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An international comparison of long-term care funding and outcomes: insights for the social care green paper

The challenges facing long-term care systems are well known, if not widely understood: with an ageing population and increasing care costs, how to finance a system that is fair to both recipients and the taxpayer whilst also providing equitable access to high quality care?

This problem is not confined to England, but it is particularly acute here. From 1996 to 2017 in England, there have been four independent reviews, five consultations and seven government policy papers attempting to answer these questions. A Green Paper, previously the responsibility of the Cabinet Office but later passed to the newly renamed Department for Health and Social Care, is set to add to this list.

While England has a long history of exploring sustainable solutions to long-term care, there has been little consideration of what can be learned from other countries. In light of the Government’s Social Care Green Paper, Age UK commissioned Incisive Health to prepare a comparative analysis of long-term care funding models and outcomes in France, Germany, Spain, Italy and Japan. These five countries face similar demographic challenges to England and represent a diverse range of approaches to organising a long-term care system and could inform the overall debate around the Green Paper. This paper sets out:

  • A definition of long-term care (page 3)
  • That these are different systems, but a with shared demographic and financial challenges (page 4)
  • A summary of the long-term care systems in each country (page 7)
  • A comparative analysis of long-term care in relation to:
    • Service structures (page 9)
    • Funding levels (page 15)
    • Funding models (page 18)
    • Outcomes (page 21)
  • Our conclusions (page 25)

Profiles for each of the five countries have been included at annex 1. A discussion of the definitions used throughout this report has been included at annex 2.