Chapter 2.5 sets out how long term care is provided and how it is paid for. Long-term care (LTC) refers to a broad package of personal, social and medical services provided over extended periods of time which may be delivered by care professionals or by informal care givers. Key learning includes that

• Population ageing, particularly in advanced economies, creates growing demands for LTC.

• There are inequities in the need for and access to LTC. Older people, women, those with lower incomes and lower levels of education are all more likely to need care, but less likely to have access to it.

• Funding arrangements for LTC are problematic in many countries

• – Voluntary insurance and out of pocket payments commonly fill public coverage gaps but create inequities.

• – Asset-tests for eligibility for publicly funded care are essentially regressive wealth taxes due to the unequal distribution of LTC needs.

• – Encouraging for-profit provision theoretically fosters competition, availability and responsiveness but the pressures to generate profits can jeopardize quality and safety.

• Countries face urgent pressures on LTC and could usefully consider

• – Increasing public expenditure and broadening the funding mix for LTC

• – Better, fairer pooling of resources across generations

• – Revenue sources independent of payroll contributions since labour markets as a revenue base will shrink at the same time that demand for ageing-related LTC increases

• – Better data and indicators to assess access, quality, and value for money

• – Patient-centred and coordinated approaches to LTC.