Long-Term Care Financing in Belgium

With rapid aging, change in family structure, and the increase in the labor participation of women, the demand for long-term care has been increasing in Korea. Inappropriate utilization of medical care by the elderly in health care institutions, such as social admissions, also puts a financial burden on the health insurance system. The widening gap between the need for long-term care and the capacity of welfare programs to fulfill that need, along with a rather new national pension scheme and the limited economic capacity of the elderly, calls for a new public financing mechanism to provide protection for a broader range of old people from the costs of long-term care. Many important decisions are yet to be made, although Korea is likely to introduce social insurance for long-term care rather than tax-based financing, following the tradition of social health insurance. Whether it should cover only the elderly long-term care or all types of long-term care including disability of all age groups will have a critical impact on social solidarity and the financial sustainability of the new long-term care insurance. Generosity of benefits or the level of out-of-pocket payment, the role of cash benefits, and the relation with health insurance scheme all should be taken into account in the design of a new financing scheme. Lack of care personnel and facilities is also a barrier to the implementation of public long-term care financing in Korea, and the implementation strategy needs to be carved out carefully.

There is evidence of benefits from the national health insurance systems in the EU Member States in the case of better-adjustment of housing units to the functional capacities of older adults. Still, the systematic approach to evaluating the social value (SV) of investments in specialised housing and other types of built environment is not yet developed. This paper aims to show how these benefits can be quantified if we evaluate the actuarial present value (APV) of reducing public expenditures in Long-term care (LTC), including Health care (HC) in these systems, after the development of specialised housing units which can accommodate the declined functional capacities of seniors. The paper presents steps to measure the SV as the impact of investments in the properly built age-friendly public housing stock, creating positive externalities for HC expenditures and LTC systems achieved for the Health Insurance Institute of Slovenia, thereby decreasing expenditures for this body. We developed a new model to forecast the SV of investments in specialised social housing as savings for national health and care systems, particularly the Central-European health and care insurance systems. We were forecasting the different demands for different specialised housing as part of the social infrastructure for insured older adults, which mitigates public expenditure on HC and LTC services. The multistate transitions are described based on projections and probability-weighted cashflows (actuarial present value, APV) are calculated. Unfortunately, there are no documents by the European Commission yet, although the Commission stresses the need to develop such a model.

The rancor accompanying the repeal of most of the 1988 Medicare Catastrophic Act reflects both the national need to improve health and long-term care benefits for the elderly and the political obstacles to finding new sources of financing for such benefits. Neither the need nor the obstacles will go away, but policymakers are now likely to look for lower-cost, efficient, and privately funded alternatives. The authors have developed and tested one such approach: the Social Health Maintenance Organization (SHMO). Operating since 1985, the SHMO model integrates community-based, long-term care services into the managed, prepaid HMO design. The four test sites are adding long-term care to Medicare at no extra cost to the government and only modest premiums for the 17,000 current members. Although the benefits offer limited protection for long-term nursing home care, they do cover long-term care in community settings, where people tend to prefer to stay. Also, integration of the acute and long-term care systems improves the ability to respond to the medical needs of frail members, who also have high acute-care use. The SHMO's model of front-end, community-oriented, long-term care benefits integrated with Medicare appears to be a practical, affordable, and clinically appropriate way to address the rising concern with the lack of coverage and services for long-term care.

Large increases in the need for long-term care (LTC) services are expected as baby boomers age. Little has been published about patient and caregiver preferences for information about LTC. However, our qualitative research findings suggest that potential consumers may find it difficult to obtain accurate and timely information about LTC programs and services. In-person, semistructured interviews were conducted with 47 subjects, including patients (n = 25) within 90 days of their referral to a LTC placement (including NH, assisted living, home care, and community) and their caregivers (n = 22). Interview questions addressed the events that seemed to trigger their need for a LTC referral, the resources they used to become more informed about LTC options and the issues they confronted with the LTC referral process. Qualitative analyses identified a number of patient and informal caregiver-reported barriers to making decisions about LTC services, including insufficient information about LTC programs and community resources, unclear funding requirements and inadequate funding, and difficulty knowing how to plan for LTC or make LTC decisions. A potential solution may be an online LTC Guide designed to provide accurate information about the range of LTC services, with an emphasis on home and community-based services. This Guide was developed to address the gap in comprehensive LTC information identified in the findings of this study.

Purpose The purpose of the study was to examine the frequency and competency in care services by length of job experience and level of service difficulty among direct care-workers in long-term care facilities in Korea. Methods A cross-sectional survey study design was used and data for 383 care-workers were analyzed. The case workers were recruited from 29 nursing homes located in different areas of Korea. Results Mean age of care-workers was 53.42±7.14, (M±SD) scores for frequency and competency were 4.08±0.59 and 3.92±0.66, respectively. There was no significant difference in frequency of long term care services, but competency was significantly different by length of job experience (t=-3.27, p=.001). For level of service difficulty, frequency of long term care service was highly significant only for level 5 service difficulty (t=-2.70, p=.007), but competency case-workers with over 3 years of job experience was highly significant for level 3 (t=-3.00, p=.003), level 4 (t=-3.61, p<.001), and level 5 (t=-3.78, p<.001) service difficulty. Conclusion Findings indicate that competency of long term care service is significant by length of job experience and a high level of service difficulty, thus these factors should be considered in assigning roles for direct care-workers in long-term care facilities. 주요어: 요양보호사, 장기요양, ë ¸ì¸ìš”ì–‘ì‹œì„¤, ìˆ™ë ¨ë„, 난이도 Key Words: Health personnel, Long-term care, Nursing homes, Work performance

Long-term care (LTC) is a major health policy issue owing to increasing LTC expenditures and the anticipated growth in the aging population. However, accessing LTC services, especially home- and community-based LTC services, is often difficult. This manuscript describes the Community Connector Program, the first known program to use a model in which community health workers (CHWs) help to connect adults in need of LTC to such services. We examine the community-university-government agency partnership created to implement and evaluate the program, summarize the evaluation design, and provide first-year implementation results. Descriptive statistics were used to characterize persons served and services to which persons were connected. The quasi-experimental evaluation design, which is planned to estimate the program's impact on LTC service utilization and costs within the Arkansas Medicaid program, is described. Community Connectors linked 686 persons (92% > or =18 years, 80% African American, 58% female) to at least one needed service. Only 39% of adults served needed LTC based on an LTC screening tool. Nearly all (93%) adults in need of LTC had health insurance; 53% had Medicare; 37%, both Medicare and Medicaid; and 11%, Medicaid. Community Connectors referred adults in need of LTC to 68 agencies and helped them to connect to services to address an average of two needs per adult. Preliminary results from the first-year implementation evaluation indicate the program is effective in linking persons to needed LTC, although program refinements were made to improve targeting of intended program recipients.

隨著總生產率下降、人口成長率下降與平均餘命的延長，台灣的65歲以上老年人口早於民國82年達到人口老化國家門檻的7%，預計民國107年達高齡社會的14.7%，民國117年達超高齡社會的22.5%。伴隨人口結構的快速高齡化、家庭照顧功能的消失與失能失智人口的增加，以生活照顧而非醫療治病為主的長期照護(長照)保險制度即將成為我國社會福利的另一主幹。 從目前我國長照保險規劃報告，我們可以歸納以下的重點。長照的對象應該是65歲以上日常生活與工具性日常生活失能的老人、失智者與身心障礙者。長照的納保原則上會比照健康保險，以全民為對象。長照的傳遞，將由相關之保險局負責從申請、訪視評估與需求判定，而照顧計劃之擬定以及執行則希望由地方政府完成，以達因地制宜效果。財務規劃上，根據實際調查預估之失能人口、照護分級(需支援、需照護一、二、三級)以及現今十年長照計劃使用率，民國100年，110年及120年之高推估保險總費用將達GDP之0.75%，0.97%及1.25% (低推估為0.36%，0.46%及0.61%)，但是給付卻上限遠低於德國、日本，甚至南韓。 針對這份長照保險草案，個人認為可以從服務策略看到在未來長照服務執行上，確實存在顧客期望差距的知識缺口、自以為是的標準訂定缺口、實務輸送服務的輸送缺口、服務提供與行銷的溝通缺口乃至可能的顧客實際感受差距的服務缺口。其中，尤其是服務提供人員的素質、訓練與理念奠定，將是長照服務能否成功的關鍵。為求補強服務策略分析上的弱點，個人認為可以從照服員與照管專員等第一線人員的專業訓練課程標準化與在職評估制度化，來強化人力資源。財務規劃上，更須依照工作內容與實際付出，提昇給付上限與支付標準，強化長照從業者的工作尊嚴與工作控制感，清晰其社會角色地位，當更有助於我國未來推動全面的長照保險。

This study examines the factors influencing individuals' willingness to pay higher taxes to support long-term care (LTC) services, a pressing issue as aging populations drive rising LTC demand and public spending. We use data from the 2020 and 2022 waves of the OECD's "Risk that Matter" survey, a cross-national survey examining people's perceptions of the social and economic risks they face. We employ generalized linear mixed-effects models configured as logistic regression models, including country-level random intercepts and country-level covariates. We also conduct standard logit regressions for individual countries to analyze local nuances further. The findings reveal that higher income, older age, female gender, left-leaning political orientation, and caregiving responsibilities significantly increase the likelihood of willingness to pay for improved LTC services. At the country level, greater LTC spending as a share of GDP, higher trust in government, and policies offering cash benefits to carers also play a significant role. Overall, the results indicate strong support for additional LTC funding among sizeable demographic groups, especially older respondents and those in higher-income groups. At the same time, political orientation and certain socio-demographic characteristics are associated with differences in support. These findings are relevant for policymakers considering reforms to improve the provision of LTC services.

The importance of having access to care options and being able to finance this has been laid bare through the experience of the COVID-19 health emergency. While most countries have public options for long-term care and health care, these are not always comprehensive and may not support the needs of the community. Having long-term and health care options that are affordable are important public policy considerations, especially when ageing is affecting many OECD countries and morbidity is impacting health outcomes. Private insurance can extend care options, and provide additional services that may not always be available through the public sector. However, insurance is not uniformly offered across countries, especially given the differences in the public system, and the manner in which it is made available will differ as well.This report examines selected countries that have characteristics in their long-term care and/or healthcare system, which may facilitate the use of private insurance to support the provision of public health and long-term care services.

Depending on their place of residence, older persons have unequal access to long-term care (LTC) services. This article investigates how the county-level supply of inpatient and outpatient LTC services influences individual-level LTC choices of older persons. Administrative data on LTC service supply from the German Care Statistic are combined with representative survey data on the LTC choices of N = 1303 persons aged 80+ from the German Federal State North Rhine-Westphalia. Random utility models are applied to model the choice among three care arrangements: receiving inpatient care in an institutional setting (e.g., nursing home), receiving outpatient care in the community, and living in the community without receiving inpatient or outpatient care. The main findings are: Higher inpatient service supply increases the probability that older persons leave the community and enter institutional LTC. Higher outpatient service supply increases the probability that older persons choose to receive outpatient care in the community instead of entering institutional LTC. The results suggest that policy makers must consider the county-level LTC service supply when designing equitable LTC systems that meet the needs of older persons in a cost-effective way.

Objective Cenobamate has recently been introduced as new anti-seizure medication (ASM) for patients with focal onset seizures (FOS) who are insufficiently controlled despite the use of three previous ASMs. To date, few evaluations have addressed the budgetary impact for the healthcare payer of add-on ASMs in patients with drug-resistant epilepsy (DRE). This study aims to assess the budgetary implications for the Belgian health insurer, the National Institute for Health and Disability Insurance (NIHDI), if cenobamate were reimbursed for the adjuvant treatment of FOS in adults with DRE. Methods A prevalence-based budget impact model (BIM) was developed from the perspective of the Belgian NIHDI, considering all direct healthcare costs over a 3-year time horizon. A standardized expert elicitation process with experienced epileptologists was conducted to collect data on Belgian clinical practice. Source data uncertainty impact was investigated through a one-way sensitivity analysis (OWSA). Results Over a 3-year period, considering the cumulative drug costs of cenobamate, replacement of other third-generation ASMs, and savings generated at medical cost level, the introduction of cenobamate as adjunctive treatment for the target population was estimated to reduce the NIHDI budget by −€8,105,616. The robustness of these savings was confirmed through an OWSA. Conclusion The savings at medical cost level fully offset the impact of cenobamate on the drug budget, leading to an overall healthcare budget saving of −€8,105,616 for NIHDI. This favourable outcome is largely due to cenobamate’s high efficacy reflected in its high response rate and significant effect on reducing seizure frequency.

Use of long-term care (LTC) services among older adults in Asia has emerged as an important issue in light of rapidly aging countries and changing family structures. Simply building more LTC facilities will not result in higher usage rates, and more insight is needed on the usage of existing services. Few studies have been conducted among Asian populations outside Western settings on this topic. The multi-ethnic population in Singapore is useful for understanding the factors influencing the use of long-term care services in Asia. We present our qualitative findings on long-term care service usage in the older population (50+ years) over time. We highlight caregivers' needs as an important determinant of LTC use. Although preferences of the care recipients were considered, caregiver needs, the availability of formal and informal care support, attitudes, perceived control, and social norms surrounding family caregiving governed the use of formal LTC services in Singapore.

Independent foundations' primary focus is grant making.In general, their assets come from the gift of an individual or family.Community foundations' assets usually come from many donors rather than a single source, and grant making is limited to a particular region.Community foundations are usually classified as private charities under the tax law and are subject to different rules and regulations than are other private foundations. Access To CareAccording to 1988 Census Bureau estimates, over thirty-one million Americans are without health insurance.The demographics of these people are diverse, and their ranks continue to grow as the service industry burgeons and as competition in health care increases.Regional disparities in access also exist.Foundation funding in this area ranges from economic analyses of the problem to direct provision of care.

BackgroundDuring a four-year action research project (2003-2007), a program targeting all type 2 diabetes patients was implemented in a well-defined geographical region in Belgium. The implementation of the program resulted in an increase of the overall Assessment of Chronic Illness Care (ACIC) score from 1.45 in 2003 to 5.5 in 2007. The aim of the follow-up study in 2008 was to assess the effect of the implementation of Chronic Care Model (CCM) elements on the quality of diabetes care in a country where the efforts to adapt primary care to a more chronic care oriented system are still at a starting point.MethodsA quasi-experimental study design involving a control region with comparable geographical and socio-economic characteristics and health care facilities was used to evaluate the effect of the intervention in the region. In collaboration with the InterMutualistic Agency (IMA) and the laboratories from both regions a research database was set up. Study cohorts in both regions were defined by using administrative data from the Sickness Funds and selected from the research database. A set of nine quality indicators was defined based on current scientific evidence. Data were analysed by an institution experienced in longitudinal data analysis.ResultsIn total 4,174 type 2 diabetes patients were selected from the research database; 2,425 patients (52.9% women) with a mean age of 67.5 from the intervention region and 1,749 patients (55.7% women) with a mean age of 67.4 from the control region. At the end of the intervention period, improvements were observed in five of the nine defined quality indicators in the intervention region, three of which (HbA1c assessment, statin therapy, cholesterol target) improved significantly more than in the control region. Mean HbA1c improved significantly in the intervention region (7.55 to 7.06%), but this evolution did not differ significantly (p = 0.4207) from the one in the control region (7.44 to 6.90%). The improvement in lipid control was significantly higher (p = 0.0021) in the intervention region (total cholesterol 199.07 to 173 mg/dl) than in the control region (199.44 to 180.60 mg/dl). The systematic assessment of long-term diabetes complications remained insufficient. In 2006 only 26% of the patients had their urine tested for micro-albuminuria and only 36% had consulted an ophthalmologist.ConclusionAlthough the overall ACIC score increased from 1.45 to 5.5, the improvement in the quality of diabetes care was moderate. Further improvements are needed in the CCM components delivery system design and clinical information systems. The regional networks, as they are financed now by the National Institute for Health and Disability Insurance (NIHDI), are an opportunity to explore how this can be achieved in consultation with the GPs. But it is clear that, simultaneously, action is needed on the health system level to realize the installation of an accurate quality monitoring system and the necessary preconditions for chronic care delivery in primary care (patient registration, staff support, IT support).Trial RegistrationTrial registration number: ClinicalTrials.gov Identifier: NCT00824499

Long-term care insurance has been introduced in Korea a year ago, and we are in a stage requiring to set principles regarding the generosity of coverage and how to gradually extend the coverage. This study empirically analyzes how the long-term care insurance in Korea is operated. Special attention is given to who is the main beneficiary of the long-term care insurance introduction, and what is the factors influencing the elderly`s decision to apply for or use long-term care services. Use of a detailed information of individuals` public health insurance and long-term care insurance from administration data made it possible to control for health status, socioeconomic status including family type, housing tenure, income level. Logit models were employed to analyze the effects of various socioeconomic factors on the likelihood of applying and using long-term care services. Also, this study employed a survey questioning whether to ever willing to take other option as a alternative to residential care or home-care and the level of cash benefit for which they are willing to replace the formal care with informal care. The result indicated that although the poorest elderly population groups are in the greatest need for the long-term care service, they are in difficulty using the service due to economic burden. This implies the copayment amount needs to be adjusted in order for the poor elderly group to be able to get the benefit of the long-term care service.