Long-Term Care Around the Globe

The rate of population aging across developed countries varies considerably. For example, in the year 2000, the percentage of the total population age sixty-five and older was higher in Japan (17.1 percent), Germany (16.4 percent), the United Kingdom (16 percent), and France (15.9 percent) than in Canada (12.8 percent), the United States (12.5 percent), Australia (12.1 percent), and New Zealand (11.6 percent). By the year 2020, Canada, the United States, Australia, and New Zealand will catch up to or slightly surpass Japan, Germany, France and the United Kingdom in this regard. Meanwhile, population aging in Germany, France and the United Kingdom is anticipated to progress to the point where, as of 2020, one in five—and, in Japan, one in four—citizens will be in this age group. These and other differences in the extent and pace of population aging across developed countries may explain why the countries with the oldest and/or more rapidly aging populations (including Germany, Japan, and the United Kingdom) have given high political priority to reforming their long-term care financing and service delivery systems.

The central challenge facing policymakers seeking to reform their long-term care systems, is, according to many experts, striking a balance in the provision of long-term care for the elderly between the family, the marketplace, and the state. To understand why this is such a difficult task, it is useful to review the evolution of long-term care systems in developed countries.