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1. Prepare now: Europe must get ready for the coming long-term care surge

Author:
Svend E. Hougaard Jensen, David Pinkus, and Nina Ruer
Publication Date:
01-2025
Content Type:
Policy Brief
Institution:
Bruegel
Abstract:
Demographic change and ageing populations in European Union countries will impact many aspects of the economy and have a direct effect on long-term care (LTC) systems. Demand for LTC already exceeds supply in many EU countries, leading to the ‘care gap’. This gap is expected to widen, threatening quality of life for the elderly, exacerbating gender disparities and imposing significant economic costs. The root causes of the gap include demographic shifts, inadequate public investment, workforce shortages and a heavy reliance on informal caregiving. Women stand to lose the most if no steps are taken to prepare LTC systems for the coming surge in demand because care, both formal and informal, is predominantly provided by women. The care gap can be reduced by either increasing the supply of care or by reducing the demand for care. We assess LTC reforms in five EU countries and explain how these can affect the care gap by influencing demand and supply. Governments should: Recognise LTC as a priority. Governments should increase public spending on LTC and make LTC a central policy priority linked to broader goals, including gender equality and economic growth. Expand funding mechanisms. Governments can introduce new means of financing, such as mandatory LTC insurance and pre-funding mechanisms. Most importantly, benefits should target those with the greatest needs, to promote equity and adequacy. Support the workforce more. The LTC sector should be made more attractive by raising wages, improving working conditions and expanding training programmes to attract and retain workers. Develop prevention strategies. EU funds could be directed to research into treatments targeting age-related diseases such as dementia. National governments could invest in public health campaigns and preventive care to reduce future demand. Use the newest technologies. EU countries should invest in robotics and assistive technologies to improve productivity and to reduce physical strain on caregivers.
Topic:
Economics, Health, Governance, European Union, and Macroeconomics
Political Geography:
Europe

2. The demographic divide: inequalities in ageing across the European Union

Author:
David Pinkus and Nina Ruer
Publication Date:
03-2025
Content Type:
Policy Brief
Institution:
Bruegel
Abstract:
The European Union is projected to enter a period of population decline after 2026, with implications for economic development and labour markets, though these will vary because of different trends in different EU countries. Between 2023 and 2050, Eastern and Southern EU countries will face the sharpest declines because of both natural population decrease and limited net inward migration. In contrast, Northern and Western countries could see population growth driven by higher migration. By 2050, working-age populations are projected to decline in 22 out of 27 EU countries, while the share of those aged 85+ in the EU as whole will more than double. This shift will strain healthcare, pension and long-term care systems across the continent. Eastern and Southern EU countries will face more severe ageing and workforce shrinkages, undermining their competitiveness and potentially contributing to increasing inequality. Western and Northern countries will also age, but slower natural population decline and larger migration inflows will give them more time to adjust. However, regional disparities within countries will likely widen as migrants concentrate in urban areas, leaving rural regions even more vulnerable to depopulation. Policies must be adapted to these different demographic trends. Eastern EU countries should focus on retaining talent, attracting migrants in sectors with labour shortages and increasing labour-force participation by women and older workers. Southern countries should strengthen family-friendly and youth-employment policies, while improving migrant integration and regional infrastructure. Western and Northern countries must prioritise migrant integration, rural development and gradual labour-market reforms for ageing populations. A coordinated EU plan for these different trends would support EU countries in addressing the challenges they will face. Integration of migrants into labour markets and societies will be especially important, though relying on sustained high migration may not be a viable long-term solution and will not be a substitute for maximising the participation of residents in labour markets.
Topic:
Demographics, European Union, Inequality, and Aging
Political Geography:
Europe

3. Long-term care policies in practice: a European perspective

Author:
Svend E. Hougaard Jensen, David Pinkus, and Nina Ruer
Publication Date:
12-2024
Content Type:
Working Paper
Institution:
Bruegel
Abstract:
This paper offers a comprehensive study of the long-term care (LTC) systems in Germany, France, Slovenia, Italy and Denmark. In many EU countries, the demand for LTC services already exceeds supply. Without major reforms, this ‘care gap’ is likely to widen further because of population ageing. This paper highlights a number of recent reforms to reduce this care gap by affecting the demand for and supply of long-term care services. We find that most measures to increase the supply of formal LTC services focus on workforce attractiveness. By examining recent policy efforts and reforms, we aim to understand in which direction LTC policy is going, and to showcase measures to prepare for the future increase in demand for care.
Topic:
Health, Public Policy, Macroeconomics, and Aging
Political Geography:
Europe, France, Germany, Denmark, Italy, and Slovenia