Long-Term Care Perspectives from Abroad

I’m firmly in the drafting stage, finally getting the chance to string together my rough outline into a cohesive paper. Right now, I am working on my “international perspectives” section in which I discuss how other countries have approached their eldercare needs. I have found it difficult to streamline this section because most developed countries have some kind of eldercare safety net, each with its own quirks and innovations. Perhaps the most striking thing about my international eldercare research is that most countries pay less for their eldercare than Americans do, including those with universal healthcare/eldercare systems. Another interesting fact is that the public funds 72% of long-term care costs through government programs such as Medicaid and Medicare. As I write in my paper, why should we pay more to get less? Universal eldercare is actually quite within reach, which is an encouraging place to be in.

There are several countries with truly innovative systems that I believe the U.S. can learn from. Perhaps the most inspiring is that of Singapore, which has a thorough system based on the vocalized needs of its elder citizens and their caregivers. Because Singapore is a very small country, its government can interact with its population directly through group discussions about eldercare needs. Having this dialogue could be very helpful on a local scale in the U.S. so as to make care more patient-centered and effectively direct resources, rather then blindly assigning them at a national level and hoping for the best.

This brings me to the next country, Germany. The German long-term care system is an important one to learn from because it has underwent many reforms since its inception in 1995. This idea, that a system can be continually changed and tinkered with to produce the best results, is something that I think Americans may have overlooked. We cannot overhaul our system in one legislative swoop. Any system we create will need adjustments. It’s vital that those adjustments are grounded in research.

Unfortunately, the saga of Sweden’s eldercare system is a cautionary tale. Twenty years ago, the Swedish system was a model of egalitarian healthcare, in that universal care was provided and the quality of care was rather good. Fast forward to the present, and the population has chosen to step away from this universal model and move towards private provision of long-term care services. This step introduces the very real possibility of unequal care, because of the way the Swedish system is structured. Basically, richer Swedes are incentivized to purchase more expensive private care through a governmental voucher system. These vouchers give wealthier Swedes the ability to add on more private services (after that initial private service is purchased) at a reduced cost. So, those who are initially able to afford an expensive private service have access to more expensive care at a cheaper price later on. This engenders inequality in the long-term care system because many elder Swedes cannot afford this initial service and thus do not have access to those additional care services for less cost like their wealthier peers.

The Swedish step towards privatization reminds me that the United States needs universal long-term care (provided by the government!) to support our elders in the most equitable and efficient way.


  1. ngmiller01 says:

    It’s very interesting that Sweden has moved to somewhat privatize eldercare. Sweden has always been known for being a country of relative equality in terms of wealth, something the U.S. could definitely learn from. They have also always boasted incredible health statistics, no doubt contributed to by many factors, but their health care system definitely has played a part. Given the success of their universal health care system in maintaining good health for its citizens, it is even more confusing as to why they would abandon this and move toward privatization in the eldercare realm. Do you know why they might be doing this?