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Mapping variability in allocation of Long-Term Care funds across payer agencies in OECD countries

Waitzberg, Ruth; Schmidt, Andrea E.; Blümel, Miriam; Penneau, Anne; Farmakas, Antonis; Ljungvall, Åsa; Barbabella, Francesco; Augusto, Gonçalo Figueiredo; Marchildon, Gregory P.; Saunes, Ingrid Sperre; Vočanec, Dorja; Miloš, Iva; Contel, Joan Carles; Murauskiene, Liubove; Kroneman, Madelon; Tambor, Marzena; Hroboň, Pavel; Wittenberg, Raphael; Allin, Sara; Or, Zeynep

Introduction: Long-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to geographical equity of access to LTC, has received limited attention. We conceptualize that LTC systems promote DE when they are designed to set eligibility criteria nationally (vs. locally); and to distribute funds among PAs based on needs-formula (vs. past-budgets or government decisions). Objectives: This cross-country study highlights to what extent different LTC systems are designed to promote DE across PAs, and the parameters used in allocation formulae. Methods: Qualitative data were collected through a questionnaire filled by experts from 17 OECD countries. Results: 11 out of 25 LTC systems analyzed, fully meet DE as we defined. 5 systems which give high autonomy to PAs have designs with low levels of DE; while nine systems partially promote DE. Allocation formulae vary in their complexity as some systems use simple demographic parameters while others apply socio-economic status, disability, and LTC cost variations. Discussion and conclusions: A minority of LTC systems fully meet DE, which is only one of the criteria in allocation of LTC resources. Some systems prefer local priority-setting and governance over DE. Countries that value DE should harmonize the eligibility criteria at the national level and allocate funds according to needs across regions.
Published in: Health Policy, 10.1016/j.healthpol.2020.02.013, Elsevier