INTRODUCTION: Long-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to geographical equity of access to LTC, has received limited attention. We conceptualize that LTC systems promote DE when they are designed to set eligibility criteria nationally (vs. locally); and to distribute funds among PAs based on needs-formula (vs. past-budgets or government decisions). OBJECTIVES: This cross-country study highlights to what extent different LTC systems are designed to promote DE across PAs, and the parameters used in allocation formulae. METHODS: Qualitative data were collected through a questionnaire filled by experts from 17 OECD countries. RESULTS: 11 out of 25 LTC systems analyzed, fully meet DE as we defined. 5 systems which give high autonomy to PAs have designs with low levels of DE; while nine systems partially promote DE. Allocation formulae vary in their complexity as some systems use simple demographic parameters while others apply socio-economic status, disability, and LTC cost variations. DISCUSSION AND CONCLUSIONS: A minority of LTC systems fully meet DE, which is only one of the criteria in allocation of LTC resources. Some systems prefer local priority-setting and governance over DE. Countries that value DE should harmonize the eligibility criteria at the national level and allocate funds according to needs across regions.

Advance Healthcare Management Institute and Charles University Prague Czech Republic

Andrija Stampar School of Public Health School of Medicine University of Zagreb Zagreb Croatia

Austrian Public Health Institute Department of Health Economics and Health System Analysis 1010 Vienna Austria

Care Policy and Evaluation Centre London School of Economics and Political Science London WC2A 2AE United Kingdom

Centre for Socio Economic Research on Ageing National Institute of Health and Science on Ageing Ancona Italy

Chronic Care Program Department of Health Barcelona Spain

Department of Health Care Management Faculty of Economics and Management Technical University Berlin Germany

Department of Health Economics and Social Security Institute of Public Health Faculty of Health Sciences Jagiellonian University Collegium Medicum 31 531 Krakow Poland

Department of Health Services Research Norwegian Institute of Public Health Norway

Global Health and Tropical Medicine 1349 008 Lisbon Portugal

Institut de recherche et documentation en économie de la santé France

Institute of Health Policy Management and Evaluation University of Toronto Toronto Ontario M5T 3M6 Canada

Nivel 3513 CR Utrecht the Netherlands

Public Health Department Institute of Health Sciences Faculty of Medicine Vilnius University LT 03101 Vilnius Lithuania

Swedish Agency for Health and Care Services Analysis Stockholm Sweden

The Smokler Center for Health Policy Research Myers JDC Brookdale Institute JDC Hill P O B 3886 Jerusalem 91037 Israel; Department of Health Systems Management School of Public Health Faculty of Health Sciences Ben Gurion University of the Negev Beer Sheva Israel; Department of Health Care Management Faculty of Economics and Management Technical University Berlin Germany

University of Nicosia Cyprus Cyprus

Citace poskytuje Crossref.org