Recent innovations in long-term care coverage and financing: a rapid scoping review

Abstract

Objectives: To identify, chart and analyse the literature on recent initiatives to improve long-term care (LTC) coverage, financial protection and financial sustainability for persons aged 60 and older.

Design: Rapid scoping review.

Data sources: Four databases and four sources of grey literature were searched for reports published between 2017 and 2022. After using a supervised machine learning tool to rank titles and abstracts, two reviewers independently screened sources against inclusion criteria.

Eligibility criteria: Studies published from 2017-2022 in any language that captured recent LTC initiatives for people aged 60 and older, involved evaluation and directly addressed financing were included.

Data extraction and analysis: Data were extracted using a form designed to answer the review questions and analysed using descriptive qualitative content analysis, with data categorised according to a prespecified framework to capture the outcomes of interest.

Results: Of 24 reports, 22 were published in peer-reviewed journals, and two were grey literature sources. Study designs included quasi-experimental study, policy analysis or comparison, qualitative description, comparative case study, cross-sectional study, systematic literature review, economic evaluation and survey. Studies addressed coverage based on the level of disability, income, rural/urban residence, employment and citizenship. Studies also addressed financial protection, including out-of-pocket (OOP) expenditures, copayments and risk of poverty related to costs of care. The reports addressed challenges to financial sustainability such as lack of service coordination and system integration, insufficient economic development and inadequate funding models.

Conclusions: Initiatives where LTC insurance is mandatory and accompanied by commensurate funding are situated to facilitate ageing in place. Efforts to expand population coverage are common across the initiatives, with the potential for wider economic benefits. Initiatives that enable older people to access the services needed while avoiding OOP-induced poverty contribute to improved health and well-being. Preserving health in older people longer may alleviate downstream costs and contribute to financial sustainability.

Keywords: Aging; Health Services Accessibility; Health Services for the Aged.

Figure 1

PRISMA flow diagram of article selection. Three reviewers initially independently screened 500 records using CAL and a combined screening sample of 1970 for a total screening sample of 3470 records. With an estimate of duplicate records of 8.4% among the first 1500, we estimate humans screened a total of 3179 records using CAL. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; CAL, Continuous Active Learning.