Abstract

This study analyzes trends in financing long-term services and supports (LTSS) across the OECD: in view of increasing pressures on the public purse due to population aging, how are countries facing the need to support the growing numbers of people needing LTSS? It focuses on clusters of strategies and the countries that are employing them.

In England and Australia, policy has shifted toward protecting citizens against the catastrophic costs associated with LTSS, albeit in a manner that does not fully protect them. In France and Germany, we see considerable expansions in private insurance for middle-income individuals: in the case of Germany, this is attributable to government action, while a combination of factors has spurred the French expansions. East Asian countries (Japan, South Korea, and Taiwan) have developed a distinctive model of social insurance for LTSS, one that is now mature enough, in the former two cases, to assess its advantages and disadvantages. The Scandinavian countries and the Netherlands are looking at ways to control costs for their relatively generous systems, often by re-thinking the relationship between local and higher levels of control, as well as, in the case of the Netherlands, the line between health and long term care systems. Meanwhile, the United States continues its lack of progress toward resolving its LTSS financing problem, although there are some indications of an emerging public/private solution.

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