This peer review hosted by the Estonian Ministry of Social Affairs explored financing schemes of long-term care (LTC) systems and discussed ideas, practices and results of scientific evidence on how to make LTC financing effective and sustainable.

The event focused on models for long-term care financing in the context of ageing societies, on how to find a balance between the state, local government and service users' contribution and marketisation of long-term care.

At the peer review, the Estonian Ministry of Social Affairs hosted experts from Austria, Bulgaria, France, Malta, Portugal, Slovenia and Spain. In addition, representatives from the European Commission, as well as a thematic expert will put the topic in the wider context of EU policy.

Background

Whilst Estonians aged 65 and older are more likely than their peers in other European countries to require assistance with activities of daily living, public spending on LTC is lower than in many other EU Member States.

Care homes, day-care services, home care and other personal care and social services are mainly financed and organised by municipalities. Whilst local authorities have the freedom and responsibility to define LTC provision locally, their capacity to fund and provide services depends significantly on their tax revenue, the age structure of the local population and political priorities. This results in differences and problems to access LTC across the country, high out of pocket payments by service users and reliance on family care givers.

Considering a future increase of LTC demand, Estonia started to explore new financing models for LTC. This is taken forward by a new needs-based local government and state partnership long-term care management and financing model. In principle, the new model will be based on the current LTC management and financing structure, reinforced by more support from the state to local governments via:

• The development of LTC services that are not possible or reasonable to develop on local level, so local governments shall have the opportunity to purchase these services from the state.
• A common voluntary standardised needs assessment tool and methodologies to assess LTC needs.
• Additional earmarked financial incentives for the organisation of LTC should be granted to local governments through a state support fund, while local governments are expected to match LTC funding with these state allocations.
• A guaranteed monthly minimum income after co-funding LTC services for service users should be established.