Gaps in social protection for health care and long-term care in Europe: Are the elderly faced with financial ruin?


Addresses for correspondence: Xenia Scheil-Adlung, Health Policy Coordinator, International Labour Office, 4 route des Morillons, 1211 Geneva 22, Switzerland; Email: Jacopo Bonan, University of Milan-Bicocca, 1 Piazza dell'Ateneo Nuovo, 20126 Milan, Italy; Email:


While public expenditure on health care and long-term care (LTC) has been monitored for many years in European countries, far less attention has been paid to the financial consequences for older people of private out-of-pocket (OOP) expenditure necessary to access such care. Employing representative cross-sectional data on the elderly populations of 11 European countries in 2004 from the Survey of Health, Ageing and Retirement in Europe (SHARE), we find that OOP payments for health care and LTC are very common among the elderly across European countries and such expenditures impact significantly on disposable income: up to 95 per cent of the elderly make OOP payments for health care and 5 per cent for LTC, resulting in income reductions of between 5 and 10 per cent, respectively. Failure to prevent financial ruin, as a consequence of excessive OOP payments, is evident in 0.7 per cent of elderly households utilizing health care and 0.5 per cent of elderly households utilizing LTC. Those particularly concerned are the poor, women and the very old.