Policy messages from The Care Dividend: Why and how countries should invest in long-term care

The WHO Centre for Health Development (WHO Kobe Centre/WKC) has released companion pieces for policymakers to highlight four key reasons for investing in long-term care (LTC) from the new book, “The Care Dividend: Why and How Countries should invest in Long-Term Care,” just published by Cambridge University Press. 

The companion pieces were written by Dr Sarah Louise Barber, Director of the WHO Centre for Health Development; Associate Professor Ludovico Carrino, University of Trieste; Dr Jonathan Cylus, European Observatory on Health Systems and Policies; Dr Stefania Ilinca (WHO Europe), and Associate Professor George Wharton, London School of Economics Department of Health Policy.

The Economic Reason: Unlocking economic growth in an ageing world

1. Investing in long-term care (LTC) is a key economic strategy as populations age. Strong LTC systems stimulate economic growth, create jobs, and support informal caregivers to participate in the workforce, offsetting concerns about slower economic growth as people retire. 
2. Investing in LTC could stimulate growth in goods and services and unlock new economic potential that outweighs incremental government spending on LTC.
3. Countries that do not invest adequately in LTC and rely on informal caregivers (predominantly women) will lose opportunities for economic growth compared with investments that enable informal caregivers to remain in or enter the workforce. 

“Timely and decisive policy action can secure the wellbeing of older adults and drive sustained economic growth. The issue is not about whether countries can afford it (if raising taxes slows economic growth) but rather preventing economic slowdown by enabling informal caregivers to participate in the labour force and work where their skills are most productive,” say the co-authors of the brief.

The Health System Reason: The vital link between LTC and health care systems

1. Coordination is critical between health and LTC systems to provide support for health, functioning and social and emotional care needs of older adults. 
2. A robust long-term care system is essential for preventing avoidable hospital admissions, delivering appropriate care, and safeguarding the viability of health systems. Similarly, a strong health system can promote better physical functioning and reduce demand for LTC later in life.  
3. Without support for LTC, the health system can be overwhelmed with older adults who occupy beds as social admissions. This can drive up health care costs and strain resources.

“LTC is a critical strategy for managing health costs linked to unmet health and social care needs of older adults. By investing in health throughout the life course, countries can delay or reduce the demand for LTC systems. Both health and LTC systems are central to the health and well-being of older persons and need to be well-coordinated to manage their needs.” 

The Socio-Ecological Reason: Fostering individual health and financial well-being through robust care

1. A well-structured LTC system is the cornerstone of well-being in later life. It protects people from catastrophic out-of-pocket costs and upholds fundamental rights to dignity, self-determination, health and security. 
2. Population ageing directly impacts on the need for LTC because needs increase steeply with age. The increasing gap between life expectancy and healthy life expectancy suggests that growing numbers of people will require years of health care and LTC as they age. Women benefit disproportionately as they are likely to live longer; as their income tend to be lower, LTC could overcome this barrier to accessing needed care.
3. Most people are unable to save enough to meet the high costs of accessing formal LTC as they age. In countries without formal LTC systems, households bear the brunt of these costs which increase the risk of poverty.

“Governments can quickly reduce financial hardship and elevate standards of living across all generations by introducing bold policies such as expanding public LTC funding and capping individual out-of-pocket payments. Investing in strong LTC systems is a primary means to improve mental and physical health and well-being of older people and their family caregivers. Policymakers can justify broadening eligibility for LTC services in terms of increased welfare and financial protection.”

The Political Reason: How governments can lead on care innovation

1. The most critical demographic trend of the 21st century is population ageing, driven by increased longevity, declining fertility rates, and increasing number of people globally. 
2. Needs can be met by formal LTC systems and informal caregivers – or LTC needs can go unmet.
3. Governments hold the key to revolutionizing LTC: they can raise resources, set eligibility rates that are equitable, ensure financial protection and quality, and invest in a strong workforce.

“Government leadership can align LTC resources with the real needs of an ageing population. Decision-makers can unify policy, funding and innovation to create a future where older adults receive high quality, sustainable care, where families and communities can flourish rather than fold under the pressure of demographic change.” 

Find the book here.

WKC conducts research about innovations in service delivery models and sustainable financing to accelerate progress towards Universal Health Coverage in the context of population ageing.