SUMMARY

At the beginning of the new century, Spain had low levels of social expenditure associated to long-term care in comparison with other European countries. The family institution was still playing a prevailing role as the main protection network to satisfy the needs of dependent people, whilst the character of the public action was subsidiary at the time. The demographic projections (population aging), along with the social changes that took place in the last decades (familiy size reduction, women’s increasing participation in the labour market…) seriously threatened the future sustainability of this system from a few decades perspective.

In this context, by the end of 2006, the Act on the Promotion of Personal Autonomy and Care for Dependent Persons, that involves the creation of the System for Autonomy and Attention to Dependence (SAAD) was approved in Spain. This new model of caring for dependent people, which is universalist and decentralized, involves different types of benefits, both economic and in-kind, and is foreseen to be completely established in 2015.

This paper aims at taking a closer look at the situation of the assistance to dependent people in Spain and at exposing the key features to understand the possible evolution of the new system from an economic perspective. So then, following an introduction on the concepts of disability and dependence, the question if older people in the future will be more or less healthy than our older contemporaries today is undertaken. This is a key point to understand the future evolution of the above mentioned assistance system. After this, we go on to describe the fundamental characteristics of the systems that provide assistance to dependent people in different countries, with special emphasis on the Spanish formal and informal care networks prior to the creation of the SAAD. Then, we focus on the description of the main characteristics of the SAAD, drawing attention to the conditions that would allow the system to be financially sustainable. The end of the article introduces a series of conclusions and reflections on the possibilities that the cooperation and the coordination among different actors of the system offer, and claims this to be a necessary though maybe not a sufficient condition to reach the sustainability of a system that is to be born in a complex context and that should undertake important future challenges.