Can social insurance for long-term care work? The experience of Germany.
In 1994 Germany enacted a universal-coverage social insurance program for long-term care to largely replace its means-tested system. The program has achieved many of its stated policy goals: shifting the financial burden of long-term care off the states and municipalities; expanding home and community-based services; lessening dependence on means-tested welfare; and increasing support of informal caregivers. Many of these goals were reached without exploding caseloads or uncontrolled expenditures. We examine the German long-term insurance program, focusing on issues of financing, eligibility and assessment, benefits, availability of services, and quality assurance. (+info)
Long-term care insurance comes to Japan.
Japan has moved decisively toward "socialization of care" for the frail elderly by initiating public, mandatory long-term care insurance (LTCI) on 1 April 2000. The LTCI program covers both institutional and community-based caregiving. Everyone age forty and older pays premiums. Everyone age sixty-five and older is eligible for benefits based strictly on physical and mental disability, in six categories of need. Benefits are all services, with no cash allowance for family care, and are generous, covering 90 percent of need. Long-term costs seemed not to be a major consideration in program design. Consumers can choose the services and providers they want, including use of for-profit companies. (+info)
Long-term care in the United States: an overview.
Although long-term care receives far less U.S. policy attention than health care does, long-term care matters to many Americans of all ages and affects spending by public programs. Problems in the current long-term care system abound, ranging from unmet needs and catastrophic burdens among the impaired population to controversies between state and federal governments about who bears responsibility for meeting them. As the population ages, the pressure to improve the system will grow, raising key policy issues that include the balance between institutional and noninstitutional care, assurance of high-quality care, the integration of acute and long-term care, and financing mechanisms to provide affordable protection. (+info)
Rearranging the compartments: the financing and delivery of care for Australia's elderly.
Aged care policy in Australia underwent rapid change following the 1996 change of federal government, although continuing to emphasize changing the balance of aged care away from residential care toward community-based care and improving quality of care. This paper examines these policy directions with reference to two specific areas: the differentiation of funding arrangements for the care and accommodation components of residential care, and the targeting of services in community care. In both cases, funding arrangements have been used as a prime mechanism for redrawing the boundaries between different components and levels of care. This process of compartmentalization appears likely to increase the diversity of the Australian aged care system in the future. (+info)
Germany's long-term-care insurance: putting a social insurance model into practice.
A growing population of elderly has intensified the demand for long-term care (LTC) services. In response to the mounting need, Germany put into effect a LTC Insurance Act in 1995 that introduced mandatory public or private LTC insurance for the entire population of 82 million. The program was based on the organizational principles that define the German social insurance system. Those individuals in the public system and their employers each pay contributions equal to 0.85 percent of each employee's gross wages or salary. Ten percent of the population with the highest incomes have chosen the option of purchasing private long term care insurance. Provisions were made for uniform eligibility criteria, benefits based on level of care needs, cost containment, and quality assurance. Over the first four years of its operation, the system has proved financially sound and has expanded access to organized LTC services. The German system thus may serve as an example for other countries that are planning to initiate social LTC insurance systems in other nations. (+info)
What older people want from long-term care, and how they can get it.
Seniors' long-term care preferences resemble those of younger persons with disabilities, but the two groups are treated differently. Younger persons with disabilities pursue the goal of social integration, whereas safety and efficiency receive undue emphasis and ageist differences prevail in the way older persons are served. Among the changes needed to help older consumers get what they want are empowering older persons and their agents to make better decisions, including providing them with more structure and better consumer information; revising attitudes toward safety and protection; and developing more vigorous advocacy by and for seniors. (+info)
Changing the chronic care system to meet people's needs.
Persons who are likely to be the heaviest users of medical and supportive care services--those with chronic illnesses, disabilities, and functional limitations--are often forced to navigate a system that requires them to perform most of the coordination functions themselves and is generally not organized around their needs. In 1996 an estimated 128 million Americans had at least one of these three conditions, and 9.5 million had all three. This paper examines the current programs designed to assist these persons and suggests changes in eligibility rules, coverage policies, and educational programs to provide a system more oriented to people's chronic care needs. (+info)
Providing long-term care benefits in cash: moving to a disability model.
This paper examines the role of a disability approach to the allocation of long-term care benefits. It first highlights the important elements of long-term care that support a disability model. It then reviews the advantages and disadvantages of this approach relative to the traditional indemnity model and summarizes key features of selected domestic and international programs that offer a disability-type benefit. The paper identifies and elaborates on the major implementation challenges and concludes with a recommendation for further examination of the costs and benefits of this approach to the public coffers, the private market, and long-term care consumers. (+info)