Health policies and data

Long-term Care


With populations in OECD countries ageing, more people are living with long-term care needs. The OECD Health Division has an ongoing programme of work to support countries in developing long-term care systems that can meet the needs of their populations now and in the future.


As people get older, it becomes more likely that they will need day-to-day help with activities such as washing and dressing, or help with household activities such as cleaning and cooking. This type of support (along with some types of medical care) is what is called long-term care.

Demand for long-term care is expected to rise, thanks in part to ageing populations and increasing prevalence of long-term conditions such as dementia. However, the availability and affordability of long-term care services varies dramatically between OECD countries. Public spending on long-term care ranges from more than 4% of GDP in the Netherlands to less than half a percent of GDP in countries such as Israel, Latvia and Poland (see chart below).

Public spending on long-term care (health and social components) in 2014 as a % of GDP


Source: OECD Health Statistics 2018.

This variation – a factor of ten – is much greater than is seen for health spending. It reflects large differences in the balance between formal provision and informal care (usually provided by families) and the share of costs that people are expected to pay out of pocket. Understanding the impact of these differences is crucial to designing long-term care policies that give people the protection and support that they need. The OECD has released a Working Paper on Measuring social protection for long-term care, which is for the first time allowing to quantify and compare the levels of social protection that people in different countries experience when they develop long-term care needs.

The quality of long-term care services is crucial to the quality of life of people who rely on these services. However, as was found in the 2013 publication A Good Life in Old Age?, the measurement of quality in long-term care lags well behind the health sector. More effective monitoring of long-term care quality, and the development of robust, comparable measures, should be a priority for OECD countries.

The prevalence of dementia is growing in OECD countries and the rest of the world, and the OECD is helping countries to develop better policies to improve the lives of people living with this condition. In 2015, the OECD published Addressing Dementia: the OECD Response which examined the challenges, policy responses and evidence of what works in tackling dementia – both in terms of the provision of health and long-term care and research to find a cure. Since then, the OECD has been working to develop comparable measures of the quality of care that people with dementia receive. These measures are currently being piloted with OECD countries. More information on the OECD’s work on dementia can be found on the dementia home page.


The OECD collects data on long-term care expenditure, system resources (beds and workers) and utilisation (number of recipients). All data are publicly available and can be accessed via the links below:


Measuring social protection for long-term care
March 2017

This working paper provides the first internationally comparable estimates of levels of social protection for long-term care in 14 OECD and EU countries and an assessment of whether social protection is adequate for people in different scenarios.

The project was supported by the European Commission (DG Employment). 

Addressing Dementia: the OECD Response
March 2015

This book brings together the OECD’s work on dementia care with our work on medical research and big data to provide a comprehensive overview of how OECD countries can rise to the challenges posed by dementia. It identifies key objectives that countries should consider when setting dementia-care policy, and ways in which these objectives might be achieved; and explores how rethinking our model for innovation and harnessing big data could help us move more quickly towards a cure. 

A Good Life in Old Age? Monitoring and Improving Quality in Long-Term Care
June 2013

Measuring the quality of long-term care is crucial if services are to be improved, but in practice quality is rarely monitored and few comparable measures exist. This book offers evidence and examples of useful experiences to help policy makers, providers and experts measure and improve the quality of long-term care services.

The project was supported by the European Commission (DG Employment).

Help Wanted? Providing and Paying for Long-Term Care
May 2011

This book gives a wide-ranging overview of the challenges countries are facing with regard to providing and paying for long-term care. With populations ageing and the need for long-term care growing rapidly, this book looks at such issues as: future demographic trends, policies to support family carers, long-term care workers, financing arrangements, long-term care insurance, and getting better value for money in long-term care.


Contact us

If you have any questions about our work on long-term care, please contact Elina Suzuki in the OECD Health Division.