TY  - RPRT
        AU  - Long, Chengxu
AU  - Lin, Zhuoer
AU  - Swearinger, Hazal
AU  - Ailshire, Jennifer
AU  - Qian, Yuting
AU  - Ming, Wai-Kit
AU  - Zhao, Huitong
AU  - Hou, Xiaohui
AU  - Wu, Bei
AU  - Yang, Wei
AU  - Chen, Xi
AU  - Chen, Shanquan
        TI  - Who Cares at the End of Life? Unmet Care Needs across 32 Countries
        PY  - 2026/Oct/
        PB  - Institute of Labor Economics (IZA)
        CY  - Bonn
        T2  - IZA Discussion Paper
        IS  - 19020
        UR  - https://www.iza.org/publications/dp19020
        AB  - 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.
        KW  - end-of-life care
KW  - unmet care needs
KW  - informal care
KW  - long-term care insurance
KW  - cross-national comparison
        ER  -