium and France)
• Non-profit organizations or family: (Greece)
No. 6
Global variations in Organizing Eldercare IV
Supply: Who are the primary suppliers of eldercare?
• Public municipalities and some private and/or Non-profit
providers: (Denmark, other Nordic countries, UK)
• Non-profit providers and some private companies:
(Netherlands, Germany, Italy, etc.)
No. 7
Summing up on global (European)
variations as related to Denmark
Financing eldercare: Who pays?
• Denmark is unique in the sense that almost all costs are
financed by tax payers
Organizing eldercare: Who controls and organizes the
eldercare?
• Denmark, other Nordic countries and UK relies heavily on
local government administration to organize and control
Supply: Who are the primary suppliers of eldercare?
• Denmark, other Nordic countries and UK relies on local
government supply, but increasingly private providers as well
No. 8
The Danish Long-Term Care System
The Danish long-term care (LTC) system for the elderly and
people with disability, including home-help services, is a
universal system.
• The Danish Central government is responsible for
determining the overall principles underpinning the long-term
care system.
• Local authorities are responsible for the delivery of LTC
services, make and implement LTC policy and decide how
LTC resources are allocated
•
No. 9
Key facts Danish Long Term Care
• Approx. 16.1% of the Danish population is aged over 65 (OECD
average 15%) while 4.1% of the population is aged over 80 (OECD
average 4%)
• Denmark spent 2 % of its GDP on health related long term care
in 2007, of which 1,8% was publicly funded.
• Denmark spent 1,2% GDP on home long-term care and 0,8% on
institutional long-term care in 2007
• In 2007 there where 9.5 formal long-term care workers per 1000
population over the age of 65, above the average OECD of 6.1
workers
• In 2008, there were 14.5 long-term care beds per 1,000
population aged 65 years old and over, substantially lower than
OECD-average of 44.5 beds (OECD Health Data, 2010)
No. 10
Benefits and Eligibility Criteria
• The Danish LTC system provides comprehensive coverage for a wide-range of
social services, including home adaptation, assistive devices and home help
• One of the main aims of the social services for elderly and disabled people is
to ensure that they can manage in their own homes.
• In cases where elderly or disabled people cannot manage on their own, they
can move to residential care homes and sheltered homes
• Eligibility is based on a needs’ assessment performed by the local authority
• Eligible individuals may receive a cash benefit in order to employ necessary
assistance
• In order to qualify for this allowance, an individual must meet a given level of
need
No. 11
Discussion of the Danish system I
Advantages:
• Sons and daughters of elderly people are able to work full time
far away from their parents knowing that there is a reasonably
well functioning system to take care of them
• The municipalities has continuously taken professionally good
care of improving the LTC system – both in terms of efficiency
– delivering value for money – and in terms of quality –
improving the quality of eldercare
• Equality: All elderly, no matter of previous income in work life,
are given a relatively high quality of eldercare
• Public debate: Since we are all dependent of this system, public
debate tend to focus on how a decent level a eldercare quality
looks like
No. 12
Discussion of the Danish system II
Disadvantages:
• The Danish Long Term Care system is very expensive and
imply a high administrative burden on taxpayers – Denmark
has for many years been in top 2-3 in terms of incom tax level
• The paternalistic features of the system, defining one societal
acceptable standard of eldercare for all elderly, could be seen
as too collectivistic and against a more individual approach to
life as elder citizens
• Since the elderly has increasing electoral power, the system
may tend to enhance too much money spend on the elderly
compared to other groups in society
No. 13