Long-term Care


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.  

Key issues in long-term care policy

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.

A significant share of the spending on LTC services is covered by government or compulsory insurance schemes. Total government/compulsory spending on LTC (including both the health and social care components) accounted for 1.7% of GDP on average across OECD countries in 2017. At 3.7% of GDP, the highest spender was the Netherlands, followed by Norway (3.3%) and Sweden (3.2%). In these countries, public expenditure on LTC was around double the OECD average. At the other end of the scale, Hungary, Estonia, Poland, and Latvia all allocated less than 0.5% of their GDP to the delivery of LTC services.

Long-term care expenditure (health and social components) by government and compulsory insurance schemes, as a share of GDP, 2017 (or nearest year) 


Note: The OECD average only includes 17 countries that report health and social LTC. Access the data behind the graph.
Source: OECD Health Statistics 2019.

This variation 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.



Data on long-term care

Access our latest data from OECD Health Statistics in the dataset Long-term resources and utilisation:

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