The future of long-term care
Newsletter 2008-6
Publication date : 2009-04-15
As the number of older people increases and
with it the need for long-term care, several countries are looking at ways of
keeping care affordable while ensuring equal access to all. Estimates suggest
that the share of the population aged 65 and over will approach 20% by 2030
and 25% by 2050. More significantly, the share of those aged 85 and older, is
expected to double from 1.5% in 2005 to 3% in 2030 and to rise to over 5% by
2050.1 The Netherlands, where there is currently a
public debate about the future of long-term care, hosted a Peer Review meeting
in February this year. The Peer Review focused on the AWBZ (Exceptional Medical
Expenses Act), introduced as long ago as 1968 to respond to the need for
non-hospital care. Although participants in the Peer Review agreed
that there is no unique solution, they also agreed that social insurance
should be the preferred funding source since it offers greater
protection against service cuts than tax-financing, especially during periods
of recession. Participants felt that private insurance could not form the
backbone of long-term care systems, since if it were risk-related, it would
rule out universal provision, and if it were compulsory it would be
indistinguishable from social insurance. However, sustainable long-term care requires
more than the right balance between collective and individual responsibility.
While participants agreed that the provision of care should become more
integrated, they warned against the danger of health care taking precedence
over long-term care and taking funds away from this. Accordingly, there was
much interest in the Dutch scheme of ‘personal budgets’ (PBs), under which
individuals receive a specific allowance to use on the services they choose, so
controlling costs while giving people more autonomy. It was also stressed that policies should address the question of how to
balance demand and supply of qualified staff given the looming shortage of professional care workers. This, it was
noted, could be achieved by reducing demand, as well as by increasing supply,
through prevention, better healthcare and special measures, such as the
‘reablement’ scheme in the UK, which helps people be more self-sufficient in
their own homes. Equally, more people could be encouraged to take up care work
by making it more attractive and increasing pay. 1 OECD (2007):“Trends in
Severe Disability Among Elderly People” DELSA/HEA/WD/HWP Lessons learned
