The greater visibility of societal ageing and higher share of individuals with disabilities have created new challenges for housing and urban policies. Housing needs can influence individual choice of living environment and the willingness to undertake housing improvements. This is especially relevant in southern European countries where the family is still the main provider of care for the elderly. This study makes an empirical analysis of the underlying preferences for housing and perceptions of housing suitability in the event of dependency in old age, drawing upon a new representative database of the Spanish population. It explores whether preferences are stable for different age-groups and different levels of individual affluence, calculated in terms of income and housing assets. The study found preferences for `ageing in place', which became stronger as individuals grew older. The effect of affluence, or the `wealth effect', was considerable. Acting independently and exhibiting higher health needs, it restrained individuals from choosing institutional care options. Those respondents who preferred to `age in place' were relatively less affluent. Those with relatively less formal education, preferred living with their relatives.

One of the limitations of cross‐country health expenditure analysis refers to the fact that the financing, the internal organization and political restraints of health care decision‐making are country‐specific and heterogeneous. Yet, a way through is to examine the influence of such effects in those countries that have undertaken decentralization processes. In such a setting, it is possible to examine potential expenditure spillovers across the geography of a country as well as the influence of the political ideology of regional incumbents and institutional factors on public health expenditure. This paper examines the determinants of public health expenditure within Spanish region‐states (Autonomous Communities, ACs), most of them subject to similar financing structures although exhibiting significant heterogeneity as a result of the increasing decentralization, region‐specific political factors along with different use of health care inputs, economic dimension and spatial interactions. Copyright © 2006 John Wiley & Sons, Ltd.

This paper reports findings from a European Commission funded study of future long-term care expenditure in Germany, Italy, Spain and the United Kingdom, and presents projections of future long-term care expenditure in the four countries under a number of assumptions about the future. Macro-simulation (or cell-based) models were used to make comparable projections based on a set of common assumptions. A central base-case served as a point of comparison by which to explore the sensitivity of the models to alternative scenarios for the key determinants. The sensitivity of the models to variant assumptions about the future numbers of older people, the prevalence of functional dependency and informal care, patterns of long-term provision, and macroeconomic conditions are examined. It was found that, under the base-case, the proportion of gross domestic product spent on long-term care is projected to more than double between 2000 and 2050 in each country. The projected future demand for long-term care services for older people is sensitive to assumptions about the future number of older people, the prevalence of dependency and the availability of informal care, and projected expenditure is sensitive to assumptions about rises in the real unit-costs of services and the structure of the models. It is important, for planning purposes, to recognise the considerable uncertainty about future levels of long-term care expenditure.

The population in the developed world has experienced a significant increase in life expectancy over the last 50 years. Simultaneously, while the onset of comorbidities has been deferred to older age groups, health-care expenditure has grown dramatically, primarily owing to the advancement of medical technology and the expansion of individual income levels, along with population ageing in the wake of increased longevity. However, the contribution of population ageing to health expenditure growth is subject to some theoretical and empirical scrutiny. This paper takes the question of ageing and health and health care to the data to evaluate the net impact of ageing. We focus on two main questions, namely the welfare valuation of longevity improvements for various OECD countries, along with the ‘red herring’ hypothesis which suggests that population ageing has a small and almost negligible impact on health-care expenditure. Our estimates lead us to suggest an average gain in longevity of 4.5 years since 1980, corresponding to about 13.5 per cent of lifetime income of a 20-year-old in 2000. Furthermore, we confirm a weak red-herring claim, that is, that population ageing accounts for only a 0.5 per cent annual growth rate of health-care expenditure. Finally, we find that the rise in longevity leads to a further demand for life-prolonging medical care.