The WHO Centre for Health Development (WHO Kobe Centre – WKC) has produced a seminal series of research briefs on Financing LTC: Lessons for Low- and Middle-Income Countries (LMICs) which distil key research findings for policy-makers about LTC policies, systems and institutions.
Brief 1 addresses the issue of what drives the demand for LTC in LMICs. The number of people aged 65 years and older will increase in middle-income countries, where most older people will be living by 2050. At the same time, many people in LMICs will experience the onset of age-related health problems before the age of 65 years. Investments in formal LTC are needed to ensure that older people have access to needed services.
Brief 2 explores options for policy-makers on population coverage of public LTC. Governments that decide to invest in LTC for older adults face policy choices of whether service coverage is universal or selective in covering specific groups or the poor. While universal LTC is assumed costly, this depends on the generosity of the benefits package and decisions about its implementation.
Brief 3 covers the thorny issue of how countries finance LTC. Where no LTC system exists, individuals, families and communities cover costs, leading to inequitable access to services and negatively impacts economic growth. This brief contains specific lessons for LMIC settings in using general taxation and insurance programmes for LTC.
Brief 4 discusses the LTC services that can be covered in the benefits package, which may include medical or nursing care, personal care, and assistance and social care. Establishing an LTC benefits package is an ongoing process. It requires continuous assessment of how needs and eligibility are determined, setting thresholds for eligibility, regularly revising benefits and services based on evidence, and linking services to financing and delivery systems that promote quality.
Brief 5 presents evidence about how countries align financing and delivery in LTC. It discusses the balancing act of providing coverage across institutions and in the community for widely varying health and social services for beneficiaries. Many countries are shifting service delivery to communities, but this approach may not be cost saving because delivering care outside of institutions requires investments in quality assurance systems at community level.
Brief 6 covers how countries can ensure financial protection in LTC in recognition that most people are unable to save enough to access needed care as they age. Policies may include targeting those in greatest need, including people with dementia or who have suffered strokes. Countries have also eliminated caps on needed services and capped individual payments to protect people from very high LTC spending.
Brief 7 presents evidence on promoting quality and value in LTC. The COVID-19 pandemic revealed shockingly high rates of preventable mortality among vulnerable older people in LTC settings which could often be attributed to inadequate quality and safety measures in LTC institutions. LMICs can learn from mistakes in more developed settings and invest early in LTC quality and safety to protect vulnerable older people.
Brief 8 presents global evidence financial sustainability in LTC, which requires considering the broader economy-wide impacts of LTC investments across economic, health and social sectors.
This series was written by WKC’s Director, Dr Sarah Barber, jointly with the WHO Departments on Health Governance and Financing, and Ageing, in cooperation with global experts on LTC financing and systems.
These include co-authors and reviewers from Dalhousie University ( Marilyn MacDonald, Erin Langman, Julie Caruso); European Observatory for Health Systems and Policies ( Jon Cylus); Harvard University ( Terence Cheng, Winnie Yip); Independent Health and Aged Care Pricing Authority ( Kees van Gool); Japan Society for the Promotion of Science (Mariko Kanamori); Kyoto University (Sasaki Noriko, Yuichi Imanaka, Goto Etsu); London School of Economics (J Costa-Font); Miami University ( Sara McLaughlin); National Center for Geriatrics and Gerontology (Xueying Jin; Tami Saito; Taiji Noguchi; Ayane Komatsu); Organisation for Economic Cooperation and Development ( Ricarda Milstein, Luca Lorenzoni); University of Lisbon (Ricardo Jorge Alcobia Granja Rodrigues); University of Santiago (Pablo Villalobos Dintrans); University of Trieste ( Ludovico Carrino); WHO Centre for Health Development ( Megumi Rosenberg); WHO Communicable and Non-Communicable Diseases Department ( Katrin Seeher); WHO Country Office for Indonesia ( Feby Oldfisra); WHO Department of Maternal, Newborn, Child and Adolescent Health and Ageing ( Jang Hyobum); WHO Regional Office for Europe ( Cassandra Simmons); WHO Regional Office for South-East Asia ( Tsolmongerel Tsilaajav).
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