What Long-Term Care Looks Like around the World

What are other countries doing to provide — and pay for — long-term care for their aging populations? Although the answer varies, one aspect is consistent with the American experience: they are worrying about it. In all countries a substantial share of people needing long-term care are over the age of 80 and have dementia-related problems. Is the U.S. approach like or unlike the systems put in place in other countries?

The Organisation for Economic Cooperation and Development (OECD), based in Paris, collects statistics about its member countries, including the U.S. A 2011 study of how 25 of these countries provide and pay for long-term care found that most OECD governments have set up collectively-financed schemes for personal and nursing care costs. Although these systems are set up differently, they all are based on the principle that everyone should pay into a fund that supports older people who need long-term care, including personal care. They see this as a collective responsibility, not solely a personal one.

Ten long-term care differences among countries around the world

Looking at a representative group of ten countries, not including the U.S., there are some striking differences from the American approach:

  • Some of the countries, such as Norway, have universal coverage as part of a tax-funded social care system.

  • Others have dedicated social insurance schemes, as in Germany, Japan, France, the Netherlands, and Luxembourg.

  • A few arrange coverage mostly within the health care system, as in Belgium.

  • Several countries have universal personal-care benefits in cash (Italy), or in kind (Australia).

  • The only country with safety net or means-tested programs, other than the U.S., is the United Kingdom; Scotland, however, which has its own parliament, has free personal long-term care coverage.

  • In the UK, a country that has had universal health care coverage since the aftermath of World War II, there is significant political opposition to tax-funded long-term care.

  • Within the broad category of social insurance schemes, there are different funding mechanisms: general revenue (France and Japan), payroll tax (Germany, Japan), or income-related taxes and means-tested copays (the Netherlands).

  • Similar to the U.S., however, these countries face projections for a rapidly increasing share of the population aged 80 and above, and continue to put a larger share of funding toward institutional care, even though more than half of the older care recipients receive care at home. Another similar finding is that caregiving leave is less frequently available than parental leave. Paying caregivers (carers in the European terminology) may increase the supply of family care but carers risk being trapped into low-paid roles in a largely unregulated part of the economy.

  • Despite the differences in funding mechanisms and service delivery, the percentage of public expenditures for all long-term care were quite similar across countries, including the U.S. Only the Netherlands had a higher percentage — 1.7 percent of Gross Domestic Product (GDP) as opposed to 1.0 percent in Germany.

  • The OECD report sees private long-term care insurance only as a niche market in the United States and France, the largest markets in the OECD community, with the U.S. share at 5 percent of people over the age of 40 having this kind of insurance and the French share at 15 percent.

The full report is available at the OECD's website.

Variations in long-term care across borders

In each country long-term care policy develops from a specific background of history, politics, resources, culture, community standards, emphasis on personal and family responsibility, and the role of government in social welfare. From this perspective, the U.S. policies are distinctly “American,” just as the policies in Norway are distinctly “Scandinavian.” But times change, and populations change, and all countries are facing similar challenges now and even more daunting problems in the future.

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