The Case for Universal Long-Term Care

Abstract

Long-term care (LTC) is one of the most pressing public policy challenges today. Implementing policies to meet the population's demands becomes relevant in many countries, particularly in a context of rapid population aging. Both the technical complexities and the financial burden of implementing LTC policies discourage policy makers’ actions in this area. In this environment, targeted policies arise as a solution to reduce the cost of implementing LTC policies. This article presents several arguments in favor of implementing universal—vs targeted—LTC initiatives. Arguments are divided into general arguments against targeting public policies, using categories proposed by Amartya Sen, and LTC-specific arguments, based on the concept of LTC as social security. Information shows that despite the financial arguments in favor of targeted policies, in the case of LTC, its costs may overcome the benefits. These results provide important lessons for policy makers, particularly regarding the design of (universal) LTC policies, warning that the allegedly simple solution of targeting benefits needs to be revisited, and replaced for policies that could balance universalism and resource constraints. This message is particularly important today for countries that face the challenge of increasing LTC needs and tighter resource constraints.