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This study examines the sensitivity of future long-term care demand and expenditure estimates to official demographic projections in four selected European countries: Germany, Spain, Italy and the United Kingdom. It uses standardised methodology in the form of a macro-simulation exercise and finds evidence for significant differences in assumptions about demographic change and its effect on the demand for long-term care, and on relative and absolute long-term care expenditure. It concludes that mortality-rate assumptions can have a considerable influence on welfare policy planning. Relative dispersion between country-specific and Eurostat official estimates was found to be higher for the United Kingdom and Germany than for Italy and Spain, suggesting that demographic projections had a greater influence in those countries.

This article examines the universalization of long-term services and supports (LTSS) in three countries that have reformed LTSS funding in the past ten to fifteen years--Scottish and Spanish reforms extending public insurance to everyone needing LTSS, and the Dutch reform, which rolled back Europe's older funding system. Although universal systems save health systems money and improve the financial well-being of families, attention should be paid to subsidy designs, the role of needs tests to modulate demand, and the development of home- and community-based services. [ABSTRACT FROM AUTHOR]

We use quasi-experimental evidence on the expansion of the public subsidization of long-term care to examine the causal effect of a change in caregiving affordability on the delivery of hospital care. More specifically, we examine a reform that both introduced a new caregiving allowance and expanded the availability of publicly funded home care services, on both hospital admissions (both on the internal and external margin) and length of stay. We find robust evidence of a reduction in both hospital admissions and utilization among both those receiving a caregiving allowance and, albeit less intensely, among beneficiaries of publicly funded home care, which amounts to 11% of total healthcare costs. These effects were stronger when regions had an operative regional health and social care coordination plan in place. Consistently, a subsequent reduction in the subsidy, five years after its implementation, is found to significantly attenuate such effects. We investigate a number of potential mechanisms, and show a number of falsification and robustness checks. [ABSTRACT FROM AUTHOR]

We study the effect of further public caregiving subsidies (and expansions of insurance to cover long-term care) on savings and saving behaviour. Specifically, we examine the unique progressive introduction of a universal public long-term care subsidy ( Sistema para la Autonomía y Atención a la Dependencia, SAAD) in Spain. We draw on a difference-in-difference (DID) strategy to show a contraction of savings after the policy intervention, but only among younger elders who receive primarily cash benefits (unconditional caregiving allowance) as opposed to home help (a contraction ranging between 13 per cent and 39 per cent of the subsidy amount). Reductions in savings by individuals in the second and third quintiles of the income distribution, those aged under 75, those without children and those residing in regions that implemented the reform earlier drive the effect. [ABSTRACT FROM AUTHOR]

We study whether caregiving and intergenerational transfer decisions are sensitive to changes in economic incentives following the inception of a new unconditional and universal system of allowances and supports, after the introduction of the 2006 Promotion of Personal Autonomy and Care for Dependent Persons Act (SAAD in Spanish), and the ensuing effects of its austerity cuts after 2012. We find that whilst the introduction of a caregiving allowance (of a maximum value of €530 in 2011) increased the supply of informal caregiving by 20-22 percentual points (pp), the inception of a companion system of publicly subsidised homecare supports did not modify the supply of care. Consistent with an exchange motive for intergenerational transfers, we estimate an average 17 pp (8.2-8.7pp) increase (decrease) in downstream (upstream) transfers among those receiving caregiving allowances. Our estimates resulting from the reduction in the allowances and supports after the austerity cuts in 2012 are consistent with our main estimates, and suggest stronguer effects among lower-income families. [ABSTRACT FROM AUTHOR]

Can the rise in obesity among children be attributed to the intergenerational transmission of parental influences? Does this trend affect the influence of parent's socioeconomic status on obesity? This paper documents evidence of an emerging social gradient of obesity in pre-school children resulting from a combination of both socio-economic status and less intensive childcare associated with maternal employment, when different forms of intergenerational transmission are controlled for. We also estimate and decompose income related inequalities in child obesity. We take advantage of a uniquely constructed dataset from Spain that contains records form 13,358 individuals for a time period (years 2003–2006) in which a significant spike in the growth of child obesity was observed. Our results suggest robust evidence of both socioeconomic and intergenerational gradients. Results are suggestive of a high income effect in child obesity, alongside evidence that income inequalities have doubled in just three years with a pure income effect accounting for as much as 72–66% of these income inequality estimates, even when intergenerational transmission is accounted for. Although, intergenerational transmission does not appear to be gender specific, when accounted for, mother's labour market participation only explains obesity among boys but not among girls. Hence, it appears income and parental influences are the central determinants of obesity among children. [ABSTRACT FROM AUTHOR]

Understanding long-term care (LTC) reform is at the core of the study of European social policy. Particularly important are the effects of regional devolution on the development of LTC services, being one of the few areas only subject to limited welfare retrenchment. One important question is the extent to which a devolved system of welfare governance influences the process of welfare reform as well as the degree of diversity in the provision and financing of LTC. The article draws upon evidence from Italy and Spain, two ‘Latin Rim’ countries, both of which have faced similar demands over the last twenty years for reform of systems with limited entitlement to long-term care. It argues that when there is a latent demand for reform, welfare devolution does not inhibit reform when fiscal blame-avoidance opportunities arise at the central government level. Furthermore, we examine the extent to which devolution leads to increasing fragmentation and diversity. The article's findings indicate that by diffusing policy responsibilities, devolution has enhanced LTC reform and reduced pre-existing welfare fragmentation in Spain. In contrast, the lack of countrywide reform in Italy is explained by the absence of political opportunities for the diffusion of the fiscal blame that has frustrated attempts to reform the existing national cash allowance. [ABSTRACT FROM AUTHOR]

The regional organization of the Spanish national health system offers a 'unique field' for exploring the sources of health inequalities as well as for testing the effects of political decentralization on health and healthcare inequalities. Drawing from the results of an empirical analysis where inequalities in three dimensions of health (outcome), healthcare (access) and healthcare payments (financing) are estimated, this article first explores the association between three such inequality dimensions alongside other system and socio-economic controls. Second, we examine whether the first wave of asymmetric healthcare devolution which took place in Spain between (1980-2001) -- whereby health policy responsibilities were transferred to a few region states (autonomous communities [ACs]) -- correlates with higher inequalities in health, healthcare and health financing. Our findings suggest that inequalities in health and healthcare appear to be driven by income inequalities and inequalities in use but not by inequalities in financing and health expenditure. Region states politically responsible for the organization of healthcare did not exhibit significant differences in health and healthcare inequalities and tend to exhibit a better equity performance. [ABSTRACT FROM AUTHOR]

Abstract: Wide cross-country variation in obesity rates has been reported between European Union member states. Although the existing cross-country differences have not been analyzed in depth, they contain important information on health production determinants. In this paper we apply a methodology for conducting standardized cross-country comparisons of body mass index (BMI). We draw on estimations of the marginal density function of BMI for Italy and Spain in 2003, two countries with similar GDP and socio-economic conditions. We produce different counterfactual distribution estimates using covariates (health production inputs) specified in a quantile regression. Our findings suggest that Spain-to-Italy BMI gaps among females are largely explained by cross-country variation in the returns to each covariate, especially for younger women. We find that adverse underlying determinants do not explain the gap observed in particular between younger Spanish females and their Italian counterfactuals; behavioural differences appear to be the key. We tentatively conclude that Spanish policy on obesity should target mainly younger females. [Copyright &y& Elsevier]

Abstract: We examine the influence of socio-environmental (and birth cohort specific) effects on both adult height and gender dimorphism (height gap). Our data set is from contemporary Spain, a country governed by an authoritarian regime for about 40 years. Both OLS and quantile regression approaches are used to examine these patterns. Furthermore, we then draw upon a Blinder-Oaxaca decomposition approach to explain the influence of socio-political environment in explaining gender dimorphism. Our findings point to a significant increase in adult height in the generations that benefited from the country''s economic liberalization in the 1950s, and especially among those brought up after the transition to democracy in the 1970s. In contrast, individual heterogeneity suggests that only in recent generations has “height increased more among the tallest”. We also find that the effects of education on height are greater among shorter individuals. Although the mean gender difference in height is 11.7cm, birth cohort and capabilities effects along with other controls explain on average roughly 4% of the gender height dimorphism, irrespective of the quantile considered. [Copyright &y& Elsevier]

The access to publicly funded long-term care (LTC) in Spain has been traditionally rationed through the use of means tests based on individuals’ current income and needs. However, individuals’ wealth, primarily housing assets, is progressively taken into account. Parallel to this feature, the responsibilities for the organization of LTC services have been devolved to region-states – autonomous communities (ACs), giving rise to some regional heterogeneity, though limited evidence has been reported on the underlying determinants. This paper examines the current role of housing assets in determining public and private funding for long-term care in Spain. Secondly, we present a qualitative and quantitative examination of the regional heterogeneity in the provision and public funding criteria determining eligibility for public support for LTC. Finally, we report survey evidence on the individual's willingness to sell (WTS) their housing assets in order to either totally or partially finance the access to LTC. Our findings suggest that housing assets are the main source of wealth accumulation at old age. Yet there is significant regional heterogeneity in the access to LTC resulting from regional differences in the means testing criteria. Progressively, all ACs are considering housing assets in their means testing criteria. Interestingly, individuals’ willingness to sell their housing assets declines with age and is more common among less skilled and widowed individuals. [ABSTRACT FROM AUTHOR]

This paper attempts to provide a critical examination of the regulation of the Spanish pharmaceutical market. We provide an extensive empirical evidence on the evolution of pharmaceutical cost-containment over the last two in the decades. Our findings suggest that policies aiming to improve efficiency and quality have not managed to contain costs, while cost-effectiveness is still overlooked. Cost-sharing has been progressively declining, the introduction of generics competition and reference pricing tools have not succeed in bringing sizeable savings. At the institutional arena, the government industry negotiation process has been largely untransparent and descentralisation processes have not been aligned on achieving desired pharmaceutical goals. [ABSTRACT FROM PUBLISHER]