Abstract

In most OECD countries, the governments have to manage tensions between growth in the need for long-term care (LTC) services for older people and significant public budget constraints. Not surprisingly, therefore, cost-containment policies are of increasing relevance. Nevertheless, despite the flourishing interest in the comparative literature in reforms and the sustainability of LTC policies, a systematic review of these measures has not been produced so far, to the best of our knowledge. This paper aims to contribute to filling this gap. Using a scoping review, the paper aims to define a conceptual model of cost-containment policies by providing an analytical synthesis of the core of cost-containment measures, grouping them within the analytical level at which they operate. A scoping method was chosen for this review as this approach is particularly suited to addressing broad topics, such as cost-containment, rather than narrowly defined research questions.

The paper presents a typology of cost-containment policies in LTC across the OECD and a preliminary outlook regarding potential negative implications of these policies. Cost-containment policies cluster into two areas according to their focus: demand-side policies, which reduce the actual chances of receiving LTC services and/or make them more expensive for users; and supply-side ones, which modify the provision of services. Demand-side polices consist in tightening eligibility criteria (needs testing/means testing/carer sighting), reducing care responsiveness (increasing waiting time/extending the time to process cases) and introducing or raising co-payments. Supply-side policies consist in changing the mix of services (prioritising community care over residential care/prioritising cash benefits over services in kind/shrinking the care package available) and reducing the intensity and/or quality of services (direct reductions/indirect reductions). Negative implications can be grouped in two macro spheres relating to a worsening of the beneficiaries' care arrangements, and to an increased demand for individual/family resources, in both economic terms and time and efforts terms.