Book Chapter

Do education levels influence incidence and prevalence of long-term care among the elderly in Germany? Evidence from the German Microcensus Panel data (2001-2004)

Grigorieva, O.
In: Doblhammer, G. (Ed.): Health among the elderly in Germany: new evidence on disease, disability and care need, 91–114
Beiträge zur Bevölkerungswissenschaft 46
Leverkusen, Budrich (2015)


As the proportion of elderly increases, the problems of long-term care provision and utilization are increasingly attracting the attention of researchers and policy makers. Individual health status, living and financial arrangements, and community resources are all expected to have an impact on care use. Drawing from German Microcensus Panel data (2001-2004), this paper analyzes the impact of socioeconomic status by means of education on the transition to statutory long-term care among the elderly in Germany. The sample used for the analysis is restricted to individuals aged 65 years and above; whereby men and women and western and eastern parts of Germany are studied separately. The sample size employs almost 25,000 elderly in the analysis of incidence in care use, while more than 26,000 cases are considered for the study of prevalence in care utilization. The paper examines the transition to care by using the receipt of cash benefits for home care (“Pflegegeld”) as a proxy. Eligibility for benefits depends on a subjective physical assessment of the applicants and is based on an evaluation of limitations in daily living activities (not disability per se). The incidence in care use is defined here as newly reported cases receiving benefits for the first time during 2002-2004, whereas prevalence corresponds to the proportion of people receiving benefits throughout the period 2001-2004. Despite deviations between estimates of Microcensus data and official aggregated long-term care statistics, these are the only data available to study the association between education and long-term care use among the elderly living in private households and staying in the institutions. The paper discusses the advantages and disadvantages of using these data and “Pflegegeld” as the proxy for the estimations of care incidence and prevalence. Also, a panel logit model is used to assess the impact of explanatory variables on the first use of care and the Generalized Estimation Equations (GEE) model is applied to study the factors’ influence on the prevalence in care utilization. The overall incidence was 18.7 cases per thousand people aged 65 and above.  On the whole, about 4.5% of the elderly received benefits during the four years of the analyzed period. The results also reveal that education does matter for both incidence and prevalence in long-term care use. Regardless of sex or region, the rates for the highly educated are lower. The logit regression results demonstrate that education has an impact on the transition to care for men and people from western Germany. When GEE model is applied, education has a strong impact on the use of care for both men and women as well as for people residing in both regions.

Keywords: Germany, aged, health
The Max Planck Institute for Demographic Research (MPIDR) in Rostock is one of the leading demographic research centers in the world. It's part of the Max Planck Society, the internationally renowned German research society.