Chapter 22 - Long-Term Care Financing, Service Delivery, and Quality Assurance: The International Experience

Abstract

Long-term care is an issue of worldwide concern, now and for the future, in both high-income, developed countries and middle-income, developing countries. This chapter provides an overview of long-term care in other countries, with an emphasis on the United Kingdom, Germany, and Japan. It discusses financing, service delivery, and quality assurance. These countries will have to face the issues of long-term care, which are currently low on their policy agendas. Long-term care financing differs among high-income countries across several dimensions. These characteristics include how much of the economy is spent on long-term care, the extent to which care is publicly or privately financed, whether public programs are means-tested or provide universal coverage, whether responsibility for long-term care is a national or state and local government responsibility, and how the relationship between medical and long-term care is defined. Total long-term care expenditures are a modest portion of the economy, especially compared with overall health expenditures. Whereas private spending for long-term care plays a role in long-term care financing in all high-income countries, public spending dominates expenditures. Although financing of long-term care is overwhelmingly by the public sector, service providers include a mix of government-run, nonprofit, and for-profit organizations. A key issue in the design of long-term care systems is the level of government responsible for financing and delivery. Countries vary in the proportion of their long-term care expenditures for older people that are directed to home and community-based services.