Introduction

In ageing societies it is not simply access to long-term care (LTC) that is important, but also its safety, effectiveness and responsiveness. This is not least because good quality LTC should help maintain the health and functional status of people for longer, but also because poor quality care can cause serious harm and has the potential to be life-threatening. Indeed, concerns around the quality of LTC services are the second highest priority area for LTC reform across OECD countries, just behind the fiscal and financial sustainability of LTC systems (Colombo et al, 2011).

The political debates about ensuring the quality of LTC services are largely driven by three issues. First, scandals around abuse and neglect arise frequently enough across OECD countries to ensure safety is a relatively constant political concern. Second, the effectiveness of LTC is of interest since OECD countries tend to invest a significant amount of public resources in LTC (Colombo et al, 2011). Politicians are accountable to the public and need to demonstrate the value of these services to show that taxpayers’ money has been spent wisely. And third, the responsiveness of services to their users is a concern, an issue that is linked to the lack of both information about the quality of providers’ services and incentives to develop services that are right for users rather than easy for providers to deliver. Despite underlying similarities in problems experienced, a variety of policy solutions are found across OECD countries to promote quality.

The aim of this chapter is to describe and compare the policy instruments and approaches used by selected OECD countries to promote the quality of LTC services. Since the way in which each country promotes quality is inextricably linked with the overall design and features of the system, we have chosen to illustrate the policy options using six countries – Australia, Austria, England, Finland, Japan and the US – whose LTC systems differ on a variety of characteristics. These countries vary according to the degree to which the management of different aspects of the LTC system is centralised or decentralised, how the system is financed, the eligibility criteria and the make-up of the LTC market in terms of private and public provision, as shown in Table 8.1.