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How different countries allocate long-term care resources to older users: changes over time
London School of Economics, UK ; Catholic University of Milan, Italy.
National Institute of Health and Science on Ageing (INRCA), Italy.ORCID iD: 0000-0002-1497-0011
Tokyo University, Japan ; University of Michigan, USA.
Keio University, Japan.
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2016 (English)In: Long-term care reforms in OECD countries: Successes and failures / [ed] Cristiano Gori, José-Luis Fernandez, Raphael Wittenberg, Bristol: Policy Press, 2016, 77-116 p.Chapter in book (Refereed)
Abstract [en]

A key policy debate in long-term care (LTC) policies across OECD countriestoday can be summarised by the following question: what measures and strategiescan be adopted to optimise resources? New policies are required for balancingfinances and access to care, with different options on the table and waiting forgovernments’ decisions.This chapter looks at changes over time in public resource allocation amongLTC users in the same OECD countries considered in the previous chapter (exceptfor Australia). As in Chapter Four, this chapter focuses exclusively on publiccare inputs, defined as those inputs that are (at least partially) publicly funded,and looks at users aged 65 and over. Chapter Four led the way to reconsideringhow public resources are allocated in different LTC systems through an in-depthanalysis of current spending. To complement that analysis, this chapter adopts along-term perspective, investigating the changes that have occurred over the last20–25 years in three crucial dimensions of resource allocation: the mix of LTCservices for older people, their intensity, and their coverage.The countries considered are representative of the OECD environment withrespect to both the overall welfare models and the models of LTC policies.Concerning the former, as Campbell et al have noted in Chapter Four, ‘wehave Sweden in social-democratic Northern Europe, Italy in familial SouthernEurope, Germany in corporatist mid-continent, Australia, the US and Englandas quite different versions of the Anglo-Saxon “residual” model, and Japan as therelatively new entry that shares aspects of all the other models.’ From the pointof view of LTC policies, the sample of countries selected represents the differentmodels in the OECD context:

• Universal coverage within a single programme: this model guarantees people access toformal services without taking into account users’ income or assets as eligibilitycriteria. It is also organised as a single system, separated or integrated with theoverall health system (Germany, Japan and Sweden).

• Mixed systems: in this case, LTC is provided through a mix of different universalprogrammes and benefits operating alongside, or a mix of universal and meanstestedLTC entitlements (England and Italy).

• Means-tested systems: under this type of scheme, LTC coverage is providedthrough safety-net programmes. In countries using this system, income and/or asset tests are used to define thresholds for eligibility to publicly fundedcare. Only those falling below a set threshold are entitled to publicly fundedservices or benefits (the US) (Colombo et al, 2011).

This chapter is organised as follows. First, it addresses the issue of resourceallocation, providing a definition of the topic and the methodology used. Themain policies implemented in each of the six countries are then examined. Finally,a comparative discussion on the trends emerging across our sample is presented,followed by a final paragraph looking ahead.

Place, publisher, year, edition, pages
Bristol: Policy Press, 2016. 77-116 p.
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Gerontology, specializing in Medical and Health Sciences Political Science (excluding Public Administration Studies and Globalization Studies)
Research subject
Health and Caring Sciences; Medicine, Gerontology; Social Sciences, Political Science
Identifiers
URN: urn:nbn:se:lnu:diva-52260Libris ID: 19129371ISBN: 978 144731 071 6 OAI: oai:DiVA.org:lnu-52260DiVA: diva2:923739
Available from: 2016-04-27 Created: 2016-04-27 Last updated: 2016-04-28Bibliographically approved

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Barbabella, Francesco
Health Care Service and Management, Health Policy and Services and Health EconomyGerontology, specializing in Medical and Health SciencesPolitical Science (excluding Public Administration Studies and Globalization Studies)

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CiteExportLink to record
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