How do countries compare in their design of long-term care provision?: A typology of long-term care systems

Models and approaches to long-term care provision vary greatly across OECD countries. This paper reviews existing classifications in the literature and provides a new, comprehensive typology based on five key dimensions: access, availability, funding, governance, and quality. Using a clustering methodology, countries are grouped according to their score across these dimensions, resulting in four distinct long-term care system types. The first cluster includes countries with comprehensive, well-governed, and decentralised long-term care systems that are affordable, offer broad coverage, support family carers, rely on public providers and ensure high quality standards. The second cluster shares many of these features but tends to be more centralised, slightly less generous, more reliant on the private sector, and less likely to use means-testing to restrict access. The third cluster consists of countries with decentralised long-term care systems, characterised by stricter eligibility criteria, fewer public resources, and greater reliance on informal carers. Finally, the fourth cluster comprises countries where public long-term care systems tend to provide limited access and financial support, rely heavily on families, and show weaker quality standards and outcomes.