Financing sustainable and quality long-term care (LTC) is a challenge for policymaking in low- and middle-income countries (LMICs). The WHO Centre for Health Development (WHO Kobe Centre – WKC) has tackled this challenge in a series of research briefs on Financing LTC: Lessons for Low- and Middle-Income Countries, which explain current practices in countries to make research and evidence more accessible for policymakers.
Building on the previous briefs, Brief 5 discusses how countries allocate resources for LTC across different delivery settings, balancing the aim of providing coverage of widely varying services for beneficiaries with financial sustainability and financial protection.
While developed LTC systems reflect how nursing homes are still a major expenditure category, trends show a shift to providing services at home and in community settings, perhaps due to individual preferences. However, this shift may not necessarily be cost-saving for public payers.
“Significant investment is required to ensure delivery of quality LTC, including skilled caregivers, home and community visits, and systems for quality and safety checks, and medical referrals,” says WKC Director, Dr Sarah Barber, and author of the Brief series.
“Similarly, some patients with life-limiting illnesses and their families may prefer to opt for home-based palliative care which can reduce pressure on hospitals and institutions. However, significant investment is required to ensure quality care for pain management, for instance,” says Dr Barber.
LTC financing and delivery systems that integrate health or social services may promote access for those such as older persons who might otherwise struggle to navigate these systems. Governments can choose to provide services directly or purchase services from private providers who might compete to offer choice and care options at lower costs. With care quality a concern in this case, governments are still responsible for decisions such as enrolling and accrediting eligible providers, identifying who is eligible, setting reimbursement rates, and monitoring quality control.
“An interesting option that some countries offer is cash subsidies for beneficiaries to purchase personal, health or medical services from either professional or informal caregivers. Theoretically, this allows choice, enabling people to stay at home, and reducing reliance on institutional care. However, we found that the impact of cash subsidies is unclear, and current evidence suggests that subsidies are insufficient to generate the demand for professionally provided services and meet care needs.
“A failure to align financing and delivery in LTC could have quite undesirable effects. For instance, in settings with weak regulations, such as in many LMICs, purchasing low-quality LTC services may lead to suboptimal outcomes. It may pressure women to remain in traditional informal caregiving roles and negatively impact the overall economy of the household,” she concluded.
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.