SDG 3: Good Health and Well-being | SDG 5: Gender Equality | SDG 10: Reduced Inequalities | SDG 17: Partnerships for the Goals
Ministry of Health and Family Welfare | Ministry of Social Justice and Empowerment
OECD working paper, How Can Co-ordination Improve Long-Term Care Delivery? notes that as demographic ageing increases, long-term care (LTC) has become a vital public service requiring seamless integration between health and social care sectors. Fragmented delivery currently prevents consistent access to care for those with long-term physical or cognitive impairments and places a heavy burden on families, particularly women.
Building on case studies from Canada (Quebec), Costa Rica, France, and Japan, the report identifies four key policy dimensions—governance, funding, workforce, and data-sharing—as essential for a structured LTC model. Strategic recommendations include implementing Single Entry Points to guide individuals through coherent care pathways and establishing Vertical Co-ordination mechanisms to align governance and financing between national and local government levels.
Key Pillars of Co-ordinated Long-Term Care Delivery
Multi-Level Governance: Establishing vertical alignment across government levels and horizontal co-ordination between healthcare providers and social organizations.
Sustainable Financing & Pooling: Utilizing tax-based or contributory insurance models (e.g., Japan’s LTCI) where pooled funds are redistributed based on old-age population ratios and regional vulnerability.
Integrated Workforce Management: Training interdisciplinary teams and utilizing case managers as a pivot for needs assessment and individualized service planning.
Digital Interoperability: Implementing computerized user files (e.g., France’s DUI) and public dashboards to track outcomes and facilitate real-time service adaptation.
Performance-Based Incentives: Providing conditional bonuses and co-ordination grants (e.g., France’s dotation de coordination) to fund co-ordinating nurses and integrated home care.
What is “Vertical Co-ordination” in LTC? Vertical co-ordination refers to the systematic alignment of governance and financing arrangements across different levels of government—national, regional, and municipal—to ensure residential and home-based services are delivered coherently. For example, in Japan, the national government sets broad principles and fee schedules, while prefectural governments oversee regional healthcare planning, and municipal governments act as primary administrators developing “Municipal LTCI Service Plans”. This multi-level approach ensures that local adaptability is maintained while adhering to national quality standards, effectively limiting the risks of service fragmentation and geographic inequity.
Policy Relevance
As India’s elderly population is projected to double by 2050, the transition to “Structured Multi-Level LTC” is critical to moving away from fragmented, family-only care models to a sustainable, state-supported framework.
Strategic Impact:
Bridging the Formalization Gap: Japan’s 700-hour training for personal care workers and the use of “Living Support Co-ordinators” provide a template for the Skill India mission to professionalize the domestic LTC workforce.
Scaling Digital Public Infrastructure: Adapting models like Costa Rica’s SINIRUBE—which links medical records with socio-economic data—can help India integrate the Ayushman Bharat Digital Mission with social welfare registries.
Empowering Local Governance: The Costa Rican Red de Cuido model, involving municipal governments and local committees, can be adapted to India’s Panchayati Raj institutions to manage equitable care distribution.
Unlocking the Gender Dividend: Implementing state-supported care coordination can reduce the 60-minute daily care gap and increase female labor force participation by reducing the unpaid care burden on women.
Follow the full report here: OECD: How can co-ordination improve long-term care delivery?