Public responsibility for long-term care (LTC) – in particular, care for frail older people – has expanded rapidly in most advanced nations in the past two or three decades. A key issue is resource allocation: how much money to spend and on what. But although the LTC field has drawn more and more attention from researchers – we know far more about how various approaches work than ever before – patterns of resource allocation have not been adequately studied. As a recent report indicates, ‘the current available statistics about public LTC programs are somewhat patchy’ (Carrera et al, 2013, p 31). Actually, information is available about LTC expenditure in most individual countries, and recently several admirable surveys of LTC policy across several countries have appeared (see, for example, Colombo et al, 2011; Riedel and Kraus, 2011; Mot et al, 2012; Rodrigues et al, 2012; Genet et al, 2013; OECD, 2013; Ranci and Pavaloni, 2013; Mor et al, 2014). However, systematic comparative analysis of expenditure and coverage of national LTC systems has been lacking.
The objective is simple; the task is quite difficult. Two of us discovered this in trying to compare expenditures in just three countries, Germany, Japan and the US (Campbell et al, 2010). It took far longer than we expected and required many delicate decisions to match up the categories. The present study takes on seven countries, a number small enough to manage the necessary mutual adjusting with our limited time and resources, but large enough to represent significant models of LTC policy.
To draw on quite conventional images in the welfare state literature, we have Sweden in social-democratic Northern Europe, Italy in familial Southern Europe, Germany in corporatist mid-continent, Australia, the US and England as quite different versions of the Anglo-Saxon ‘residual’ model, and Japan as the relatively new entry that shares aspects of all the other models. This chapter presents details of each country's approach to LTC and how their policies have changed over time. This chapter is essentially a ‘snapshot’ cross-sectional analysis of spending and coverage data.
Since our contribution is largely methodological, we begin by explaining how we have tried to deal with the inherent problems of comparing LTC policy. There are four key approaches.