This brief is part of a series about financing health and social long-term care: lessons for low- and middle-income countries (LMICs). Countries take a universal or selective approach, or some mix of the two, in identifying the population that will be covered under LTC programmes. Decisions are based on the economic and social contexts, and LTC is designed with consideration of the existing infrastructure for delivering health and social care. Universal approaches are grounded in the principle of ensuring equal access to health and social care. Selective approaches focus on those in greatest need, primarily those who are low-income. While selective approaches are perceived to cost less, the total costs may be offset by the high cost of implementing means-testing to identify beneficiaries. The selective approach may also result in high levels of unmet needs among people who do not meet the low-income thresholds. Mixed universal and selective approaches enable universal coverage for some services or populations and means-tested eligibility for others; thus, older people may face high payments for some needed services. Many LMICs have initiated mixed approaches to LTC, using public and private resources while building the policies, systems and infrastructure for universal coverage of LTC.

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.

The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.