Developmental trajectories of health and long-term care systems: The transitions of solidarity in four Asian countries

Abstract

PurposeDifferent from the development of health sector, there are significant variations in the underpinnings and formation timings of solidarity-based long-term care (LTC) systems. This paper compares the historical developmental trajectories and identifies factors of the transitions of the actual practices of solidarity - the scope of community, the scope of interdependence, and the costs of joint action - in the health and LTC sectors in four East Asian countries: Japan, South Korea, Taiwan, and Singapore. MethodsComparative policy analysis. ResultsHealthcare tends to be considered a universal value such that its boundary should include all residents, while LTC is closer to an entitlement of citizens. The differing solidarity reflects path dependency as well as historical legacies and policy diffusion between the health and LTC sectors. In both health and LTC sectors, the costs involved in collective service provision are not distributed evenly between generations. DiscussionCentralized governance is a prevailing feature of health and LTC sectors in East Asia, allowing solidarity-based institutional arrangements to be established without an overall sense of solidarity. The relationship between solidarity and health and LTC systems is complex and dynamic.