Long term-care protection for older persons
31
Country Institutional care
Home-based care Americas
Argentina Limited nationwide services
Limited nationwide services
Brazil
– No nationwide services – Very limited capacities, mainly concentrated
in urban areas and in the North-East – In some communities only
– No nationwide services – Very limited capacities in communities
Chile Very limited nationwide services
Very limited nationwide services
Colombia
– No nationwide services – Very limited capacities, concentrated in urban
areas – No nationwide services
– No services in communities
Mexico Very limited nationwide services
– No nationwide services – Very limited capacities in communities
Asia and the Pacific Australia
Nationwide services Nationwide services
China Very limited nationwide services
In some communities only – No nationwide services
– Very limited services, concentrated in urban areas
India No nationwide services
No nationwide services
Japan Nationwide services
Nationwide services
South Korea Nationwide services lower availability in rural
and “fishery” regions Nationwide services lower availability in rural
and “fishery” regions
Thailand
– No nationwide services – Limited capacities mainly private ones,
concentrated in the capital city Bangkok and some other cities
– No nationwide services – Very limited services, concentrated in a few
areas pilot areas
Europe Germany
Nationwide services Nationwide services
Poland Nationwide services
Nationwide services
Russian Federation Limited nationwide services Very limited nationwide services
Turkey
– No nationwide services – Very limited capacities, concentrated
in big cities in some communities only
– No nationwide services – Very limited services, concentrated in
municipalities such as İstanbul, Ankara, Kocaeli, Trabzon
United Kingdom Nationwide services
Nationwide services
Source: ILO based on legislation and literature review.
In conclusion, in addition to the tight eligibility rules, limited scope of benefits, and absence of a sufficient LTC workforce, access to needed LTC is significantly hampered by
the large absence of infrastructure for institutional and home-based care.
3.3. The LTC financing crisis: Insufficient public funding results in intolerable high private
expenditure, access gaps and inequalities
The choice of financing mechanisms for social protection including LTC defines the overall amount of funds available and creates different distributional effects. If LTC funds
derive from taxes, governments often use progressive income taxes or sometimes revenues
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Long term-care protection for older persons
from value added taxes that burden particularly persons with low income. In tax funded schemes the minister of finance will decide each year on the amount made available for
public LTC support. Thus, related decisions often reflect tradeoffs with other government priorities.
In social insurance settings the generation of funds is based on income-related contributions, usually from employers and their employees holding formal employment
contracts. As a result, distributional effects of LTC financing will occur among those who contribute. Furthermore, intergenerational effects will arise between contributors and LTC
recipients. The overall amount of funds generated reflects the contributory capacity of those who are legally covered, usually the entire formal economy. Special regulations
might apply for informal economy workers.
Another form of funds that governments frequently use to finance LTC relates to private OOP including private insurance arrangements. Such direct payments to providers
of LTC show regressive income impacts thus burdening particularly persons with low or no income and might even result in impoverishment.
3.3.1. The average public expenditure for LTC is less than one per cent of GDP
Figure 12 provides an overview of the amount of public LTC expenditure spent on average between 2006 and 2010 in selected countries. The data reveal very low shares of
public LTC financing in most countries. The average public expenditure for formal LTC among the countries observed is as little as less than 1 per cent of GDP:
In Africa, most countries spend 0 per cent of GDP on LTC – only in South Africa is a
public expenditure of 0.2 per cent of GDP observed.
In the Americas, expenditure varies between 1.2 Canada, 0.6 USA and 0 per cent of GDP in countries of Latin America
In Asia and the Pacific, the highest amount as a per cent of GDP is spent on LTC in New Zealand 1.3 and lowest in Australia 0, while countries such as China, India
and Indonesia spend around 0.1 per cent of GDP on LTC.
In Europe, public expenditure is the highest globally reaching on average in the time period indicated more than 2 per cent in Denmark, the Netherlands and Norway
whereas the lowest public expenditure occurs with 0 per cent in Turkey and Slovakia.
Long term-care protection for older persons
33
Figure 12. Public expenditure for LTC in per cent of GDP, 2006-2010, average in selected countries
Source: ILO estimates 2015; OECD 2012.
0.2 1.2
0.6 0.1
0.1 0.1
0.7 0.3
1.3 1.1
1.7 0.3
2.2 0.2
0.8 1.1
0.9 0.5
0.3 1.7
0.4 0.5
0.7 0.9
2.3 2.1
0.4 0.1
0.2 0.7
0.5 0.7
1.2 0.9
1 2
Algeria Ghana
Nigeria South Africa
Argentina Brazil
Canada Chile
Colombia Mexico
United States Australia
China India
Indonesia Japan
Korea New Zealand
Thailand Austria
Belgium Czech Republic
Denmark Estonia
Finland France
Germany Greece
Hungary Iceland
Ireland Israel
Italy Luxembourg
Netherlands Norway
Poland Portugal
Russia Slovak Republic
Slovenia Spain
Sweden Switzerland
Turkey United Kingdom
Public expenditure on LTC, in of GDP, 2006-2011 average
