This brief is part of a series about financing health and social long-term care: lessons for low- and middle-income countries (LMICs). The number of people aged 65 years and older will increase in LMICs, where most older people will be living by 2050. Many people in LMICs will experience the onset of age-related health problems before the age of 65 years. Long-term care (LTC) can include some acute care medical services delivered in health facilities, but it primarily refers to support provided outside of the health system by caregivers in institutions or at home to allow people to maintain their routine activities. Individuals’ unmet needs increase the demand for LTC. Without formal LTC services and systems, the costs of LTC shift to the family. Informal caregivers, primarily women, may need to reduce their working hours or leave the labour force prematurely, placing pressure on the economy and household resources. The availability of informal caregivers has declined along with decreases in fertility and family sizes, and increased opportunities for women in the formal workforce. In the absence of formal LTC services and systems, individuals seek care in the acute care medical system, which can increase health care costs while offering suboptimal care for older adults. People underestimate their need for LTC, even though many may require intensive support or institutional care that may exceed their income. Given the market failures of LTC insurance, public intervention is well-justified to meet this demand.

This brief is the ninth in a series discussing long-term care financing in low- and middle-income settings. The focus is workers in the formal long-term care system.

Key policy issues in long-term care (LTC) are complex and the numbers of persons needing such care continue to incease. This volume addresses these issues: the role of and support to the family; integration with health and social systems; case management; and strategies for designing LTC systems.

This overview of health financing tools, policies and trends--with a particular focus on challenges facing developing countries--provides the basis for effective policy-making. Analyzing the current global environment, the book discusses health financing goals in the context of both the underlying health, demographic, social, economic, political and demographic analytics as well as the institutional realities faced by developing countries, and assesses policy options in the context of global evidence, the international aid architecture, cross-sectoral interactions, and countries' macroeconomic frameworks and overall development plans.