Application of a macrosimulation model to future demand of long-term care in an Italian region: results and implications

Rossella Di Bidino, Health Technology Assesment Unit - Gemelli Hospital
Ranieri Zuttion, Local Health Agency “Bassa Friulana ASS 5
Elena Tubaro, Local Health Agency “Bassa Friulana ASS 5
Maura Garbo
Sandra Ponta
Erica Cecotti

Ageing of population, patterns of care and social structure should be strictly investigated to project the demand for long-term care (LTC). The PRAI Frenesys-E-Welfare Project conducted in the Friuli Venezia Giulia (FVG) region in Italy investigated these issues adapting and detailing the cell-based PSSRU (Personal Social Service Research Unit) model originally developed by Wittenberg et al. for UK. The FVG model is a macro simulation tool based on of 94 cells. The first part estimates the number of older people with different levels of dependency with different levels of dependency by age group, gender, household type and housing tenure. While the second part focused on the levels of LTC service demand. The graduation of dependency for institutionalized people was added to the model. Multiple sources of information were involved from National Statistical Office databases to regional ones focused on health service utilization and functional elderly status. The base case scenario replicated the 2000 access to LTC services to the projected population for each year till 2051. While alternative scenarios were based on different definition of population projections, age-specific dependency rates, and availability of informal care. The numbers of dependent older people in FVG are projected to grow from 2001 to 2031 by 68% given a 42% increase in the 65+ population. That would be associated with a 100% increase in domiciliary service demand. Impact on the residential care was investigated for each of the services involved in the network of care. The expenditure level of the model is currently not developed given data availability limits. Anyway the model allows to conclude that the current network of care should be re-designed in order to take into account demographic (ageing of the population) and social (frailness impact on daily living, carers availability etc.) pressures.