Indicators of familialism and defamilialization in long-term care: A theoretical overview and introduction of macro-level indicators

Many countries have been working on revising their long-term care (LTC) policies to meet the increasing demand for care. Generally, little attention is paid to the potential (unintended) consequences of LTC policies for inequality among care users or informal caregivers. Saraceno previously explicitly argued that differences in care use and provision depend on the type of LTC policy, and that policies with contrasting consequences for inequality can be implemented at the same time. We call upon future research to empirically test the impact of different types of LTC policies on socio-economic inequalities in care. To stimulate and facilitate such research, our aims are to outline theoretical arguments for the differential impact of LTC policies on socio-economic inequalities in care and to create macro-level indicators for different types of supportive LTC policies in European countries over time. Our study’s research question is: Can we find and capture different dimensions of LTC policies in macro-level indicators that are comparable over countries and time? In particular, we focus on supported familialism (for example, informal caregiver support), supported defamilialization through the market (for example, in-cash benefits for care users), and defamilialization through public provision (for example, availability of beds in residential care). Besides a summary of the literature on LTC policies and how they may affect socio-economic inequalities in care, we outline our search process for macro-level LTC indicators and present descriptive information on the different types of LTC policies and their correlations. We discuss the difficulties that arise when translating theoretical insights about different types of LTC policies into high-quality measures for many countries and time points.