by Greer Van Zyl and Sarah Barber, WHO Centre for Health Development (WHO Kobe Center)

Introduction

Governments need to strengthen their financing systems for health and long-term care (LTC) to ensure that older persons have access to essential services and are protected from financial hardship when paying for these services. Policy choices are critical in how health and social services for older people are delivered and how these services are purchased. Payment methods and pricing contribute to broader system objectives such as promoting quality, increasing equity, and encouraging coordination between health and social services.

The WHO Centre for Health Development (WHO Kobe Centre/WKC) and the Organisation for Economic Co-operation and Development (OECD) undertook nine country studies to describe experiences how purchasing and pricing LTC has been used to attain better coverage, quality, financial protection, and outcomes. The report Pricing long-term care for older persons included country case studies on Australia, France, Germany, Japan, the Republic of Korea, the Netherlands, Spain, Sweden and the United States, and how these experiences can inform other countries in better responding to the demand for services appropriate to the needs of older persons.

How the briefs were developed

In 2025, the WKC worked with nine groups of authors to update the country report summaries on pricing and purchasing LTC. The summaries aim to make the country case studies and experiences more accessible to policymakers. Each country summary presents the LTC system’s strengths and weaknesses, best practices and lessons for other settings.

Key messages from this work:

• LTC needs assessments determine eligibility and benefits and have been used to link payments with health and social care needs.
• Monitoring for unmet needs is important where eligibility criteria are stringent and user charges are substantial, as they may result in reduced utilization of needed care.
• Funding to LTC should be based on a secure reliable source that reduces any regional inequities in resources available.
• The way services are financed can reduce fragmentation and encourage coordination among different service providers and across different levels of government.
• Price adjustments and add-on payments could be used more broadly to foster equity in provider payment, particularly in addressing geographic variations in the costs of providing care.
• Quality measurement in LTC requires further policy development, and quality metrics could be better linked to price levels and payment mechanisms.

Overview of the briefs:

LTC pricing and purchasing in Australia is characterised by consumer choice and control within a highly regulated, market-based system. The Australian Government is currently transitioning from funding services that provide residential care for older people toward a more proactive approach that supports people to live in their own home for as long as possible, and prevents or delays admission to residential care. This brief was written by Sarah Wise and Michael Woods of the University of Technology Sydney, and Kees van Gool of the University of Sydney, in Sydney, Australia.

The summary for France examines the loose connection between pricing, costs and quality with regional inequalities across the country. It was prepared by Zeynep Or and Anne Penneau of the Institut de recherche et documentation en économie de la santé in Paris, France. Lessons for other settings include the shift from using global budgets based only on historical costs towards adjusting payments based on the volume and case-mix of patients cared for, and efforts to integrate quality of care data into the calculation of payments.

Germany introduced a separate LTC insurance system in 1995, recognizing the unique nature of LTC in contrast to health services. The LTC insurance system aims to balance the pressures of increased demand and the number of LTC beneficiaries with the appropriate contribution rates for enrolees and copayments for beneficiaries. This brief was written by Ricarda Milstein, Michael Mueller and Luca Lorenzoni of the OECD in Paris, France.

Japan’s brief by Prof Naoki Ikegami of Keio University in Tokyo, Japan, focuses on the rapid growth of Japan’s LTC system and its financial sustainability. He stresses the importance of monitoring and evaluating the eligibility criteria and regulating the fee schedule are key elements as these two elements control the flow of money within the LTC system.

Soonman Kwon, School of Public Health, Seoul National University, Republic of Korea prepared the brief for the Republic of Korea.  It discusses overcoming coordination challenges between health and social services; linking payments to quality and performance; and offering lower co-payments to increase access to community-based care and move away from institutional LTC.

In the Netherlands, price setting and contracting help to ensure equitable access to LTC. For other settings, lessons include the need to align decision-making power, incentives and financial risk throughout the system, integrating pricing for tailored care and providing incentives to improve patient outcomes. This summary was written by Pieter Bakx, Erik Schut and Bram Wouterse of Erasmus University in Rotterdam, (Kingdom of the) Netherlands.

The summary for Spain reports on the pressure to the LTC system of increasing demand from beneficiaries and declining numbers of informal caregivers as Spain’s population will be the oldest in the OECD by 2050. It was prepared by Manuel Flores of the Universitat Autònoma de Barcelona in Barcelona, Spain. Lessons learned include guaranteeing sustainability through stable revenues, shifting from informal care providing to formal home care, and setting prices to promote quality.

Sweden provides and pays for universal and comprehensive care for older persons. This brief by Luca Lorenzoni of the OECD in Paris, France, explains the outcomes of Sweden’s major reforms of 1992 which give municipalities the main responsibilities for LTC for older persons. Lessons for other settings include the need for sustainability; regulation; providing information for consumers for informed choices; and monitoring equity.

Dr Luca Lorenzoni of the OECD in Paris, France also prepared the brief for the United States, which examines the safety net for LTC services. For other settings, lessons include need for a more comprehensive public system given the low demand for long-term services and support (LTSS) insurance due to low perception of risk, and large variations in coverage and access at state level.

Suggested citation:

WHO Centre for Health Development (2025, 9 June) Pricing and purchasing long-term care: A series of country summary reports from the WHO Centre for Health Developments. GOLTC Blog, Global Observatory of Long-Term Care, Care Policy and Evaluation Centre, London School of Economics and Political Science. https://goltc.org/publications/pricing-and-purchasing-long-term-care-a-series-of-country-summary-reports-from-the-who-centre-for-health-development/