From the Editor-In-Chief Health AffairsVol. 19, No. 3 Family, Marketplace & The State: Striking A BalanceJohn K. Iglehart AffiliationsFounding EditorPUBLISHED:May/June 2000Free Accesshttps://doi.org/10.1377/hlthaff.19.3.6AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSLong-term services and supportsMedicare savings programsHealth insurance exchangesMedicare eligibilityHealth servicesResearchersEvery industrialized nation is grappling with the challenges provoked by aging populations that require a broad array of health and long-term care services. The policies they pursue all reflect a melding of three major sources of care: the family, the marketplace, and the state. In this thematic issue we address how a variety of nations are accommodating the growing demands they face to finance and provide high-quality long-term care. While all nations are striking balances that reflect their own policy imperatives, the approaches they embrace generally resemble the structure of their acute-care health insurance systems. These approaches fall into two broad categories: social insurance and means-tested programs, or some combination of the two. The United States, as in so many things, has pursued a variety of approaches for different populations, but none universally; this underscores the uncertainty over what role government should ultimately play in this vexing equation. Under social insurance (the Medicare program is America's leading health insurance example), all taxpayers are required to pay relatively small amounts shared equally by employers and employees to support a broad social goal to which all eligible beneficiaries are entitled, regardless of their income. Under means-tested programs, which are financed directly by tax revenues, the only eligible persons are those whose incomes fall below a certain threshold. In our lead paper Alison Evans Cuellar and Joshua Wiener discuss Germany's universal long-term care program, emphasizing that almost three-quarters of its beneficiaries are cared for in noninstitutional, community-based settings. Next, John Campbell and Naoki Ikegami describe Japan's new program, which they characterize as “the most radical program of public, mandatory long-term care insurance in the world.” Following are papers on long-term care in the United States, Australia, and New Zealand. The authors of the American paper, Judith Feder, Harriet Komisar, and Marlene Niefeld, make clear that U.S. policymakers have yet to address many of the long-term care issues that Germany and Japan—both of which have older populations—have already faced.Other offerings underscore, at once, the differences and the similarities of many of the health care issues all industrialized nations face, be they questions of long-term care or broader structural concerns. Among the most compelling are those issues facing the resource-starved National Health Service (NHS) of the United Kingdom. After a period of fourteen years the Nuffield Trust invited American economist Alain Enthoven to return to England for another examination of its status. Enthoven studied the NHS in 1984, and some of his conclusions had influenced the government of Margaret Thatcher. His new findings, articulated initially as the renowned Rock Carling Lecture, and six international reactions to them, are published in this issue. Two offerings on Canada punctuate the state of that country's health care system: One is an interview with the federal health minister, Allan Rock; the second is an interesting look at how its health services research and policy communities are linking their respective agendas. The United States, where policymakers only occasionally recognize research and where researchers delve into matters of little concern to policy, should take note. The issue also includes the latest health spending trends among member nations of the Organization for Economic Cooperation and Development, an update on the outpatient pharmaceutical policies of seven nations, a special report on how the Pew Charitable Trusts' health and human services program has changed, and an essay by David Mechanic on rediscovering the social determinants of health.Once again, we are joined in this international effort by the Commonwealth Fund, a private American foundation that is determined to build a broader network of policy-oriented health care researchers whose scholarship provides lessons for the United States and other industrialized countries. In 1996, under the directorship of Robin Osborn, the fund established the International Program in Health Policy as a successor to the Harkness Fellowships, an international exchange program it had operated since 1925. Its new fellowships enable leading scholars from the United Kingdom, Australia, and New Zealand to conduct research in the United States that is relevant to health care policy in both the United States and the fellow's home country. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 1 History Published online 1 May 2000 InformationCopyright © by Project HOPE: The People-to-People Health Foundation, Inc.PDF downloadCited byCare Stress Experienced by Caregivers of Elderly Individuals With Disabilities and the Coping Strategies Utilized: A Survey Study in the City of Nanjing, China8 April 2019 | Journal of Family Issues, Vol. 40, No. 10