菲沙研究所-反思加拿大的长期护理（英）-2021-82页_2mb

报告摘要

Summary of Rethinking Long-Term Care in Canada

Core Content

This report analyzes the long-term care (LTC) system in Canada and compares it to the experiences of four countries—Germany, Japan, the Netherlands, and Sweden—that have successfully integrated LTC into their universal health-care systems. The study highlights the importance of public-private collaboration and decentralized governance in addressing the challenges of an aging population and ensuring the financial sustainability and quality of LTC services.

Main Challenges in Canada

High Institutional Dependency: Most LTC in Canada is still provided in institutions, despite growing public interest in home-based care.
Lack of Choice and Competition: In many provinces, especially Quebec, there is little to no competition among LTC providers, and user choice is limited.
Long Wait Times: Provinces like Ontario and Quebec face significant delays in providing LTC placements and home-care services.
Inadequate Funding and Coverage: Private LTC insurance is underutilized due to limited awareness and the perception that government will cover all costs.
Financial Burden on Individuals: A large portion of LTC costs are borne by individuals through out-of-pocket expenses, with only those below a certain income threshold receiving full public funding.
Demographic Pressures: Canada's aging population and the increasing prevalence of chronic diseases and cognitive impairments are placing unprecedented demands on LTC systems.

Key Policy Lessons from Other Countries

1. Universal Access with Cost Sharing

All four countries provide universal access to LTC services, but cost sharing is a common feature, which does not lead to reduced access or inequity.
Patients are encouraged to contribute to the financing of care, which promotes cost efficiency and responsible use of services.

2. Decentralized Governance

These countries have adopted decentralized governance models, allowing local authorities to make decisions based on specific community needs.
In contrast, Canada has moved toward centralization, reducing the autonomy of regional health authorities and limiting local responsiveness.

3. Choice and Competition

Choice and competition among care providers are promoted, which improves quality of service and efficiency.
Private for-profit providers are increasingly involved, and their ability to adapt to changing user needs is seen as a strength.

4. Cash-for-Care Schemes

Countries like Germany and the Netherlands have implemented cash benefits that allow seniors to choose care providers, including family members.
These schemes are more cost-efficient than traditional government-directed programs and increase autonomy and personalization of care.

5. Home-Centered Care Models

All four countries have shifted toward home and community-based care, reducing reliance on institutional care.
This shift aligns with population preferences and helps soften the financial impact of aging on LTC systems.

Comparative Financial Overview

Canada's LTC spending accounts for 2% of GDP, with 78.4% from governments, 3.3% from private insurers, and 18.3% from out-of-pocket spending.
Other OECD countries typically spend less on LTC as a percentage of GDP, yet still manage to provide universal access and better outcomes.

Conclusion

The Canadian LTC sector faces significant challenges, including institutional overreliance, lack of choice, and financial sustainability concerns. In contrast, the four countries studied have demonstrated that decentralized governance, public-private collaboration, and choice-based models can lead to better quality, greater efficiency, and more sustainable LTC systems. These insights suggest that reforms in Canada should consider decentralization, increased private sector involvement, and more flexible funding mechanisms to better meet the needs of an aging population.

Key Takeaways

Universal access is a common feature in the four countries, but cost sharing is also integral.
Decentralization allows for local responsiveness and better alignment with user preferences.
Choice and competition among providers improve service quality and efficiency.
Cash-for-care schemes enable greater autonomy and personalized care.
Home-based care is increasingly favored and has helped reduce institutional pressures in these countries.

Recommendations

Canada should explore decentralized models to improve local decision-making and responsiveness.
Public-private partnerships should be encouraged to increase flexibility and service options.
Cash benefits could be introduced to support user choice and reduce institutional reliance.
Investment in home care should be prioritized to align with population preferences and reduce wait times.