We Americans often fall into the trap of looking at our problems in isolation. But every nation in the world faces its own challenges when it comes to caring for the elderly and younger people with disabilities. An imporant new report from the Organisation for Economic Cooperation and Development (OECD) provides an important international context for caregiving and caregivers in the developed world.
The OECD study, Help Wanted: Providing and Paying for Long-Term Care, is eye-opening. Lots of statistics here, but they are really pretty interesting. In some ways, developed countries use similar models to deliver and pay for care. But there are some stark differences among them. And in some key areas, the U.S. is going its own way.
It turns out, for instance, that family members are the bedrock of caregiving throught the developed world. One of every 10 adults over 50 is helping a relative or friend who has a disability. Two-thirds of those caregivers are women. However, the intensity of their care varies widely–family members in northern Europe provide fewer hours of assistance than those in southern Europe, for example. In part, that may be because the Nordic countries have tax-funded social programs that pay for long-term care and ease burdens on families.
Care recipients look a lot alike no matter where they live. Most are women and many are over 80. Except in Eastern Europe, where those getting care tend to be younger, and Japan, where more are older, between 50 percent and 60 percent of those getting care are octogenarians or older.
On average, countries spend about 1.5 percent of their Gross Domestic Product on public long-term care programs–much less than they spend on health care. But there is a lot of variation. The U.S. spends about 1 percent, well below the average. The Netherlands and Sweden spend far more (3.5 percent and 3.6 percent). Private long-term care insurance barely exists in most countries.
When it comes to care for the elderly only, John Creighton Campbell, Naoki Ikegami, and Mary Jo Gibson and found that public spending in the U.S. is actually higher than Germany, even though Germany has a universal system.
Every major developed country in the world, except for the U.S. and the United Kingdom, has some system for universal long-term care. It may be social insurance (Germany, Japan, and Korea), a personal care benefit (France, Italy, and Australia), or fully-integrated social care (Norway and Sweden). Among major countries, only the U.S. and the U.K. still operate a welfare-based system (Medicaid in the U.S.). To learn more about how countries pay for care, take a look at this paper I wrote last year for the Commonwealth Fund.
Help Wanted? isn’t exactly bedtime reading, but it is an important look at how the rest of the world manages the care needs for its rapidly aging populations. There are some interesting lessons here as we think about how to go about caring for out parents.