DESK REVIEWS | 03.02.01.07. Are some aspects of long-term care covered by the country’s main health financing mechanisms (for example by the insurance schemes)?

DESK REVIEW | 03.02.01.07. Are some aspects of long-term care covered by the country’s main health financing mechanisms (for example by the insurance schemes)?

Yes. SUS provides the health-related LTC, such as visits from community health teams, domiciliary care, and provision of treatment, which are all financed by the municipality budget of primary/secondary healthcare (Brazilian Ministry of Health, 2019l).

References:

Brazilian Ministry of Health. (2019l). Sobre a Assistência Farmacêutica.

The NPHCE and other elder care related schemes are covered by the country’s main health financing mechanisms. Ayushman Bharat (MoHFW, 2019a) proposes to transform the primary healthcare system in the country through the establishment of Health and Wellness Centres (HWCs). The HWCs are envisioned to provide primary healthcare services, with an addition of care for older persons and palliative healthcare services (Keshri and Gupta, 2019).

References:

Keshri, V., & Gupta, S. (2019). Ayushman bharat and road to universal health coverage in India. Journal of Mahatma Gandhi Institute of Medical Sciences, 24(2), 65. https://doi.org/10.4103/jmgims.jmgims_44_19

Ministry of Health and Family Welfare. (2019a). Ayushman Bharat Health and Wellness Centres: Accelerating towards health for all April 2018 – September 2019. Government of India. Available

The main health financing insurance in Indonesia is regulated through the national independent social insurance institution (Badan Penyelenggara Jaminan Sosial (BPJS)). In the health sector BPJS or BPJS-Kesehatan covers the health care costs of all members, irrespective of their age. However, the LTC guideline for Puskesmas explained that most components of LTC services are still not covered under the national health insurance or other insurances, and therefore they might be covered by donations or out-of-pocket expenses (Kementerian Kesehatan RI Direktorat Jenderal Kesehatan Masyarakat, 2018).

As LTC services are aimed towards increasing quality of life by assisting with daily activities, there is a link with services provided by BPJS-Kesehatan, specifically BPJS-Prolanis, which aim to increase quality of life of members with chronic illnesses, such as diabetes and hypertension. This scheme provides services such as screening, reminders to visit healthcare facilities and home visit as well as public activities and projects for people previously identified to be eligible to be part of ‘Prolanis Clubs’ (BPJS Kesehatan, 2014). These services do have LTC components in them, however, are not classified as LTC services or geriatric services.

References:

BPJS Kesehatan. (2014). Panduan Praktis PROLANIS (Program Pengelolaan Penyakit Kronis)/PROLANIS Guideline. In BPJS Kesehatan.

Kementerian Kesehatan RI Direktorat Jenderal Kesehatan Masyarakat. (2018). Pedoman untuk Puskesmas dalam Perawatan Jangka Panjang bagi Lanjut Usia. Kementerian Kesehatan RI.

The lump sum amount under health covers long-term care services. Also, the older persons cash transfer targeting those aged 65 and above has supported 833,129 households (i.e. one person per household regardless of the number of people who have attained the age of 60 in the household) (Kenya Institute for Public Policy Research and Analysis (KIPPRA), 2019).

References:

Kenya Institute for Public Policy Research and Analysis (KIPPRA). (2019). Social Protection Budget Brief (No. 67/2018-2019). Nairobi, Kenya. https://repository.kippra.or.ke/bitstream/handle/123456789/2278/social-protection-budget-brief-pb67.pdf?sequence=1&isAllowed=y

 

As previously mentioned, there are only two strategies in the country that cover some long-term care services, one at the Mexican Institute of Social Security, IMSS (one of the main social security institutions in Mexico) and one from Mexico City’s Health Secretariat. Both provide domiciliary services for people with functional disabilities.

Historically, long-term care have been run by NGOs, charities and faith-based organisations (FBO’s), financed via the State (for those who are eligible) or privately (i.e., out of pocket payments) (Lloyd-Sherlock, 2019a). Medical aid schemes in South Africa cover medical events; however, long-term care such as frail care services are rarely supported (Du Preez, 2015). However, depending on the insurance product purchased, despite not covering long-term care accommodation and care in facilities, medical insurance covers any chronic medication or aids required while being frail or incapacitated (Du Preez, 2015).

References:

Du Preez, L. (2015). Frail care: What you should know. Personal Finance. Available from: https://geratecza.com/2018/07/30/frail-care-what-you-should-know-laura-du-preez/

Lloyd-Sherlock, P. (2019a). Long-term Care for Older People in South Africa: The Enduring Legacies of Apartheid and HIV/AIDS. Journal of Social Policy, 48(1), 147–167. https://doi.org/10.1017/S0047279418000326