Joan Costa-Font of LSE calls integration of health and long-term care systems inevitable

He writes that long-term care needs were not part of early welfare state designs in most high-income countries; that U.S. public funding falls mainly on means-tested Medicaid, which was not originally designed to fund long-term care; and that a shrinking private insurance market leaves most households exposed to substantial out-of-pocket risk. He also writes that individuals wrongly assume long-term care is part of their health insurance coverage. Medicare's rules mark that seam directly: the program does not pay for custodial or personal care that helps with daily living, such as bathing or dressing, when this is the only care a person needs, and it does not cover 24-hour-a-day care at home. Costa-Font discloses that he is a Section Editor for the journal.