The WHO Centre for Health Development (WHO Kobe Centre – WKC), in cooperation with the Departments of Health Governance and Financing and Maternal, Child Health and Ageing, is undertaking a major research project on long-term care (LTC) financing to provide evidence for policies in low- and middle-income countries about the design and financing of LTC.
As part of a series summarizing current evidence, WKC commissioned a rapid scoping review about initiatives to improve coverage, quality, financial protection and financial sustainability in LTC, which has been published in the BMJ Open.
For this scoping review, lead authors Marilyn Macdonald and Lori Weeks of the School of Nursing, Dalhousie University in Canada, found 24 eligible studies published in any language between 2017 and 2022 that captured LTC initiatives for people aged 60 and older. These studies addressed coverage based on the level of disability, income, residence, and employment, as well as financial protection, out-of-pocket payments, and the risk of poverty related to costs of care, among others.
They found that where LTC insurance was mandatory with appropriate funding, initiatives assisted care provision at home or in communities. Efforts to expand population coverage were common across the initiatives, which could have wide economic benefits. Those that enabled older people to access needed services without financial hardship contributed to improved health and well-being.
A range of care that starts with remaining at home through to institutional care embraces the notion of ‘the right support, at the right amount and the right time to delay decline’. This may promote independence among older people for a longer time. It may also alleviate costs and contribute to financial sustainability.
This study identified gaps in the existing literature and proposed areas for improvement, such as the importance of including equity measures.
Read more about WKC’s LTC work here.