Comparative Assessment of Long-term Care System Generosity: Mapping Benefits and Inclusiveness Internationally

Long-term care is a comparatively young but increasingly important social policy field. However, international comparative data on the topic are (still) scarce. Addressing this gap, this paper introduces a comprehensive framework for gauging LTC system generosity and presents our corresponding novel data, the Long-Term Care Benefits dataset (LTCB). Building on previous discussions in welfare research, we conceptualise generosity by means of two dimensions that depict the distribution and variety of LTC benefits: scope of benefits (what is provided and how much of it) and inclusiveness (who is entitled and eligible). More specifically, our resulting LTC generosity framework outlines 17 in-kind, cash and regulatory benefits for people in need of care as well as caregivers, plus criteria measuring benefit levels and the conditions that (potential) beneficiaries need to fulfil. In a second step, we applied the framework while collecting de jure information from laws and secondary sources on these different aspects of LTC system generosity. Covering a sample of 40 countries, our empirical analysis of the LTCB data finds that in-kind benefits are the most common benefit type and means-related co-payments are the most prevalent form of cost-sharing for LTC services. We also find great variety in the number and kind of eligibility criteria employed within and across countries, which also implies LTC system fragmentation. Furthermore, in line with welfare state research, inclusiveness in LTC is stricter in liberal welfare states than in Nordic countries. While our novel dataset offers the most comprehensive and systematic de jure data collection on LTC benefits so far, it also has several limitations, such as missing (standardised) data on the level of benefits and its limited information on the (de facto) relevance of benefit schemes and recipients.