Putting Quality First: Contracting for Long-Term Care

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Provision Another area of variation is the extent to which services and facilities are delivered by public, private not-for-profit or for-profit providers. While in the UK and Germany the share of private providers is comparatively high, the Nordic countries are still characterised by extended public service provision. Also, the role of not-for-profit organisations is dependent on national traditions. For instance, in Germany and Austria not-for-profit organisations have traditionally delivered LTC services, which led to their expansion in recent decades. In Eastern Europe, where not-for-profit organisations had to be reintroduced during the transition to market economies, there is still a lack of such providers in LTC.

Differences in long-term care across countries

There is a general tendency to organise LTC services at local level, be it in the Nordic or in Mediterranean countries – and local authorities are characteristically of various sizes with significantly different scopes of autonomy. For instance, municipalities in Nordic countries are larger than in Southern Europe, they levy local taxes and enjoy autonomy within national framework legislation. In Spain, this autonomy, except for taxes, is granted to the regions, while in Italy there are inter-communal entities that manage health and social care within the regions and impact the organisation of LTC.

Public expenditure and financing Public expenditure and financing range from small budget lines within social assistance schemes, as in many Eastern European countries, to expenditures for LTC that amount to more than 3% of GDP such as in the Netherlands or Sweden. This difference in expenditure also reflects the extent to which access to services is guaranteed and which rights and entitlements are granted by legislation. While in Germany, Luxembourg and the Netherlands there are social insurance branches granting access to LTC, countries such as Ireland, Switzerland or Poland grant access to services and facilities based on a social assistance rationale. Differences in expenditure are also linked to the extent to which LTC schemes grant services in kind, such as in the Nordic countries and the Netherlands, rather than cash benefits, as in Continental welfare regimes (AT, FR, DE, CZ).

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