ArticleEClinicalMedicine2022
Financial social protection and individual out-of-pocket costs of long-term care in the USA and Europe: An observational study.
Article in EClinicalMedicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it, 16 citations in OpenAlex.
- Is there an association between out-of-pocket hospital costs, quality and care outcomes? A systematic review of contemporary evidence.BMC health services research · 2023Pooled it
- A 1-km resolution dataset of affordability-constrained accessibility to elderly care facilities in China.Scientific data · 2026Article
- Paying for home care: a cross-sectional study of participants of the Canadian Longitudinal Study on Aging.BMC health services research · 2025Article
- Twenty-year trend in comorbidity score among adults aged 50-85 years in Lombardy, Italy: Age-Cohort-Period analysis and future trends.BMJ open · 2025Observational
- The impact of long-term care insurance on household expenditures of the elderly: Evidence from China.PloS one · 2025Article
- Characteristics of Italian, German and Spanish Socio-Economic, Public Health and Long-Term Care Systems Associated with COVID-19 Incidence and Mortality in the First Pandemic Year: Lessons for Future Sustainability in an International Perspective.Healthcare (Basel, Switzerland) · 2024Article
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 2 countries.
Funding
Abstract
Background: Empirical evidence informing policies aiming at ensuring affordability of long-term care (LTC) costs is limited. Combining system-level with individual-level data, we quantify the burden of out-of-pocket costs of LTC services on households in 13 European countries and the USA and explore how social protection systems impact affordability of care. Methods: In this observational study, we use harmonised data from the Health and Retirement Study (HRS), collected between 2012 and 2016, and from the Survey of Health, Ageing and Retirement in Europe, collected between 2013 and 2017. We assess the severity of LTC needs of older adults (65+) on the basis of self-reported limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs). We classify countries' social protection systems in terms of affordability and progressivity using information obtained from country officials. We examine variation in individual-level out-of-pocket LTC costs by social protection systems' affordability and progressivity. Findings: Out-of-pocket LTC costs are heterogeneous across countries and increase with individuals' needs. In countries where LTC is more affordable and social protection systems less progressive, older adults incur significantly lower levels of LTC costs. Within Europe, not only are costs lower where systems are characterized by higher affordability and lower progressivity, but they also represent a lower share of households' disposable income. Interpretation: Our findings indicate that the social protection systems significantly affect the level of out-of-pocket costs faced and reported by older adults with LTC needs as well as the share of their income that is devoted to pay for care. Funding: We received funding from the National Institute on Aging (grant number R01 AG030153). The OECD programme of work on ageing and long-term care is partly funded by the European Union.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.