Long-term care financing: lessons for low- and middle-income settings. Brief 1. Drivers of the demand for long-term care

Book excerpt: This brief is part of a series about financing health and social long-term care: lessons for low- and middle-income countries (LMICs). The number of people aged 65 years and older will increase in LMICs, where most older people will be living by 2050. Many people in LMICs will experience the onset of age-related health problems before the age of 65 years. Long-term care (LTC) can include some acute care medical services delivered in health facilities, but it primarily refers to support provided outside of the health system by caregivers in institutions or at home to allow people to maintain their routine activities. Individuals’ unmet needs increase the demand for LTC. Without formal LTC services and systems, the costs of LTC shift to the family. Informal caregivers, primarily women, may need to reduce their working hours or leave the labour force prematurely, placing pressure on the economy and household resources. The availability of informal caregivers has declined along with decreases in fertility and family sizes, and increased opportunities for women in the formal workforce. In the absence of formal LTC services and systems, individuals seek care in the acute care medical system, which can increase health care costs while offering suboptimal care for older adults. People underestimate their need for LTC, even though many may require intensive support or institutional care that may exceed their income. Given the market failures of LTC insurance, public intervention is well-justified to meet this demand.