Cost-containment long-term care policies for older people across the Organisation for Economic Co-operation and Development (OECD): a scoping review

Abstract

In most Organisation for Economic Co-operation and Development (OECD) countries, the government has to manage tension 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 scoping review of these measures has so far not been produced. This article aims to contribute to filling this gap. We present a typology of LTC cost-containment policies across the OECD. Cost-containment policies cluster in 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. Furthermore, an indirect outcome of the review is that it allows an overview of potential negative implications of these policies. These negative implications can be grouped in two macro spheres relating to a worsening of the care arrangements for beneficiaries and to increased demand for individual/family resources, in both economic and time and effort terms. In the light of the expected profound impacts of the COVID-19 outbreak on all social security sectors in the medium and long term, this article provides a valuable tool for both academic and policy-making debate. It allows an analytical comprehension of cost-containment strategies adopted in LTC sectors linking them with the related impacts on beneficiaries and their families.

Long-Term Care Insurance for Older Adults in Terms of Community Care in South Korea: Using the Framework Method

“…The findings of the research suggest a number of significant policy measures that should be undertaken to revise LTCI for older adults to meet the aims of community care. There should be an urgent need for overall reformation, including reinforcement of the LTCI system [33,34] and modifying the role of the local government. Most of all, there is a need to actively expand the new kinds of health services that can be used at home.…”

Dependency and Elderly Care: The Cost of the Long-Term Care System in the Context of the SDGs

“…Ageing populations have forced national governments to control growing long-term care (LTC) public expenditure. This has resulted in an increasing centrality of costcontainment policies [4].…”

The Risk of Household Socioeconomic Deprivation Related to Older Long-Term Care Needs: A Qualitative Exploratory Study in Italy and Spain

“…Since the 1990s, the cost containment of long-term care policies and the spread of cash benefits schemes imply a growing informal care rate and the parallel expansion of for-profit home care across Europe [11][12][13]. An increasing number of studies, focusing on the impact of LTC expenditure on the income of informal caregivers of dependent older people [14], set out the additional costs that individuals must defray with the onset of dependency and the difficulty in doing so given the current level of state pensions [15] or looking into the financial sustainability of an ageing population and higher levels of public healthcare expenditure [16].…”