Title

Background

Implementing universal health coverage (UHC) implies ensuring access and financial coverage for care for older persons. In Phase 1 of this research on pricing health care services, we found very different systems in place for financing and access to benefits for services for older persons in comparison with health services. Phase 2 focuses on the organization and financing of long-term care services, and the systems in which services are priced, organized and delivered.

Methods

Nine country case studies were commissioned, representing a range of health care systems, experiences in purchasing and price setting, and the commitment to improve financing mechanisms to attain broader policy goals. Each case study describes the organization, coverage, financing and entitlement for facility-based health care, home-based care, residential care and personal care for older persons. The case studies describe long-term care financing, pricing long-term care services, and the policies in place to ensure fiscal sustainability and provide financial protection. 

Findings

The summary report distils lessons learned from the case studies in long-term care financing and price setting and draws policy lessons to drive country action, particularly in low- and middle-income settings. The report concludes that:

• Public investments in formal LTC systems are important because of population ageing and declines in the availability of family caregivers, many of whom are women.
• The overall objectives of a given LTC system will have an influence on how care is organized and financed in that system.
• A separate funding stream may help ensure that LTC funding is not diverted to other purposes, promotes transparency in management; however, the separation of funding for LTC and health care may pose problems in coordination across health and social care.
• Funding to LTC should be linked with need and the care provided; all of the countries studied use objective needs assessments to determine eligibility, and link prices and payments with health and social care needs.
• Where cost control is the primary objective and eligibility criteria are stringent, unmet needs may emerge. Therefore, needs assessment systems should be monitored to ensure that they enable access to needed care. Similarly, systems of user charges should be formally evaluated as to whether their application results in reduced utilization and unmet need.
• Funding to LTC to should be based on a secure reliable source that reduces any regional inequities in resources available.
• Price adjustments and add-on payments could be used more broadly to foster equity in provider payment.
• Quality measurement in LTC is an important area requiring further policy development, which can be linked to price levels and payment mechanisms.

Global implications

Lessons learned from countries with mature long-term care systems can be an important resource for middle- and low-income countries, who are facing the challenges of providing appropriate quality health and social care for older populations. An important lesson is that formal investments in financing public LTC are important because of the increased demand for these services with population ageing, and the declining availability of informal caregivers.  

Local implications 

The case study from Japan provides important lessons learned for other countries, including the need to consider sustainability in the design of LTC, monitoring the eligibility criteria, enabling informed choice and monitoring equity in access.