The WHO Centre for Health Development (WHO Kobe Centre – WKC) has produced a series of research briefs on financing long-term care (LTC) which translate research evidence to guide policy-makers on designing and financing LTC in low- and middle-income countries.
Brief 6 in the series Financing health and social long-term care: lessons for low- and middle-income countries (LMICs) addresses how countries can ensure financial protection in LTC.
Most people are unable to save enough money for the LTC services they may need, either because they underestimate their future needs and the costs of LTC, or mistakenly believe it is covered under universal health services or health insurance. Without financial protection, the costs are very high for older adults. Even in high-income countries with pension systems, about half of older people with care needs would experience poverty if there were no financial protection under the public LTC systems.
In countries without formal LTC systems, these costs shift to individuals, families and communities. People who are poor and in ill health are likely to be disproportionately affected, and women are particularly hard-hit as they usually live longer, have care needs for longer, yet lack the resources to pay for them.
Some countries have shown that strong, formal LTC systems can protect older people from forgone care and high LTC spending. Notably, countries with a universal approach to LTC that provide generous benefits are more effective in ensuring financial protection and reducing out-of-pocket expenditures for people with low incomes compared to countries with selective LTC systems that specifically target the poor.
Targeting coverage for individuals with complex needs – such as those with dementia and stroke – can help protect those who face high payments associated with intensive caregiving needs. This is particularly important in LMICs where the burden of dementia is projected to increase, and the vast majority of the global burden of stroke already occurs in low- and middle-income settings.
To protect older people from catastrophic LTC spending, it is necessary to limit individual maximum payments and eliminate caps on needed LTC benefits. In some settings, older people receive special entitlements to reduce out-of-pocket payments for needed health and social care. In low- and middle-income settings, investments in strong LTC institutions and policies are needed to protect families from high spending or forgone care.
WKC conducts research on sustainable financing for health to accelerate progress toward universal health coverage - coverage, quality, financial protection and positive health outcomes - for older adults.
Read more about this research here.