Public provision and financing of long-term care: case studies in middle- and high-income countries

Book excerpt: As global populations age, governments around the world are investigating how to fund long-term care (LTC) in an equitable and sustainable manner. The research reported here has three objectives: (i) to identify and classify middle-income countries (MICs) and high-income countries (HICs) that have established LTC for older populations; (ii) to describe the financing features and undertake a detailed assessment of the public LTC programmes in these countries; and (iii) to identify and discuss the benefits, disadvantages and challenges of the different public LTC financing strategies, based on the experiences of high-income countries and on observations of the reviewed countries. The public LTC financing system of 13 countries is reviewed: five HICs (Australia, Japan, the Netherlands (Kingdom of the), Singapore and Uruguay), and eight MICs (China, Costa Rica, India, Indonesia, Malaysia, Serbia, South Africa and Thailand). Although information on LTC expenditure is not consistently reported or available for all countries, the 13 reviewed countries vary considerably in terms of their national income, total spending on health and public share of health care spending. This report concludes with some deliberations and lessons learned on financing options for LTC, specifically for low- and middle-income countries. Overall, the report offers valuable insights into how policy-makers can design effective and sustainable public LTC financing systems, ensuring that individuals and their families receive the necessary support and assistance to lead dignified lives as they age.