The social long-term care insurance model: comparing actor configurations across countries and time

Abstract

To date, social long-term care insurance (SLTCI) systems have been introduced in six countries globally: the Netherlands, Israel, Germany, Japan, Luxembourg and South Korea. Applying an actor-centred, multi-dimensional framework and fuzzy-set analysis, the present article investigates the typical characteristics and variations of these SLTCI schemes at introduction and today. In short, we find that the SLTCI model features dominant social contribution financing, a mix of for- and non-profit providers, and state regulation. In light of the relevance of corporate self-regulation often associated with social insurance systems, the dominance of state regulation is unexpected. The analysis also reveals considerable variance between cases, most notably concerning the extent of private individual actors’ involvement. While geographical proximity of countries does not explain differences between SLTCI systems, “temporal clusters” seem to partly drive the variation of SLTCI actor configurations.

Choice of formal and informal care among community‐dwelling older people with or without dementia under a long‐term care insurance pilot program in China

“…Debate on whether informal care (normally provided by family members, friends and neighbours) can be paid from public funding has drawn extensive attention. 1 For example, Germany introduced the Long-term Care Insurance (LTCI) Act in 1995 and innovatively allowed a choice between cash benefits and care services for community-dwelling care recipients to maintain and involve more informal caregivers in caregiving. This design also aligns with person-centred care initiatives 2 respecting individuals' decision-making and care arrangement preferences.…”

“…In the context of population ageing, a growing number of countries have introduced long‐term care (LTC) policies to meet the increasing care demands. Debate on whether informal care (normally provided by family members, friends and neighbours) can be paid from public funding has drawn extensive attention 1 . For example, Germany introduced the Long‐term Care Insurance (LTCI) Act in 1995 and innovatively allowed a choice between cash benefits and care services for community‐dwelling care recipients to maintain and involve more informal caregivers in caregiving.…”

Socioeconomic inequity in access to care among older people in Japan

“…nursing homes, hospitals, home care, households, and social providers) (5). To date, only six countries have adopted national social LTC insurance systems, namely the Netherlands, Israel, Germany, Luxembourg, South Korea, and Japan (6). Japan is the first Asian country, which has adopted a public universal LTC insurance in 2000, principally covering all citizens aged ≥40 years (7).…”

“…To calculate the descriptive differences in LTC utilisation across education and income groups, but not the CI, both indicators were divided into five categories. The category for education included lowest (<6), lower-middle (6–9), middle (9–12), higher-middle (12–15), and higher (16+). Despite different pre- and post-World War II educational systems, this categorisation roughly corresponded to the distinctions between elementary, secondary, high school, and university or higher.…”