Aging, Disability, and Long-Term Care, RTI International, Washington, DC, USA.
J Aging Soc Policy. 2020 Jan-Feb;32(1):15-30. doi: 10.1080/08959420.2018.1563470. Epub 2019 Jan 8.
The Great Recession substantially affected most developed countries. How countries responded to the Great Recession varied greatly, especially in terms of public spending. We examine the impact of the Great Recession on long-term services and supports (LTSS) in the United States and England. Financing for LTSS in these two countries differs in important ways; by examining the two countries' financing and program structures, we learn how these factors influenced each country's response to this common external stimulus. We find that between 2006 and 2013, LTSS increased in the United States in terms of spending (17%) and number of people served; in contrast, over the same period, LTSS in England decreased in terms of spending (6%) and people served. We find that the use of earmarked LTSS funding in the United States, compared to non-earmarked funding in England, contributed to different trajectories for LTSS in the two countries. Other contributing factors included differences in service entitlements, variations in ability of state and local governments to tax, and larger macroeconomic strategies implemented to combat the recession. We analyze the implications of our findings, especially as related to the potential shift to Medicaid block grant LTSS funding in the United States.
大衰退对大多数发达国家产生了重大影响。各国对大衰退的反应差异很大，尤其是在公共支出方面。我们考察了大衰退对美国和英国长期服务和支持（LTSS）的影响。这两个国家的 LTSS 融资在重要方面存在差异；通过考察两国的融资和计划结构，我们了解了这些因素如何影响每个国家对这一共同外部刺激的反应。我们发现，2006 年至 2013 年间，美国 LTSS 的支出（17%）和服务人数均有所增加；相比之下，在同一时期，英国 LTSS 的支出（6%）和服务人数有所减少。我们发现，与英国非专用资金相比，美国专用 LTSS 资金的使用情况导致两国 LTSS 呈现出不同的轨迹。其他促成因素包括服务权益的差异、州和地方政府征税能力的变化，以及为应对衰退而实施的更大规模的宏观经济战略。我们分析了这些发现的意义，特别是与美国转向医疗补助定额拨款 LTSS 资金的潜在转变有关。
