The 2nd HPD report - Health Policy Monitor

LTC: Variety of
concepts and
definitions
Beneficiaries,
quality, eligibility,
funding
the oldest old (80 years or older), is growing faster than that of
any other age group. This increase results not only from prolonged
life expectancy but also from decreasing fertility rates.
Aging societies face important economic and social changes
that require a timely and adequate response. International organizations,
governments and civil society must enact proactive
aging policies and programs that enable older citizens to enhance
their health, participation and security.
Some countries have concentrated on providing coverage for
services needed by persons who can no longer manage their daily
lives independently. Policies directed at providing and financing
such services are often summarized under the term “long-term
care” (LTC). However, this notion does not follow per se a common
definition: In some countries, long-term care includes both
nursing care and personal care. In others, LTC means nursing
care only. As an umbrella term, LTC covers all age groups; that is,
LTC is not just provided to the elderly, but can also reach younger
people, the disabled and the chronically ill.
The provision of care is also a major issue of political debate.
Most societies must rely on care provided by family members or,
more generally, laypersons instead of professionals.
Moreover, both eligibility for financial support and the definition
of neediness are bones of contention in the current debate.
Last but not least, quality deficits and poor coordination of services
in and between sectors also need to be addressed.
Reforms on these issues are high on the agenda in the Netherlands,
in Spain, in the United Kingdom and elsewhere. Australia
has established a Ministry for the Aging and addresses the broad
spectrum of policies on aging through a comprehensive strategy.
This approach is still more the exception than the rule.
Regarding the financing of long-term care, countries face a
choice between social insurance contributions and taxes on the
funding side and between the insurance principle and meanstesting
on the eligibility side. Countries such as Austria and
Germany have introduced insurance coverage in the last decade
and are now in the process of discussing or introducing reforms
of their schemes. Other countries such as Singapore, Spain,
Switzerland and France are just beginning to introduce such
coverage. New Zealand and the United Kingdom are discussing
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