Other countries have already addressed the problem of long-term care of the elderly with varying degrees of success.
In the US, there are four major programmes, of which Medicaid, which provides means-tested health services for the poor, and Medicare, a non-means-tested, medical need service for the over-65s, are the most important, says the Working Party report, Financing Long-Term Care in Ireland.
Partnership solutions are very much a reality in the US where private long-term care products have been available for 20 years. Employees and employers are encouraged to fund private insurance policies which are often then combined with federal and state schemes to meet the cost of long-term care. In Britain, the state meets the total cost of care if the person's assets are below £10,000, a portion of the cost if assets are between £10,000£16,000 and makes no contribution if assets are more than £16,000. Private longterm care insurance in a number of forms, has been available since 1991, but is not popular, for a number of reasons including: lack of perceived need, lack of understanding of the current state provision, the complexity of the product and its high cost. A royal commission is currently examining both short- and longterm care needs of the elderly.
Despite its sophisticated welfare state, says the report, Germany has not made much provision for long-term care and most people have had to pay for it themselves. A "whole-of-life" long-term care insurance product that was brought out in the 1980s was not a success and in 1993 a social insurance financing model was adopted and introduced two years later. The scheme is financed on a pay-as-yougo basis with both workers and employers making contributions with benefit priority given to people being cared for at home rather than in residential centres. In France, most elderly people continue to be taken care of at home, and regionally-operated home-help services are given a priority, though the numbers of people requiring and getting residential care are increasing. Funding for formal care is made by employees and employers into three statutory social insurance schemes. France has the largest market in Europe for private longterm care insurance policies with benefits that interface with the French social security system. New "autonomy allowances", depending on the person's level of physical and mental dependency, are also being made for people on low incomes who receive longterm care in their own or residential homes. The costs of these allowances can be recovered from relatives if there is an inheritance worth more than 250,000 francs - about £27,000.
In Japan public medical insurance is compulsory and the elderly are given medical care virtually free of charge. Nursing homes and geriatric hospitals provide most long-term care for the rapidly increasing elderly Japanese population, but they tend to be overcrowded and inadequate. Reforms in the system have been under way, with new programmes to encourage more home care, health awareness, increased housing for the elderly, day-care and shortstay services. Contributory payments are being sought for some new long-term services and in 1999 a compulsory long-term care insurance scheme will be introduced. The government will contribute 50 per cent of the cost from general taxation with the balance funded from a rise in consumer taxes and contributions. Private long-term care insurance was introduced in Japan 10 years ago, but has had limited success, mainly because of the high cost of premiums.
