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Long-term care in the health system: European tendencies and Bulgarian experience

Theresa Vassileva, Marilena Pittara


Introduction: One of the most serious challenges faced by health systems in the world is population ageing, which stresses the increasing importance of long-term care. This research aims to provide a concise definition of long-term care, the kinds of services included in it, the trends in long-term care costs and the scope of the services, as well as the various financial arrangements for long-term care.

Materials and methods: This is a review article which summarizes the findings in literature concern­ing the content and scope of the concept `long-term care`. The paper is based on materials, analyses and statistical data by the Organization of Economic Cooperation and Development (OECD), the Eu­ropean Union and Bulgarian sources.

Results and Discussion: The term `long-term care` refers to a range of services provided for people with limited ability (physical and/or mental) to function who therefore depend on outside assistance for meeting various needs (medical and nonmedical) for an extended period of time. The share of long-term care health costs in GDP and in total health costs varies significantly across the EU mem­ber-states. It is substantially lower in the new Central and Eastern European members, among which Bulgaria ranks last. EU countries can be grouped on different dimensions to deliver a typology of long-term care systems, some of the classifications being presented in the research.

Conclusion: The long-term care system faces a number of challenges, connected with the increasing costs parallel to the rising expectations for higher quality and efficiency. A challenge in every coun­try, even the most developed one, is the provision of the adequate number and qualification of formal carers as well as various types of assistance for the informal carers - financial, information, consul­tative and psychological.


long-term care; long-term health care; long-term care costs; formal and informal services; institutional and community-based providers



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