Governance and finance of long-term care - University of Birmingham

Allen et al., 2011 Governance and Financing of LTC | European Overview
et al., 2010). Further reforms were announced in Spring 2011. Again elements of the LTC were moved to
the local authorities. In France, the expected law for financing LTC is intended to rely strongly on an
individual mandatory type of LTC insurance which would be mutual and thus secured through a fund.
The success and effects of such strategies remain unknown, with some presenting potential challenges
to equity and access e.g. increasing emphasis on user responsibility/payments.
Underlying the sustainability debate in many countries is the role played by informal care, care which in
most European countries continues to provide the bulk of LTC at least when provided at home (see
Triantafillou et al., 2010). In Austria, Germany and France, LTC systems were set up as a supplement to
care provided by the family, with cost-­‐containing motivations in mind (even if not explicitly stated).
There are however, growing concerns over how much care families will be able to supply and for how
long, as carers themselves will be ageing and more isolated. This in turn may pose added pressure on
public social protection systems or give rise to gaps in care provision which already exist in many
countries.
The financial sustainability of LTC depends also on the degree to which health care and other
components of social LTC services will be integrated in comprehensive reform steps. The country
examples point towards a variety of possibilities to pool various funding sources:
• The Greek national report highlights the importance of integrating health and social care at a local
level.
• Switzerland reports that the federal government refers to case management as a means to improve
cooperation between ambulatory and residential care, as well as between medical and social
services.
• The Swedish company ‘Tio Hundra’ has contracts with both the county councils (responsible for
nursing and hospital care) and the municipality (responsible for social care).
• In England, use of ‘total place’ welfare budgets seek to move decisions over benefit payments to a
local level, with welfare spending incorporated into pooled area-­‐based budgets.
National governments have also started to foster various support mechanisms for local cooperation for
integrated LTC:
• The Netherlands report a central state cooperation with municipalities, welfare organisations and
housing corporations. In the Netherlands, so-­‐called ‘care standards’ are developed and implemented.
Based on existing guidelines and consensus needs are described and purchased in the near future,
but also how it should be delivered. At this moment, care standards exist for Diabates, COPD and
cardio-­‐vascular risk-­‐management. The dementia care standard is developed by the Dutch Alzheimer
Association and Vilans. This care standard overarches acute care, LTC and social care.
• The Finnish response has been to improve clients’ active participation in the planning of appropriate
care.
• In the UK special attention has been given to joint commissioning and to creating integrated service
providers for LTC services.
• Slovakia has taken a step toward the governance of integration by highlighting elements of an
integrated LTC system under new legislation.
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