What long-term care looks like around the world | ET REALITY


CANADA. Provinces and territories fund long-term care services through general tax revenues. The money budgeted is not always enough to cover all services and some localities give priority to those with the greatest needs. The amount of subsidies people can receive, their out-of-pocket costs, and the availability of services vary by province and territory, as is the case in the United States with state Medicaid programs. The supplier mix also varies regionally: For example, nursing home care in Quebec is primarily run by a public system, while in Ontario homes are mostly for-profit. Notably, Canada’s long-term care system is separate from its national health care system, which pays for hospitals and doctors with no out-of-pocket costs for patients. In 2021, Canada spent 1.8 per cent of its GDP on long-term care, 80 per cent more than the United States spent.

BRITTANY. Local authorities pay for most long-term care through taxes and grants from central government. Private providers typically provide services. Government contributions are based on financial need and co-payments are generally required. As in the United States, middle-class and wealthy people pay most or all of the costs themselves. Unlike the United States, the government provides payments directly to low-income people so they can hire workers to care for them in their homes. Britain has also taken steps to prevent people from losing all their wealth to pay for long-term care. It subsidizes care for people with savings and property of less than $30,000, while in the United States most people do not qualify for Medicaid until they have exhausted all but $2,000 to $3,000 of their assets. In 2022, the proposed government expand subsidies to people who have up to $105,000 of wealth and property, with a lifetime limit of about $100,000 on what someone spends on long-term health care, excluding room and board in a nursing home. But the plan was postponed until 2025. In 2021, Britain spent 1.8 percent of its GDP on long-term care, 80 percent more than the United States.

SINGAPORE. Singapore recently instituted a mandatory long-term care insurance system for those born in 1980 or later. Citizens and permanent residents are automatically enrolled in an insurance plan called CareShield Life from 30 years old. They must pay premiums until they retire or turn 67 (whichever is later) or until they are approved to use the services. The government subsidizes 20 to 30 percent of premiums for those earning about $2,000 a month or less. Monthly payments start at approximately $440. Government subsidies for nursing homes and other institutional care can range from 10 percent to 75 percent depending on payment capacity. Those who earn more than $2,000 a month do not receive subsidies. CareShield is optional for Singaporeans born in 1979 or earlier; They are covered by an older voluntary plan. Singapore also provides a monthly means-tested cash subsidy (this year around $290) to help with care costs.

Sources: National Bureau of Economic Research Project on International Comparisons of Long-Term Care; Kathleen McGarryprofessor of economics at UCLA; The Commonwealth Fund; Organization for Economic Cooperation and Development; government websites.

Note: Spending comparisons with the United States are based on the most recent OECD data and include government spending and mandatory insurance programs as a percentage of each country’s gross domestic product, which is the total monetary value of all goods and services. finished services produced within a country’s economy. borders. The comparisons cover people of all ages and exclude the expense of voluntary insurance plans and out-of-pocket costs. All monetary figures are in US dollars.

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