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Financing long-term care: ex-ante, ex-post or both?

Costa-Font, Joan ORCID: 0000-0001-7174-7919, Courbage, Christophe and Swartz, Katherine (2015) Financing long-term care: ex-ante, ex-post or both? Health Economics, 24. pp. 45-57. ISSN 1057-9230

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Identification Number: 10.1002/hec.3152


This paper examines the heterogeneity in the public financing of long-term care (LTC), and the wide-ranging instruments in place to finance long-term care services. We distinguish and classify the institutional responses to the need for LTC financing as ex-ante (occurring prior to when the need arises, such as insurance) and ex-post (occurring after the need arises, such as public sector and family financing). Then we examine country-specific data to ascertain whether the two types of financing are complements or substitutes. Finally, we examine exploratory cross-national data on public expenditure determinants, specifically economic, demographic and social determinants. We show that although both ex-ante and ex-post mechanisms exist in all countries with advanced industrial economies and despite the fact that instruments are different across countries, ex-ante and ex-post instruments are largely substitutes for each other. Expenditure estimates to date indicate that the public financing of long-term care is highly sensitive to a country’s income, ageing of the population, and the availability of informal caregiving.

Item Type: Article
Official URL:
Additional Information: © 2015 John Wiley & Sons
Divisions: Social Policy
Centre for Economic Performance
Health Policy
Subjects: H Social Sciences > HC Economic History and Conditions
H Social Sciences > HV Social pathology. Social and public welfare. Criminology
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
JEL classification: H - Public Economics > H5 - National Government Expenditures and Related Policies
I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy; Regulation; Public Health
J - Labor and Demographic Economics > J1 - Demographic Economics
Date Deposited: 05 Jan 2015 10:06
Last Modified: 21 May 2024 23:21

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