title: Considering long-term care insurance for middle-income countries: comparing South Korea with Japan and Germany.
abstract: Financing and provision of long-term care is an increasingly important concern for many middle-income countries experiencing rapid population aging. We examine three countries (South Korea, Japan, and Germany) that use social insurance to finance medical care and have developed long-term care insurance (LTCI) systems. These countries have adopted different approaches to LTCI design within the social insurance framework. We contrast their financing systems and draw lessons regarding revenue generation, benefits design, and eligibility. Based on this review, it seems important for middle-income countries to start developing LTCI schemes early, before aging becomes a significant problem and substantial revenues are needed. Early financing also ensures that the service delivery system has time to adapt because most middle-income countries lack the infrastructure for providing long-term care services. One approach is to start with a limited benefit package and strict eligibility rules and expanded the program as the country develops sufficient experience and more providers became available. All three countries use some form of cost-sharing to discourage service overuse, combined with subsidies for poor populations to maintain appropriate access. A major policy choice is between cash benefits or direct provision of services and the approach will have a large impact on the workforce participation of women.
authors.affiliation: Chairman, Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Seoul, Korea; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 225N Collington Avenue, Baltimore, MD, 21231, USA.
authors.forename: Jong Chul
authors.initials: JC
authors.lastname: Rhee
authors.affiliation: PhD Student in Health Economics and Policy, Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. Electronic address: ndone1@jhu.edu.
authors.forename: Nicolae
authors.initials: N
authors.lastname: Done
authors.affiliation: Professor, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
authors.forename: Gerard F
authors.initials: GF
authors.lastname: Anderson
mesh_terms: D004608:Eligibility Determination; D005260:Female; D005858:Germany; D006282:Health Personnel; D006801:Humans; D007182:Income; D007353:Insurance, Long-Term Care; D007564:Japan; D008134:Long-Term Care / Q000191:economics* / Q000458:organization & administration*; D011157:Population Dynamics / Q000639:trends; D056910:Republic of Korea; D012943:Social Security / Q000191:economics
keywords: Financing; Germany; Japan; Long-term care insurance; South Korea