The average public expenditure for LTC is less than one per cent of GDP
34
Long term-care protection for older persons
The generosity of benefits provided can be assessed using public expenditure on LTC spent per person aged 65+ as shown in figure 13.
Figure 13. Public expenditure on LTC per person 65 years and over in selected countries,
in PPP dollars, 2013
Source: OECD 2013; World Bank 2015 population data 2013.
It reveals that with the exception of one high-income country the majority of high and middle-income countries are providing some kind of financial support to cover the costs of
LTC. Globally public LTC support ranges between lowest expenditure of 0 PPP per capita and highest amounts of up to more than 8,000 PPP per person. The globally highest
amounts of public financing on LTC per person aged 65+ are spent in Europe Norway with 8,406.1 PPP followed by an Asian country Korea spends 7,945 PPP on LTC per
capita.
When grouping public expenditure into five categories 0-200 PPP; 200-500 PPP; 500-1,000 PPP; 1,000-5,000 PPP, and more than 5,000 PPP it can be concluded that
public expenditure of African countries ranges in the lowest categories between 0 and 500 PPP, while countries of other regions are found in each of the categories. The range
of public expenditure per capita in selected countries is shown below:
0 and 200 PPP per year and persons aged 65+:
– Africa: Algeria, Ghana and Nigeria;
– Americas: Brazil, Chile, Colombia, and Mexico: – Asia:
Australia, China, Indonesia and India; – Europe:
Portugal, Slovakia and Turkey;
0 0 0 450.2
3336.6
0 0 0 2206.4
133.0 99.4
186.3 994.1
7945.0
818.1 2639.6
3838.7
505.1 5221.7
280.0 1629.8
2297.1 1826.0
614.2 395.7
5436.3
1481.6 1442.1
1120.4 5622.4
6088.8 8406.1
633.5 136.8
361.7 1111.3
891.9 1573.7
3727.0
1899.1 2000
4000 6000
8000 10000
A lg
e ri
a G
h an
a N
ig e
ri a
S o
u th
A fri
ca A
rg e
n ti
n a
Braz il
Can ad
a Ch
il e
Co lo
mb ia
Me x
ic o
Un ite
d S
tate s
A u
str al
ia Ch
in a
In d
ia In
d o
n e
si a
Japan Ko
re a
N e
w Ze
al an
d T
h ai
lan d
A u
str ia
Bel g
iu m
Cz e
ch R
e p
u b
li c
De n
mark E
sto n
ia F
in lan
d F
ran ce
G e
rman y
G re
e ce
H u
n g
ary Ic
e lan
d Ire
lan d
Is rae
l Ital
y
Lu xe
mb o
u rg
N e
th e
rl an
d s
N o
rwa y
Po la
n d
Po rt
u g
al R
u ss
ia
S lo
vak R e
p u
b li
c S
lo ve
n ia
S p
ai n
S w
e d
e n
S w
itz e
rl an
d T
u rk
e y
Un ite
d Ki
n g
d o
m
P ubl
ic L TC
ex pe
ndi tur
e pe
r pe
rs ons
65+ , i
n P
P P
in 2013
Long term-care protection for older persons
35
200 and 500 PPP
per year and person aged 65+: – Africa:
South Africa; – Europe:
Estonia, Hungary and Russia;
500 and 1,000 PPP
per year and person aged 65+: – Asia:
Japan and New Zealand; – Europe:
Czech Republic, Greece, Poland, and Spain;
1,000 and 5,000 PPP
per year and person aged 65+: – Americas: Canada and USA;
– Europe: Austria, Belgium, Finland, France, Germany, Ireland, Italy;
– Israel, Slovenia, Sweden Switzerland and the UK; and
5,000 PPP and more
per year and person aged 65+: – Asia:
Korea; – Europe:
Denmark, Iceland, Luxembourg, Netherlands, and Norway.
3.3.2. The financial resource gap excludes up to 100 per cent of the population in countries of all regions from LTC services
Based on the per capita expenditure observed we conclude that the majority of countries provide support that can be considered as largely inadequate when taking into
account the real costs occurring due to LTC in terms of services needed: In high-income countries, the onset of the need for LTC is often considerably later than at age 65. The
average expenditure per LTC user is therefore higher than the average expenditure per person aged 65 or above, regardless of their care needs.
We assume that a minimum benefit covering LTC costs for persons aged 65+ can be calculated using a population based median generated from a group of 34 representative
countries that include all financing, coverage and benefit approaches – including none. The
calculation serves as a rough and far from satisfactory indicator for assessing coverage deficits due to financial resource gaps.
In countries with the typical onset of care needs at a younger age already – mostly
countries with poorer population and lower life expectancy – this need is underestimated in
our assessment. Furthermore, the indicator does not reflect the large international wage differences for LTC workers. In addition, the data used is restricted to nursing care only
and thus excluding social care. In financial terms this can make a huge difference both for public and private expenditure which is most likely higher than indicated.
The related threshold value amounts to 1,461.8 PPP per person aged 65+ per year. Based on this value we conclude that globally the large majority of the population aged
65+ – almost 80 per cent – is concerned by an unprecedented LTC financing crisis
Figure 14.
36
Long term-care protection for older persons
Figure 14. Global LTC coverage deficit due to financial resource gaps, in per cent of the population
65 years and over excluded Threshold: 1,461.8 PPP
Source: ILO estimates 2015; OECD, 2013; World Bank, 2015 population data and national accounts in 2013.
We find in all regions countries where between 75 and 100 per cent of the population is excluded from access due to the financial resource gap, for example Ghana in
Africa, Chile in the Americas, Australia in Asia and Slovakia in Europe.
In the regions of Africa and Europe we find countries where completely inadequate levels of financing exclude from more than half up to 75 per cent of persons aged 65+
from access to formal LTC services, for example in South Africa, Poland, and Russia.
Countries where deficits hampering access to formal LTC for up to 50 per cent of the older population include Japan and New Zealand in Asia and the Pacific and several
European countries, such as in Italy and Spain.
Zero deficits are observed in few high-income countries of the Americas including Canada and the USA, and in Europe, among them Austria, Germany and Luxembourg
and South Korea in Asia.