Exploring assistance in Sweden and the United States.
OBJECTIVE
Few international comparisons of health services are performed using microlevel data. Using such data, this paper compares the need for and receipt of assistance with activities of daily living (ADLs) in comparable samples in the United States and Sweden, a country with a universal system of community-based services.


METHODS
Data from national surveys of community residents completed at approximately the same time in each nation are used to create comparable measures of need and assistance. Descriptive and logistic regression analyses compare need and assistance patterns across the nations and identify individual factors that explain receipt of assistance and unmet needs.


RESULTS
Our results indicate that a simple story of greater use of paid formal services in Sweden and more unpaid informal use in the United States masks a more complex relationship. Assistance with ADLs seems to be more targeted in Sweden; narrow differences in assistance widen considerably when the analysis is limited to those reporting need.


CONCLUSIONS
Although these two different health systems result in similar levels of overall ADL assistance, a detailed microlevel comparison reveals key distinctions. Further microlevel comparisons of access, cost, and quality in cross-national data can further aid our understanding of the consequences of health policy.
Shea
Dennis
D
Department of Health Policy and Administration, Penn State University, University Park, PA, USA.
Davey
Adam
A
Femia
Elia E
EE
Zarit
Steven H
SH
Sundström
Gerdt
G
Berg
Stig
S
Smyer
Michael A
MA
D000203:Activities of Daily Living; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003431:Cross-Cultural Comparison; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006699:Home Care Services / Q000706:statistics & numerical data*; D006701:Home Nursing / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D009313:National Health Programs / Q000706:statistics & numerical data; D012044:Regression Analysis; D012944:Social Support; D013548:Sweden; D014481:United States