Financing reform for long-term care: strategies for public and private long-term care insurance.
The way the nation provides for the financing and delivery of long-term care is badly in need of reform. The principal options for change are private insurance, altering Medicaid, and public long-term care insurance. This article uses the Brookings-ICF Long-Term Care Financing Model to evaluate each of these options in terms of affordability, distribution of benefits, and ability to reduce catastrophic out-of-pocket costs. So long as private insurance is aimed at the elderly, its market penetration and ability to finance long-term care will remain severely limited. Affordability is a major problem. Selling to younger persons could solve the affordability problem, but marketing is extremely difficult. Liberalizing Medicaid could help solve the problems of long-term care, but there is little public support for means-tested programs. Finally, universalistic public insurance programs do well in meeting the goals of long-term care reform, but all social insurance programs are expensive and seem politically infeasible in the current political environment.
Wiener
J M
JM
Brookings Institution, Washington, DC 20036, USA.
D000368:Aged; D018166:Health Care Reform / Q000191:economics*; D006801:Humans; D007353:Insurance, Long-Term Care / Q000191:economics*; D008134:Long-Term Care / Q000191:economics; D008484:Medicaid / Q000191:economics; D018803:Models, Economic; D017149:Private Sector; D017150:Public Sector; D014481:United States