What Is Out There and What Can We Learn? International Evidence on Funding and Delivery of Long-Term Care

Daniel Roland,Julien Forder,Karen Jones

doi:10.1017/s1474746421000531

Abstract

This article describes the social care funding and delivery arrangements of a varied selection of developed countries, focusing on long-term care of older people. International evidence and latest reforms can inform the debate as countries struggle economically. Some have opted for mandatory social insurance that provides universal coverage. A premium is paid and if the insured individual or relatives require support, they are entitled to it. Others opted for a similar universal system but with earmarked taxation, while others fund their social care entirely from general taxation. Many chose a safety-net system in which benefits are means-tested leaving wealthier individuals to secure private arrangements of care. Within the UK, the level of support varies as Scotland provides personal care free of charge, being more generous than England, Wales and Northern Ireland. There is no “one solution”, but understanding different options can help in the discussion of current and future reforms.

Highlights

The population of countries around the world is ageing; many industrialised countries currently have life expectancy above eighty years old; and there are projections showing that by 2030 many high income countries will have female life expectancy close to ninety years old, if not above (Kontis et al, 2017)
Some countries, such as in the United Kingdom (UK), follow a ‘safety-net’ model in general, where the benefits are means-tested and are only available to the poor or to individuals who have exhausted their savings paying for services in care homes – threshold limits are less strict for home care services and in Scotland there is free personal care for any adult in need of home care services
Funding for social care, or long-term care (LTC), can come from different sources and usually a combination of sources (Cylus et al, 2018). They range from mandatory social insurance, or long-term care insurance in Germany and Japan, to fully tax funded in Austria, or a mix of both in the case of France and Netherlands

Summary

Introduction

The population of countries around the world is ageing; many industrialised countries currently have life expectancy above eighty years old; and there are projections showing that by 2030 many high income countries will have female life expectancy close to ninety years old, if not above (Kontis et al, 2017). This article focuses on funding and main aspects of delivery of long-term care (LTC), known as social care or social assistance for older people. Some countries, such as in the United Kingdom (UK), follow a ‘safety-net’ model in general, where the benefits are means-tested and are only available to the poor or to individuals who have exhausted their savings paying for services in care homes – threshold limits are less strict for home care services and in Scotland there is free personal care for any adult in need of home care services. They differ in population size, demographic composition, economic aspects and funding methods for long-term care. Countries do share some traits such as similar proportion of older population, life expectancy, average GDP growth and a well-developed LTC system

Funding arrangements

Findings

Conclusion