Financing Longterm Care in Russia: A Case for an Insurance-based Model

As populations age worldwide, providing effective long-term care for citizens over the age of 65 poses a serious challenge for social policymakers. In OECD countries, the fundamental principles of longterm care policy were established in the 1980s and 1990s, when the socio-economic consequences of population ageing became obvious. These countries developed comprehensive institutional and financial mechanisms for the systematic provision of long-term care services. Prior to this period, care provision in many countries remained fragmented, administered by disparate agencies and financed from uncoordinated sources. Russia initiated its long-term care system in 2018 through pilot programs, in 2023 moved to implement it nationwide. Current analysis identifies substantial deficiencies: inadequate geographic coverage, regional differences in service provision, and concentration of resources on the most complex cases. These constraints are fundamentally rooted in financing limitations. Drawing on forecasts of demand for services, we identify three development scenarios, each differentiated by the scope of citizens coverage. Our analysis suggests that an insurance-based financing model deserves to be revisited as the foundation for Russia’s long-term care system. Such a model would enhance financial sustainability and enable the system to respond effectively to upcoming demographic challenges.