2021-10-25-菲沙研究所-反思加拿大的长期护理（英）_82页_2mb

Rethinking Long-Term Care in Canada

This report analyzes how four countries—Germany, Japan, the Netherlands, and Sweden—have reformed their universal long-term care (LTC) systems to improve efficiency, resilience, and care outcomes. The study identifies four key policy lessons for Canada:

🏥 1. Cost-Sharing Does Not Reduce Access to Care

• All four countries allow universal access to LTC regardless of income
• Cost-sharing (copayments) is implemented as part of universal systems
• Funding mixes public, private, and out-of-pocket contributions
• Means-testing applies to determine full public funding eligibility
• Cost-sharing incentivizes efficient use of care resources

💼 2. Private Providers Improve Efficiency and Quality

• Decentralized power distribution increases local decision-making autonomy
• Private for-profit providers show willingness to innovate and adapt
• Competition improves quality through customer choice mechanisms
• User choice systems enhance service delivery efficiency
• Regulatory standards apply equally to public and private providers

🏠 3. Home Care is Preferred and More Cost-Effective

• Four countries favor community-based/home care over institutionalization
• Shift toward home care aligns with population preferences and reduces costs
• Cash forb-care benefit systems (Germany, Netherlands) aid choice in service delivery sites
• Care at home or in the community meets specific patient needs more effectively

☰ 4. Decentralization Enables Localized Solutions

• Four countries employ decentralized decision-making structures
• Local authorities better understand specific community needs
• Centralized approaches limit flexibility and responsiveness to local conditions
• Decentralization improves coordination along care pathways

The main differences between Canada and these four countries are:

1. Governance Structure: Canada's centralized system contrasts sharply with the decentralized governance used by the comparator countries
2. Private Sector Role: Canada has significantly less private for-profit provider participation than comparator countries
3. Care Mix: Canada relies heavily on institutional care, while the other countries have shifted toward community-based care
4. Financing Models: Canada has complex, fragmented financing arrangements compared to the more streamlined approaches in comparator countries

Table comparing key long-term care policies across countries: