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Horizontal and vertical target efficiency – a comparison between users and non-users of public long-term care in Sweden



The extent to which a system of services is in tune with the needs of the population can be expressed in terms of target efficiency, which includes horizontal target efficiency – the extent to which those deemed to need a service receive it – and vertical target efficiency – the corresponding extent to which those who receive a service actually need it. Vertical efficiency can be measured by looking only at those receiving services. To measure horizontal target efficiency in a population, one must have access to population surveys. Data were taken from the baseline survey of the Swedish National Study on Ageing and Care (SNAC study). The results show that more than 80 per cent of those dependent in personal activities of daily living in the studied geographic areas were users of public long-term care (LTC). Dependency in instrumental activities of daily living was identified as the most important predictor of using LTC. Vertical target efficiency was 83–95 per cent depending on age, gender and type of household, if need was defined as dependency in instrumental activities of daily living. It was considerably lower, 35–61 per cent when defined as dependency in personal daily activities. Overall, long-term target efficiency in Sweden must be regarded as high. Few persons who need public LTC services fail to receive them.


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Address for correspondence: Mårten Lagergren, Gjorwellsgatan 15, 112 60 Stockholm, Sweden. E-mail:


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Altman, D. G. and Bland, J. M. 1994. Statistics Notes: Diagnostic tests 1: sensitivity and specificity. British Medical Journal, 308, 6943, 1552.
Davey, A., Johansson, L., Malmberg, B. and Sundström, G. 2006. Unequal but equitable: an analysis of variations in old-age care in Sweden. European Journal of Ageing, 3, 1, 3440.
Davies, B. and Challis, D. 1986. Matching Resources to Needs. Gower Publishing Company, Aldershot, UK.
Ferlie, E., Challis, D. and Davies, B. 1989. Efficiency-improving Innovations in Social Care of the Elderly. Gower Publishing Company, Aldershot, UK.
Folstein, M. F., Folstein, S. E. and McHugh, P. R. 1975. ‘Mini-mental state’: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 3, 189–98.
Geerlings, S. W., Pot, A. M., Twisk, J. W. R. and Deeg, D. J. H. 2005. Predicting transitions in the use of informal and professional care by older adults. Ageing & Society, 25, 1, 111–30.
Glendinning, C., Davies, B., Pickard, L. and Comas-Herrera, A. 2004. Funding Long-term Care. Lessons from Other Countries. Joseph Rowntree Foundation, York Publishing Services, York, UK.
Johansson, L. 1997. Decentralisation from acute care to home care settings in Sweden. Health Policy, 41, supplement, S131–43.
Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A. and Jaffe, M. W. 1963. Studies of illness in the aged. Journal of American Medical Association, 185, 21 September, 914–19.
Komisar, H. L., Feder, J. and Kasper, J. D. 2005. Unmet long-term care needs: an analysis of Medicare-Medicaid dual eligibles. Inquiry, 42, Summer, 171–82.
Lagergren, M. 2002. The systems of care for frail elderly persons: the case of Sweden. Aging Clinical and Experimental Research, 14, 4, 252–7.
Lagergren, M. 2005. What happened to the care of older persons in Sweden? A retrospective analysis based upon simulation model calculations, 1985–2000. Health Policy, 74, 3, 314–24.
Lagergren, M., Fratiglioni, L., Hallberg, I. R., Berglund, J., Elmståhl, S., Hagberg, B., Holst, G., Rennemark, M., Sjölund, B.-M., Thorslund, M., Wiberg, I., Winblad, B. and Wimo, A. 2004. A longitudinal study integrating population, care and social services data. The Swedish National Study on Aging and Care. Aging Clinical and Experimental Research, 16, 2, 5868.
Larsson, K. and Thorslund, M. 2002. Does gender matter? Differences in patterns of informal support and formal services in a Swedish urban elderly population. Research on Aging, 24, 3, 308–26.
Larsson, K., Thorslund, M. and Forsell, Y. 2004. Dementia and depressive symptoms as predictors of home help utilization among the oldest old: a population based study in an urban area of Sweden. Journal of Aging and Health, 16, 5, 641–8.
Larsson, K., Thorslund, M. and Kåreholt, I. 2006. Are public care and services for older people targeted according to need? Applying the Behavioural Model on longitudinal data of a Swedish urban population. European Journal of Ageing, 3, 1, 2233.
Livingston, G., Manela, M. and Katona, C. 1997. Cost of community care for older people. British Journal of Psychiatry, 171, 1, 56–9.
Meinow, B., Kåreholt, I. and Lagergren, M. 2005. According to need? Predicting the amount of municipal home help allocated to elderly recipients in an urban area in Sweden. Health and Social Care in the Community, 13, 4, 6677.
Montgomery, S. A. and Asberg, M. 1979. A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 4, 382–9.
Sakari-Rantala, R., Heikkinen, E. and Ruoppila, I. 1995. Difficulties in mobility among elderly people and their association with socio-economic factors, dwelling environment and use of service. Aging Clinical and Experimental Research, 7, 6, 433–40.
Savla, J., Davey, A., Sundström, G., Zarit, S. and Malmberg, B. 2008. Home help services in Sweden: responsiveness to changing demographs and trends. European Journal of Ageing, 5, 1, 4755.
Stoddart, H., Whitley, E., Harvey, I., and Sharp, D. 2002. What determines the use of home care services by elderly people. Health and Social Care in the Community, 10, 5, 348–60.
Stoller, E. P. and Cutler, S. J. 1993. Predictors of use of paid help among older people living in the community. The Gerontologist, 33, 1, 3140.
Szebehely, M. 1998. Changing divisions of care work: caring for children and frail elderly people in Sweden. In Lewis, J. (ed.), Gender, Social Care and Welfare State Restructuring in Europe. Ashgate, Aldershot, UK, 257–83.
Tennstedt, S., McKinlay, J. and Kasten, L. 1994. Unmet needs among disabled elders: a problem in access to community long term care. Social Science & Medicine, 38, 7, 915–24.
Thorslund, M., Norström, T. and Wernberg, K. 1991. The utilization of home help in Sweden: a multivariate analysis. The Gerontologist, 31, 1, 116–9.
Trydegård, G.-B. 2000. Tradition, Change and Variation. Past and Present Trends in Public Old-age Care. Stockholm Studies of Social Work 16, Department for Social Work, Stockholm University, Stockholm.
Williams, J., Lyons, B. and Rowland, D. 1997. Unmet long-term care needs of elderly people in the community: a review of literature. Home Health Care Services, 16, 1/2, 93119.


Horizontal and vertical target efficiency – a comparison between users and non-users of public long-term care in Sweden



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