Long-term care models and dependence probability tables by acuity level: New empirical evidence from Switzerland

Due to the demographic changes and population aging occurring in many countries, the financing of long-term care (LTC) poses a systemic threat. The scarcity of knowledge about the probability of an elderly person needing help with activities of daily living has hindered the development of insurance solutions that complement existing social systems. In this paper, we consider two models: a frailty level model that studies the evolution of a dependent person through mild, moderate and severe dependency states to death and a type of care model that distinguishes between care received at home and care received in an institution. We develop and interpret the expressions for the state- and time-dependent transition probabilities in a semi-Markov framework. Then, we empirically assess these probabilities using a novel longitudinal dataset covering all LTC needs in Switzerland over a 20-year period. As a key result, we are the first to derive dependence probability tables by acuity level, gender and age for the Swiss population. We find that the transition probabilities differ significantly by gender, age and time spent in the frailty level and type of care states.