EuHEA Seminar Series spring 2021

Presenting May 20th

Ricardo Rodrigues: From each according to means, to each according to needs? Distributional effects of abolishing asset-based payments for residential care in Austria

Chair: Pedro Pita Barros

Discussant: Bram Wouterse

 

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The seminars are for free. 

Objectives: As in other European countries, users of residential care in Austria were required to contribute to the costs of residential care based on both their income and assets. This asset-based out-of-pocket payment (OPP) for residential care – denominated Pflegeregress – was abolished in 2018. There is currently no empirical evidence on the distributional effect of this measure across income groups. This study thus aims to answer the following research questions: how was Pflegeregress distributed across different income and home ownership groups before 2018 and what were the distributional consequences of its abolishment?

Methods: The study uses a matched administrative (residential care users and mortality tables) and survey (SHARE, wave 6 for Austria) dataset on which a purposely built micro-simulation model was applied. The micro-simulation model estimates the annual OPPs for residential care borne by individuals 65+ for a reference year (2015). The distributional impact is assessed through a series of measures, including Concentration Indices (CI) and Curves (CC) and OPPs adjusted for need.

Results: The findings from the micro-simulation model show that in absolute value, users from the upper income quintile paid the highest total OPPs. However, asset-based OPPs (i.e. Pflegeregress) represented both a higher share of total OPPs paid and a higher proportion of the financial resources of lower income users, with a large share of the Pflegeregress financed through housing assets of home owners. The CC show that the 20% poorest individuals accounted for 25% of the estimated Pflegeregress paid in 2015. This is in contrast with the majority of higher-income individuals who could cover residential care fees from their income alone, without resorting to assets. Adjusting for need shows that this distribution was very much driven by the concentration of residential care in less affluent individuals. The abolishment of the asset-based OPPs for residential care in Austria thus benefited mostly those in the lower income quintiles.

Discussion: The Pflegeregress fell disproportionately on low-income residential care users, which means that the regressive nature of Pflegeregress made this group the largest beneficiary of its abolishment. Given how the distribution of asset-based OPPs was influenced by residential care use and duration – both concentrated on less affluent individuals – it is questionable whether asset-based OPPs in residential care are able to target payments to wealthier individuals. Other financing options such as earmarked inheritance taxes or social insurance schemes that decouple financing from use could be alternatives to circumvent the adverse distributional effects of asset-based OPPs. Our findings show the relevance of considering the distributional implications of different financing options for care.

More about: Ricardo Rodrigues

Program

Dato	Tema
11.2	Women in Distress: Mental Health and the COVID19 Pandemic Emilia Barili, University of Genoa
18.2	Factors associated with lockdown opinions during the second national lockdown in France, attitudes toward the end-of year celebrations and the use of digital contact-tracing ‘TousAntiCovid’ Pauline Kergall, University of Montpellier
25.2	An App Call a Day Keeps the Patient Away? On the Substitution of Online and In-Person Doctor Consultations Lina Maria Ellegård, University of Lund
4.3	Devil in the details: How urgency and costs influence the effects of cost-sharing on healthcare service consumption patterns Michael Berger, Medical University of Vienna
11.3	Quality provision in hospital markets with demand inertia: The role of patient expectations Luís Sá, University of Minho
18.3	Do the guidelines apply to me? - Patient information and physician agency in prenatal diagnostics Nis Lydiksen, University of Southern Denmark
25.3	Do subsidized nursing homes and home care teams reduce hospital bed-blocking? Evidence from Portugal Ana Moura, Tilburg University
Easter
8.4	How Distorted Food Prices Discourage a Healthy Diet Thijs van Rens, University of Warwick
15.4	Lifetime Healthcare Expenditures Across Socio-Economic Groups: Wiping Out the Gradient Alexander Overdal Kjærsgaard Marin, University of Aarhus
22.4	The Long-Term Effects of Hospital Deliveries in Sweden Nikolaos Prodromidis, University of Duisburg-Essen
29.4	The effect of pharmaceutical innovation on longevity: evidence from the U.S. and 39 countries Frank Lichtenberg
6.5	Why is End-of-Life Spending So High? Evidence from Cancer Patients Dan Zeltzer
13.5	No seminar
20.5	From each according to means, to each according to needs? Distributional effects of abolishing asset-based payments for residential care in Austria Ricardo Rodrigues
27.5	The seen and the unseen: Impact of a conditional cash transfer program on prenatal sex selection Sayli Javadekar, University of Bath
3.6	Volume-Outcome Relation in Elective Surgery. An application to hip replacement in Italy Francesca Cassanelli, University of Bologna
10.6	Furloughs, Teleworking and Other Work Situations during the COVID-19 Lockdown: Impact on Mental Well-Being  Israel Escudero-Castillo, University of Ovideo
17.6	Improving Health Insurance Coverage for the Poor Daim Syukriyah, University of London

Contact UiO: 

Kristi Brinkmann Lenander

EUHEA.eu 

In response to the cancellation of the in-person EuHEA 2020 conference in Oslo, the EuHEA Seminar Series was launched with the joint efforts of Oslo’s scientific committee, EuHEA and countries’ representatives. Invitation of seminar speakers was initially guided by review scores for papers submitted to the EuHEA 2020 conference in Oslo. The web-based seminars provided a venue for bringing together the Health Economics community for sharing and discussing research. Following the success of the virtual seminar series in fall 2020, seminars will continue in 2021.