Europe is ageing fast. The median age of people in the European Union increased from 39.3 years in 2004 to 44.7 years in 2024, according to Eurostat. Over the same period, the share of people aged over 80 increased from 3.8% to 6.1%. As more people suffer ill health in old age, with fewer working-age taxpayers to support them, public healthcare budgets and pension systems will be squeezed.
With public spending already at its limit across the EU, there is little prospect of increasing health budgets sufficiently to scale up the current healthcare model to meet rising demand. A radical new approach is needed.
A decades-old system in Italy for treating mental health conditions could offer a novel approach. By focusing on care in the community rather than in hospitals, the model lowers the cost of providing healthcare while also ensuring patients’ dignity and quality of life. It also frees up informal caregivers — for example, people looking after an elderly relative — to return to the workforce.
This article is part of The Parliament's latest policy report, "Building a healthier Europe."
Italy has pioneered this approach to mental health since 1978, when the country introduced Law 180. The brainchild of psychiatrist Franco Basaglia, this legislation led to the closure of mental hospitals and the promotion of a community-based model of care grounded in dignity, autonomy and social reintegration. The ‘Trieste model,’ as it came to be known, has been copied around the world.
“These health and community systems must work in synergy with welfare policies. That means supporting older people in their homes through personalised services, rehabilitation and home nursing,” Roberto Mezzina, vice-president of the World Federation for Mental Health, told The Parliament.
Strong networks central to long-term care
The way to achieve a high standard of community care is to build strong networks combining public, private and volunteer organisations alongside a patient’s family, he said, taking an integrated approach to the patient’s needs: “Health, welfare, and social support — including personalised assistance — must be interwoven and integrated.”
A new book supported by the World Health Organization, The Care Dividend: Why and How Countries Should Invest in Long-Term Care, makes the case for applying this approach to long-term care more broadly. Across a series of articles, it says that community-based care can stimulate economic growth as well as improving health outcomes, mitigating at both ends the economic slowdown caused by demographic change.
Under the current system, many people must leave the workforce to care for a family member — a burden that falls disproportionately on women, Ludovico Carrino, professor of public economics at the University of Trieste and one of the book’s authors, told The Parliament.
“We live in a society where people enjoy greater freedom and want to earn an income. Increasingly, that includes women, who today have choices they often lacked, or didn’t feel they had, in the past,” Carrino said. “This, of course, creates challenges for governments that have traditionally relied on families as a primary pillar of support.”
“Many people think that investing in the public sector is merely a cost: something done out of ethical obligation that ultimately burdens public finances,” he said. “But long-term care affects the wellbeing of multiple generations, as well as various roles within families and society.”
A recent study co-authored by Carrino found that “timely and decisive political action can ensure the well-being of older people and support long-term economic growth.” By investing in preventive care, workforce development and technological integration, the rise in healthcare costs can be made gradual and sustainable.
According to the study, delaying reforms risks undermining the sustainability of healthcare and welfare systems, as well as the overall wellbeing of society. The authors argue that Europe has a history of making bold, progressive social policy choices, and it should do so here.
At the EU level, Carrino says policymakers could work on guidelines around eligibility for long-term care and how it should be provided, something that currently varies a great deal between member states. “There’s very little consistency,” he said.
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