Key messages
- After deciding to invest in long-term care (LTC) for older adults, countries can choose universal, selective or mixed approaches to identify the population that will be covered by the public LTC system.
- The universal approach to LTC is based on the principle of equal access to services for health and social needs to the entire population and access to needed care for people with disabilites.
- Advantages of the universal approach include its broad funding base, which promotes equity and sustainability.
- While universal LTC systems are assumed to be costly, the cost depends on the generosity of the benefits package and decisions about its implementation.
- Selective LTC approaches focusing on persons in greatest need assume that individuals and families are primarily responsible for LTC, and government support is targeted to those who are unable to provide for themselves.
- The perceived lower cost of the selective approach to government may be offset by the cost of implementing means-testing to identify the people who meet low-income thresholds or those in need.
- The selective approach may also result in high unmet need and costs among people who lack the resources to pay for care but do not meet low-income eligibility thresholds.
- Mixed approaches to LTC apply universal coverage for some services or populations and means-tested eligibility for others; therefore, some older people may face high payments when accessing needed services.
- Some low- and middle-income countries have initiated mixed approaches by using available public and private resources while building the policies, systems and infrastructure for universal LTC coverage and financial protection for older adults.
