[P3–560]: Dementia Care Financing Policy in the United States and Canada: What are the Possibilities?

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Alzheimer's & Dementia

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Health care delivery



The policies that underpin a nation's long‐term service and supports (LTSS) financing system directly impact how care for Alzheimer's and other dementias is delivered. Canada and the United States offer two highly comparable cases for the analysis of Alzheimer's and dementia care financing policy. Despite significant differences in the manner in which health care is funded, these two nations have remarkably similar long‐term service and supports (LTSS) financing systems. Both nations rely on the public and private sectors to finance care and both nations have federal as well as regional level governmental structures (e.g. state and provincial governments) involved in the financing of care. Yet in spite of these similarities, the differences in the ideological orientation of the two nations are significant.


Qualitative, in‐depth interviews with government officials, policy experts, health care providers, and consumer advocates from the United States (65 interviews) and Canada (22 interviews) were carried out for each study. This data collection was supplemented by published documents, existing public policies, and legislation.


A more integrated system for long‐term services and supports was advocated by participates from both countries, as was a more robust and cohesive role for public financing. However, participants from the United States were more likely to report that a public‐private partnership in the financing of care is the most likely outcome for reform whereas Canadian participants reported that an expansion of existing publicly financed benefits at the provincial level was likely. Comprehensive federal level reform will remain difficult to achieve for both countries in the near term.


While policy reform was advocated by participants in both the United States and Canada, the type and scope of reform differed between participants from each country. Cultural (or ideological) values and competing priorities within the policy arena in each country structure the possibilities for reform and therefore the care that is provided for individuals living with Alzheimer's and other dementias.


© 2017 The Alzheimer's Association



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