Long-term Community Care in OECD Countries - Francesca Colombo, Head of Health Division (OECD)
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Recent trends in the provision and financing of long-term community care in OECD countries, and policy implications, CARER+ Final Conference: Smart Homecare, 27 March 2015, Paris
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Long-term Community Care in OECD Countries - Francesca Colombo, Head of Health Division (OECD)
- 1. LONG-TERM COMMUNITY CARE IN OECD COUNTRIES Recent trends in the provision and financing of long-term community care in OECD countries, and policy implications Francesca Colombo, Head of Health Division (OECD)
- 2. There is huge variation in what countries currently spend on LTC
- 3. Mixed systems There are a range of different funding systems for meeting these costs Comprehensive, universal, tax-funded systems Means-tested safety net system Universal LTC insurance - more comprehensive - larger copayments Nordic countries Netherlands, Japan Germany, Korea England, United States More comprehensive Wider access More expensive Multiple universal systems Italy, Czech Republic Income-related universal benefits France, Ireland, Austria Mix of universal and means-tested benefits Switzerland, Spain
- 4. Most OECD countries place a high priority on promoting community care Source: Help Wanted? (OECD, 2011)
- 5. Efforts to promote community care have been successful Proportion of LTC users living in the community Source: OECD health statistics 2014
- 6. Although most spending is still on residential care Expenditure on long-term care by setting (% of GDP)
- 7. Community care implies a large role for informal carers Estimated value of formal and informal services for people with dementia in England Source: Prince, Knapp et al. (2014)
- 8. Promoting community care must be coupled with policies to support carers Help with employment • Germany: “family caring time” law helps carers reduce hours temporarily • Canada: bringing together employers to explore how to help carers to keep working Information and training • Provide skills to care effectively and minimise negative impacts • e.g. France: carers entitled to two days of training per year. • Phone advice services in a number of countries Counselling and support • Can be effective at relieving stress • Include peer support, e.g. • dementia cafés in Japan • NHS Dementia Carers’ Support Service in England Respite care • At home, day care centres or temporary institutional care • Available but underused? • Netherlands: day care on farms provides respite to carers
- 9. There are also important considerations around gender equality Source: Help Wanted? (OECD, 2011) The likelihood of a person aged 50-64 being an informal carer, by gender
- 10. Thank you Contact: francesca.colombo@oecd.org Read more about our work Follow us on Twitter: @OECD_Social Websites: www.oecd.org/els ; www.oecd.org/health/dementia.htm www.oecd.org/health/long-term-care.htm
Notes de l'éditeur
- Some of the differences will be filled by higher out of pocket spending in some countries But some people may also be going without LTC due to less generous coverage
- This is how we categorised LTC payment systems in our 2011 report Help Wanted Categorisation is only approximate – and the implied ranking of generosity even more so In general, all systems require some sort of user copayment, although this might be means-tested or covered by separate social assistance systems But the size of these copayments varies dramatically between countries There is no such thing as a universal, free at the point of use LTC system like we see in some countries for health
- Although systems vary, there is broad agreement on r
- Most people are in home care, but most spending is on residential care This is because: People in residential care generally have higher needs Informal carers play a major role in home care, which reduces monetary costs NB: this only includes health LTC, so numbers don’t always match earlier chart
- Community care is often seen as cheaper That is often true as far as government budgets are concerned But in terms of resources it is more expensive It is just that much of the cost is non-monetary and borne by families and carers Is it fair or desirable to leave them to manage these costs alone?
- Carers are 20% more likely to have mental health problems than other people Fewer carers are in employment, and more of them who are in employment work part time Support is needed to mitigate these effects and make caring arrangements sustainable Many countries also have cash benefits, but these vary in generosity: Nordic countries effectively pay a full wage to some informal carers (although this benefit is tightly controlled to avoid abuse/fraud) Germany: care recipient can take cash instead of services to pay a carer – but this is less than the cost of the services UK: carers’ allowance £61.35 a week for people caring for more than 35 hours = £1.75 per hour (vs. £6.50 minimum wage)
- More than a third of informal carers are caring for a parent Many of these will be of working age And data shows that working age carers are much more likely to be women Since caring reduces employment possibilities, this raises questions about gender equality in the workforce Countries need to consider this when designing policies to promote community care and support informal carers