OECD Working Papers on Fiscal Federalism

This series covers issues related to intergovernmental fiscal relations and local/regional public finance, such as: tax and spending assignment across government levels; intergovernmental grants; fiscal equalization; local and regional public service efficiency; inter-jurisdictional tax competition; and macroeconomic issues such as intergovernmental fiscal management and sub-central fiscal rules. Many of these working papers are outputs of the OECD Network on Fiscal Relations Across Levels of Government. Related working papers on fiscal federalism issues are also published in other OECD working paper series on tax policy, economics, public governance and regional development. An integrated list of key papers produced by the Fiscal Network can be found at http://oe.cd/fiscalnetwork.

(Note: numbers 1, 6 and 8 are available in the OECD Economics Department Working Papers, as numbers 465, 626 and 705.)


From local to national: Delivering and financing effective long-term care

This study provides an in-depth examination of the fiscal and governance decentralisation of long-term care (LTC) across OECD countries, offering projections of future fiscal burdens of LTC spending across levels of government. With rapid population ageing and a decrease in the supply of informal care, LTC spending has increased significantly. The paper introduces a novel methodology to estimate LTC expenditures across different government levels, including central and subnational governments. By analysing country cases, it explores the responsibilities assigned to each government level and the implications for service delivery and intergovernmental coordination. The study also discusses the overall anticipated increase of LTC expenditure to 2.3% of GDP by 2040, identifying the most impacted countries. This research contributes to our understanding of LTC systems, highlights the challenges of increasing LTC costs and provides insights for optimising governance and fiscal expenditure.


Keywords: long-term care, health accounts, fiscal federalism, population ageing, social care
JEL: H51: Public Economics / National Government Expenditures and Related Policies / Government Expenditures and Health; H77: Public Economics / State and Local Government; Intergovernmental Relations / Intergovernmental Relations; Federalism; Secession; I18: Health, Education, and Welfare / Health / Health: Government Policy; Regulation; Public Health; J11: Labor and Demographic Economics / Demographic Economics / Demographic Trends, Macroeconomic Effects, and Forecasts
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