The Case for Universal Basic Services by Anna Coote & Andrew Percy

Author:Anna Coote & Andrew Percy [Coote, Anna & Percy, Andrew]
Language: eng
Format: epub
ISBN: 9781509539840
Publisher: Wiley
Published: 2020-03-16T00:00:00+00:00

Paying for care

Public spending on long-term care across OECD countries ranges from 4.3% of GDP in the Netherlands and 3.2% in Sweden, to 1.8% in France and 1.2% in the United Kingdom, with the United States at 0.5% and Greece at zero.20 This reflects different expectations about the balance of formal and informal care, and about how much people should pay out of their own pockets.

Options for paying for care include direct funding through taxation, payment via a contributory social insurance scheme to which employers and governments may also contribute, private insurance purchased by individuals, or direct payments by individual users which may (or may not) be partly or wholly offset by insurance or cash payments from government. There is usually a distinction between care and accommodation costs and it is common for individuals to have to cover the latter themselves. There is also a distinction between personal and medical care, with the latter more often covered by taxation or social insurance. In the United Kingdom, health care is almost invariably free, but poorly coordinated with a different funding system for long-term social care, the cost of which is estimated to rise from 1.1% to 2% of GDP over the coming decades.21 In other countries, where health care is covered by social insurance, it is more common for long-term care to be included in the scheme.

The Netherlands was the first to introduce a universal system of long-term care insurance in 1968. Sweden established the right to tax-funded social care in 1982/3. Compulsory long-term care insurance schemes were introduced in Germany in 1995, Japan in 2000, France in 2002 and Korea in 2008.22 All these have provided at least some support to everyone with needs above a certain level, regardless of ability to pay. However, many governments have since struggled to maintain financial viability and have adopted various strategies to constrain costs. These include restricting services, raising contributions and introducing competition between insurers and/or providers.

In Scotland, personal care is free if you are over 65 and nursing care is free at any age, provided you are assessed and found to need care by your local authority.23 In the rest of the United Kingdom, you have to meet the full costs if your capital is worth more than £23,250 a year (around 80% of median household income); if you have capital worth less than £14,250, you qualify for free care and in between you may get a partial subsidy.24 All but the rich struggle to get the care they need. Lower- and middle-income families, except the very poor, can forfeit all their life savings and property values to pay for care. And free care for the poor is very often a poor service. Workers are put under increasing pressure to do more for less. Providers make profits even when standards of care are unacceptably low. As one care-related charity put it: ‘We have seen company after company making millions whilst on the frontline vulnerable people are left without the basics to sustain life.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.