Trend: We examined and compared the access to long-term care in France, Sweden, Germany, England, Belgium, Switzerland, and The Netherlands before and after 1998. Financing long-term care is expected to be a growing problem in all these countries.
Developments: The expected rise of care demand caused by a growing population of people over the age of 65, and higher levels of individual expectation of care quality; have to be met by a decreasing proportion of the working population. The problems arising from the recent economic crises are expected to reduce the problems regarding shortage of the work force in the immediate future, but are likely to increase the financing problems in the long-term.
Governments are responding to these problems. We continue to report and comment on this process and see the following developments emerging:
• Governments are inclined to focus their responsibility, and consequently most of their limited resources, onto people with substantial and complex care needs and with none or only limited possibilities of solving problems without help.
• Governments are inclined to support the rest of the care-demanding population by facilitating them in their own efforts and solutions. Support which is financially limited that complements people's own resources, could be a part of this effort.
Consequences: These changes will have a serious impact on the current organization of care, especially in countries that either aim at or have a population with expectations of a high universal welfare level of public care. In countries where the public focus is traditionally placed on the support of dependent and poor people, one can expect a growing proportion of the population to be in need of public support.
The consequences will be:
• Most people will have to take increasing responsibility for their own (future) care demand and for their next of kin. This can be done by using informal care or through additional private insurance.
• Both local and national authorities will provide additional social care support for people with serious care needs. This support will probably be more orientated on supply and less on individual demand.
Effects: The trend is expected to have the following effects:
a) The cost of care covered by private means will proportionally increase—care covered by public means will consequently decrease.
b) It is expected that the growth of care consumption will be slowed down by the increase in private funding.
c) The logistics of the organization of care will have to be more orientated on private demand.
d) The cost of public long-term care will increasingly come from complex care and multi-problem social care.
Change: The increasing focus on clients with serious social-medical problems will result in a change of public expectation—that integration of care and integration with other public interventions like social security, child protection, employment, housing and education will not only lead to a better quality, but also to more efficiency.
Integration and efficiency in complex and long-term care will be the ‘buzz’ in the near future.