International long-term care reform: A demographic, economic, and policy overview

Advanced industrial countries around the world are making or contemplating major reforms of their systems for financing and organizing long-term care for the elderly. The paper describes major reform efforts including: the pursuit of cost efficiencies from further differentiation of the acute and long-term care delivery systems, promotion of home and community-based care alternatives to traditional institutions, and 'systems integration' involving consolidation of responsibility for long-term care at one level of government. The paper concludes by discussing the special relevance to the longterm care reform debate in the U.S. of recent British and German decisions to, respectively, decentralize versus centralize responsibility for long-term care.