Waitzberg Ruth, Schmidt Andrea E, Blümel Miriam, Penneau Anne, Farmakas Antonis, Ljungvall Åsa, Barbabella Francesco, Augusto Gonçalo Figueiredo, Marchildon Gregory P, Saunes Ingrid Sperre, Vočanec Dorja, Miloš Iva, Contel Joan Carles, Murauskiene Liubove, Kroneman Madelon, Tambor Marzena, Hroboň Pavel, Wittenberg Raphael, Allin Sara, Or Zeynep
The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, JDC Hill, P.O.B. 3886, Jerusalem 91037, Israel; Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Health Care Management, Faculty of Economics & Management, Technical University Berlin, Germany.
Austrian Public Health Institute, Department of Health Economics & Health System Analysis, 1010 Vienna, Austria.
Health Policy. 2020 May;124(5):491-500. doi: 10.1016/j.healthpol.2020.02.013. Epub 2020 Feb 29.
Long-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to geographical equity of access to LTC, has received limited attention. We conceptualize that LTC systems promote DE when they are designed to set eligibility criteria nationally (vs. locally); and to distribute funds among PAs based on needs-formula (vs. past-budgets or government decisions).
This cross-country study highlights to what extent different LTC systems are designed to promote DE across PAs, and the parameters used in allocation formulae.
Qualitative data were collected through a questionnaire filled by experts from 17 OECD countries.
11 out of 25 LTC systems analyzed, fully meet DE as we defined. 5 systems which give high autonomy to PAs have designs with low levels of DE; while nine systems partially promote DE. Allocation formulae vary in their complexity as some systems use simple demographic parameters while others apply socio-economic status, disability, and LTC cost variations.
A minority of LTC systems fully meet DE, which is only one of the criteria in allocation of LTC resources. Some systems prefer local priority-setting and governance over DE. Countries that value DE should harmonize the eligibility criteria at the national level and allocate funds according to needs across regions.
长期护理（LTC）的组织方式较为分散。付费机构（PA）从资金募集机构获得长期护理资金，并委托提供服务。然而，长期护理在各付费机构间的分配公平性（DE）作为获得长期护理地理公平性的一个前提条件，受到的关注有限。我们认为，当长期护理系统旨在在全国范围内（而非地方层面）设定资格标准；并基于需求公式（而非过去的预算或政府决策）在各付费机构间分配资金时，这些系统就能促进分配公平。
这项跨国研究突出了不同的长期护理系统在多大程度上旨在促进各付费机构间的分配公平，以及分配公式中所使用的参数。
通过向经合组织17个国家的专家发放问卷收集定性数据。
在分析的25个长期护理系统中，有11个完全符合我们所定义的分配公平。5个赋予付费机构高度自主权的系统设计的分配公平程度较低；而9个系统部分促进了分配公平。分配公式的复杂程度各不相同，一些系统使用简单的人口统计学参数，而另一些系统则应用社会经济地位、残疾情况和长期护理成本差异。
少数长期护理系统完全符合分配公平，而这只是长期护理资源分配标准之一。一些系统更倾向于地方层面的优先事项设定和治理，而非分配公平。重视分配公平的国家应在国家层面统一资格标准，并根据各地区需求分配资金。
