Title Socioekonomske nejednakosti u korištenju dugotrajne njege osoba starije životne dobi Title (english) Socioeconomic Inequalities in the Use of Long - Term Care Among Elderly People Author Maja Matanić Vautmans Mentor Saša Drezgić (mentor)Mentor Šime Smolić (komentor)Committee member Vesna Buterin (predsjednik povjerenstva)Committee member Saša Čegar (član povjerenstva)Committee member Marijana Bađun (član povjerenstva)Granter University of Rijeka Defense date and country 2025-01-17, Croatia Scientific / art field, SOCIAL SCIENCES Universal decimal classificationUDC ) 330 - Economics. Economic science Abstract Broj i udio starijih osoba u ukupnoj populaciji povećava se, osobito onih starijih od 80 godina. Zbog sve zahtjevnijih korisnika s promijenjenim navikama (želja za smještajem i skrbi u središtima gradova uz sve dostupne sadržaje, viša tehnološka pismenost, potreba za većim uključivanjem u odluke javno - političkog života osoba treće životne dobi, motivacija za radnom aktivnošću i nakon ulaska u mirovinu), dugotrajna njega starijih osoba aktualna je tema europskih socijalnih i zdravstvenih
... More politika. Članice Europske unije (EU) nastoje osigurati dovoljan broj infrastrukturnih objekata skrbi za starije i nemoćne, povećati broj profesionalnog osoblja, razviti alternativne oblike skrbi i decentralizirati postojeću skrb u manje razvijene regije. Nove generacije korisnika iskazuju želju za drugačijim pristupom skrbi, a to je skrb pružena u vlastitom okruženju (home care - pomoć u kući) uz konstantan nadzor profesionalno angažiranog osoblja. Osim pritiska na javne financije, države članice EU-a suočavaju se s problemom nedostatne radne snage, posebice u pružanju kućne njege (naročito unutar formalnog tipa), koju kompenziraju migrantima iz trećih zemalja. Međutim, nedovoljna educiranost migranata narušava kvalitetu pruženih formalnih usluga u kućnoj njezi (Kalengayi et al., 2012; Žagar et al., 2019). Organizacija za ekonomsku suradnju i razvoj (OECD, 2021) navodi kako je formalna njega jedini i isključivi oblik kućne njege. Međutim, brojni autori znanstvenih radova uključuju i neformalnu njegu kao oblik kućne njege (Ilinca et al., 2017; Rodrigues et al., 2017). Smatra se da je neformalna njega najrašireniji oblik dugotrajne njege, pa s obzirom na to, zahtjeva i pomno promišljanje distribucije takve usluge starijim korisnicima (OECD, 2021). Dugotrajna njega dijeli se na formalnu i neformalnu. Formalna kućna njega provodi se posredstvom educiranog/obučenog osoblja (češće su to njegovatelji nižeg stupnja obrazovanja ili rjeđe, medicinske sestre). Neformalnu njegu najčešće provode članovi uže obitelji i ona je ujedno najveći izazov dugotrajne njege. Uz veliki pritisak na članove obitelji koji žrtvuju svoje radno vrijeme i zdravlje, neformalna njega često je jedini izbor dostupne njege u mnogim slabije razvijenim dijelovima EU-a. Osim dohotka, koji predstavlja osnovni preduvjet za korištenje kućne njege, kulturološke i zakonske norme determiniraju sklonost prema formalnom ili neformalnom obliku kućne njege. Provođenje kućne njege značajno se razlikuje između zemalja EU-a. U provođenju kućne njege zemlje južne i istočne Europe karakteristične su po tradicionalnom obiteljskom narativu usluge, u kojem se, što zbog zakonske obveze, što zbog običaja, skrb o starijem korisniku kućanstva prenosi na članove obitelji (najčešće ženske osobe – supruge ili djecu). S druge strane, zemlje sjeverne Europe -
zbog izdašnih javnih davanja - imaju veće prilike za korištenje educiranog angažiranog osoblja u provođenju kućne njege, čime se „većinski“ teret skrbi s obitelji prenosi na treću osobu. Vjerojatno „najhumaniji“ pristup u kućnoj njezi predstavlja kombinacija obje vrste njege (formalne i neformalne) koja dominira u zemljama srednje Europe. Međutim, s obzirom na dostupnost formalne i neformalne kućne njege uvjetovane socioekonomskim prilikama (dovoljan broj njegovatelja, mogućnost izbora različitih opcija njege, organizacija sustava formalne skrbi i u ruralnim područjima), postavlja se pitanje pravednog korištenja tih usluga. Pojedini korisnici već su u početku ograničeni u mogućnostima korištenja kućne njege s obzirom na sredinu življenja. Uz to, korištenje svake od usluga kućne njege (formalnog i neformalnog tipa) zahtjeva i učešće privatnog dohotka korisnika, što s obzirom na visinu platežne moći korisnika, o(ne)mogućuje korištenje pojedine usluge. Osim dohotka i sredine življenja (urbana/ruralna sredina) i ostali čimbenici poput zdravstvenog stanja, sastava kućanstva, broja djece i razine obrazovanja mogu se povezati s oblikom usluge kućne njege. Smatra se da bolje obrazovani korisnici imaju veći raspoloživ dohodak i širi spektar dostupnih informacija te već u ranijoj fazi promišljaju o mogućnostima korištenja dugotrajne njege i načinima njihovog financiranja. U doktorskom radu se stoga identificira zastupljenost formalne i neformalne kućne njege među starijom populacijom te se istražuje postoji li horizontalna nejednakost i vertikalna nepravda u korištenju tih vrsta usluga. Dobivene informacije mogle bi koristiti nositeljima nacionalnih politika u organizaciji pravednog sustava distribucije kućne njege i to putem horizontalnog (osobe jednakog zdravstvenog stanja koriste istu razinu skrbi) i vertikalnog pristupa (osobe različitog zdravstvenog stanja koriste različitu vrstu i razinu skrbi). U radu se upotrebljavaju podaci iz 8. i 9. vala studije SHARE - Istraživanje o zdravlju, starenju i umirovljenju u Europi (Survey of Health, Ageing and Retirement in Europe - SHARE) koji su prikupljeni tijekom 2019./2020. i 2021./2022. godine u 27 europskih zemalja. Radni uzorak obuhvaća osobe koje su u vrijeme provedbe pojedinog vala istraživanja bile u dobi od 65 ili više godina. Rezultati prikazuju zastupljenost formalne i neformalne njege u korist siromašnih korisnika u analiziranim zemljama. Obrazovanje pokazuje da sve zemlje imaju djelomični koncentracijski indeks u smjeru bogatih (pro-rich), što se može izraziti da obrazovaniji ljudi doživljavaju manje nejednakosti. Obrazovanje i prihodi su u pozitivnoj korelaciji, što znači da visoko obrazovani ljudi uživaju bolje prihode. Nakon što se uzmu u obzir čimbenici potreba, nejednakosti u formalnoj skrbi nestale su za većinu zemalja, dok su nejednakosti u neformalnoj skrbi ostale u mnogo većem broju za većinu zemalja, uglavnom s orijentacijom za siromašne. Less Abstract (english) The number and share of elderly people in the total population is increasing, especially those over 80 years old. Due to increasingly demanding users with changed habits (desire for accommodation and care in city centers with all available facilities, higher technological literacy, need for greater involvement in decisions of the public and political life of people of the third age, motivation for work activity even after entering retirement), long-term care of the elderly is a current
... More topic of European social and health policies. Members of the European Union (EU) strive to ensure a sufficient number of infrastructural care facilities for the elderly and infirm, increase the number of professional staff, develop alternative forms of care and decentralize existing care to less developed regions. New generations of users express a desire for a different approach to care, namely care provided in their own environment (home care) with constant supervision by professionally engaged staff. In addition to the pressure on public finances, EU member states face the problem of insufficient labor force, especially in the provision of home care (mostly within the formal type), which they compensate for migrants from third countries. However, insufficient education of migrants impairs the quality of formal services provided in home care. The Organization for Economic Cooperation and Development (OECD, 2021) states that formal care is the only and exclusive form of home care. However, numerous authors of scientific papers also include informal care as a form of home care (Ilinca et al., 2017; Rodrigues et al., 2017). It is considered that informal care is the most widespread form of long-term care, so with this in mind, careful consideration of the distribution of such services to elderly users is required (OECD, 2021). Long-term care is divided into formal and informal. Formal home care is provided by educated/trained staff (more often than not, low-educated caregivers or, less often, nurses). Informal care is most often carried out by members of the immediate family and is also the biggest challenge of long-term care. With great pressure on family members sacrificing their working hours and health, informal care is often the only choice of care available in many less developed parts of the EU. In addition to income, which is the basic prerequisite for the use of home care, cultural and legal norms determine the preference for formal or informal forms of home care. The implementation of home care varies significantly between EU countries. In the implementation of home care, the countries of Southern and Eastern Europe are characterized by the traditional family narrative of service, in which, partly due to legal obligation, partly due to custom, the care of the elderly user of the
household is transferred to family members (most often women - wives or children). On the other hand, the countries of northern Europe - due to generous public benefits - have greater opportunities to use educated, engaged staff in the implementation of home care, which transfers the "majority" burden of family care to a third person. Probably the most "humane" approach in home care is the combination of both types of care (formal and informal), which dominates in Central European countries. However, considering the availability of formal and informal home care conditioned by socioeconomic circumstances (sufficient number of caregivers, the possibility of choosing different care options, the organization of the formal care system in rural areas), the question of fair use of these services arises. Some users are already limited in the possibilities of using home care, given their living environment. In addition, the use of each of the home care services (formal and informal type) also requires the participation of the user's private income, which, considering the level of payment power of the user, makes it (not) possible to use a particular service. In addition to income and living environment (urban/rural environment), other factors such as health status, household composition, number of children and level of education can be associated with the form of home care service. It is considered that better-educated users have higher disposable income and a wider spectrum of available information, and that they think about the possibilities of using long-term care and ways of financing it at an earlier stage. The dissertation therefore identifies the representation of formal and informal home care among the elderly population and investigates whether there is horizontal inequality and vertical inequity in the use of these types of services. The obtained information could be useful to national policy makers in the organization of a fair distribution system of home care through a horizontal (persons with the same health condition use the same level of care) and vertical approach (persons with a different health condition use a different type and level of care). The paper uses data from the 8th and 9th waves of the SHARE study - Survey of Health, Aging and Retirement in Europe - SHARE, which were collected during 2019/2020. and 2021/2022. in 27 European countries. The working sample includes persons who were aged 65 or older at the time of the individual wave of research. The results show the representation of formal and informal care in favor of poor users in the analyzed countries. Education shows that all countries have a partial concentration index in the direction of the rich (pro-rich), which can be expressed that more educated people experience less inequality. Education and income are positively correlated, meaning that highly educated people enjoy better incomes. After taking into account needs factors, inequalities in formal care disappeared for most countries, while inequalities in informal care remained much larger for most countries, mostly with a pro-poor orientation. Less Keywords
dugotrajna njega
formalna njega
neformalna njega
horizontalna nejednakost
vertikalna nepravda
starije osobe
EU
Keywords (english)
long-term care
formal care
informal care
socioeconomic inequality
horizontal inequality
vertical inequity
elderly
EU
Language croatian URN:NBN urn:nbn:hr:192:519089 Promotion 2025 Study programme Title: Economics and Business Economics Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2025-02-18 10:10:46
