What long-term care looks like worldwide

🇨🇦

CANADA. Provinces and territories fund long-term care services through general tax revenues. Budgeted money is not always enough to cover all services, and some places prioritize those with the greatest needs. The amount of subsidies people can receive, the costs they must pay out of pocket, and the availability of services vary by province and territory, as in the United States with state Medicaid programs. The mix of providers also varies regionally: For example, nursing home care in Quebec is largely run by a public system, while Ontario homes are mostly for-profit. Notably, Canada’s long-term care system is separate from the national health care system, which pays hospitals and doctors at no out-of-pocket costs to patients. In 2021, Canada spent 1.8 percent of its GDP on long-term care, 80 percent more than the United States.

🇬🇧

BRITAIN. Local governments pay for most long-term care through taxes and subsidies from the central government. Private providers usually provide services. Government contributions are based on financial need, usually requiring out-of-pocket contributions. As in the United States, middle-class and wealthy people pay most or all of the costs themselves. Unlike in the United States, the government provides payments directly to people with lower incomes so they can hire workers to care for them at home. Britain has also taken steps to prevent people from losing all their wealth to pay for long-term care. It subsidizes care for people with savings and assets of less than about $30,000, while in the United States most people don’t qualify for Medicaid until they exhaust all but $2,000 to $3,000 of their assets. In 2022, the government proposed providing subsidies to people who have as much as $105,000 in wealth and property, with a lifetime limit of about $100,000 on the amount someone spends on long-term medical care, excluding room and board in a nursing home. But the plan has been postponed until 2025. In 2021, Britain spent 1.8 percent of its GDP on long-term care, 80 percent more than the United States.

🇸🇬

SINGAPORE. Singapore recently introduced a system of mandatory long-term care insurance for those born in 1980 or later. Citizens and permanent residents are automatically enrolled in a so-called insurance plan CareShield Life from the age of 30. They must pay contributions until they retire or turn 67 (whichever comes later) or until they are authorized to use services. The government subsidizes 20 to 30 percent of premiums for those who earn about $2,000 a month or less. Monthly payouts start at around $440. Government subsidies for nursing homes and other institutional care can range from 10 percent to 75 percent depending on the ability to pay. Those earning more than $2,000 per month will not receive subsidies. CareShield is optional for Singaporeans born in 1979 or earlier; they are covered by an older, voluntary plan. Singapore also provides a monthly means-tested subsidy – about $290 this year – to help with healthcare costs.

Sources: The National Bureau of Economic Research project on international comparisons of long-term care; Kathleen McGarryprofessor of economics at UCLA; The Commonwealth Fund; Organization for Economic Co-operation and Development; government websites.

Remark: Spending comparisons with the United States are based on the most recent OECD data and include government spending and mandatory insurance programs as a percentage of each country’s gross domestic product. This is the total monetary value of all final products and services produced within a country’s borders. boundaries. The comparisons cover people of all ages and exclude expenses from voluntary insurance plans and out-of-pocket costs. All currency figures are in US dollars.