1. Long-Term Care Financing: setting the foundations
Adelina Comas-Herrera
PSSRU
London School of Economics and Political Science
Contact:
IAGG, 2nd Africa Region conference
Nairobi, December 2016

2. Outline:
Why collective LTC funding? collective vs individual/familial responses
Public sector tools to finance LTC
Looking forward to African innovations on LTC financing

3. 1. The rational for collective long term care funding
Collective vs individual/familial responses

4. Most LTC risk is shouldered by families
Families are the largest source of Long Term Care resources (in-kind).
Unpaid family care does not carry a price, but it certainly has a cost:
Cost of reduced employment (risk of impoverishment, loss of social protection…)
Costs in terms of carers health and quality of life
Long-term costs for child carers
The costs of formal care can easily be catastrophic, consuming entire lifetime savings

5. Lifetime costs of care Estimated costs At 65, excluding accommodation costs, England, 2009.
Fernandez & Forder, 2011

6. The many forms of LTC “insurance”:
Public sector schemes:
Tax-funded or social insurance
Covering all the population (universal) or those without assets or family care (residual)
Private long-term care insurance schemes
Families, offering care and support to members who need it
Community support, more or less formalised
In most countries public and private LTC coverage protection systems coexist and complement each other.

7. 2. Public sector financing for LTC

8. Public sector Financing of LTC
Tax-based systems
Variety of approaches, from residual “minimalistic” systems to generous universal care coverage.
Usually developed from social protection approach.
Susceptible to cuts: social care has lower political clout than health, education…
Often entitlements are not clear
Social LTC Insurance systems
Funds raised additionally and specifically for LTC: protection from political interference
Usually linked to health social insurance infrastructure
Clear rules of entitlement and co-payments
Expanding in Asia, following Japan and South Korea, pilots in China

9. 3. Looking to the future

10. LTC in Africa: in initial considerations
Addressing ageing cannot be left to the future: happening very fast, yet not in the political agenda.
Making explicit that unpaid care is not cost-less: impoverishment, labour participation, health
What is transferable from the experience (and difficulties) of high income countries?
How can existing service infrastructures can be adapted/expanded to deliver LTC?
Responding to ageing requires:
Universal Health Coverage, improved Social Protection & a Long-Term Care System

11. Looking forward to African innovations on LTC financing:
Building on the Health Financing systems
Community Based Health Insurance (CBHI) successes in Ghana, Rwanda
Social Health Insurance (SHI) being planned/expanded in many African countries
Towards LTC Social Insurance System: include LTC support in CBHI/SHI health insurance schemes?
Social Protection:
Use current cash transfer systems to include additional support for LTC?