ABSTRACT
Advanced industrial countries around the world are making or contemplating major reforms of their systems for financing and organizing long-term care for the elderly. The paper describes major reform efforts including: the pursuit of cost efficiencies from further differentiation of the acute and long-term care delivery systems, promotion of home and community-based care alternatives to traditional institutions, and ‘systems integration’ involving consolidation of responsibility for long-term care at one level of government. The paper concludes by discussing the special relevance to the long-term care reform debate in the U.S. of recent British and German decisions to, respectively, decentralize versus centralize responsibility for long-term care.
