Who Cares at the End of Life? Unmet Care Needs across 32 Countries

Chengxu Long, Zhuoer Lin (), Hazal Swearinger, Jennifer Ailshire, Yuting Qian, Wai-Kit Ming, Huitong Zhao, Xiaohui Hou, Bei Wu, Wei Yang, Xi Chen and Shanquan Chen
Additional contact information
Chengxu Long: Huazhong University of Science and Technology
Zhuoer Lin: Emory University
Hazal Swearinger: Cankiri Karatekin University
Jennifer Ailshire: University of Southern California
Yuting Qian: Yale University
Wai-Kit Ming: City University of Hong Kong
Huitong Zhao: China Population and Development Research Center
Xiaohui Hou: The World Bank
Bei Wu: New York University Shanghai
Wei Yang: King’s College London
Shanquan Chen: University of Hong Kong and Stellenbosch University

No 19020, IZA Discussion Papers from IZA Network @ LISER

Abstract: Rapid population aging and shrinking families are reshaping the demand for end-of-life care, yet cross-national evidence on unmet needs remains scarce. Using harmonized end-of-life survey data (2010–2021) on decedents with activity limitations from the United States, 28 European nations, South Korea, Mexico, and China, we document a striking pattern: the United States, Europe, and South Korea exhibited higher overall unmet care than China and Mexico, where sparse formal care was offset by near-universal family care. Death in an institution was associated with lower unmet care in the United States and South Korea, but not in Mexico, and urban residence in Europe and South Korea was associated with less unmet formal care than rural residence. Contrary to expectations, married Europeans faced more unmet care than their unmarried peers, with only Mexico showing the anticipated protective effect of marriage. Having children was consistently associated with lower unmet informal care across the United States, Europe, and South Korea. Results indicate that expanding formal care alone does not fully substitute for declining family care, and that policies must strengthen both systems while addressing sociodemographic disparities in access.

Keywords: end-of-life care; unmet care needs; informal care; long-term care insurance; cross-national comparison (search for similar items in EconPapers)
JEL-codes: D13 I14 I18 J14 O57 (search for similar items in EconPapers)
Date: 2026-10
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Working Paper: Who Cares at the End of Life? Unmet care needs across 32 Countries (2026)
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