The rolling out and back of universal long-term-care supports in Europe

This article examines the universalization of long-term services and supports (LTSS) in three countries that have reformed LTSS funding in the past ten to fifteen years—Scottish and Spanish reforms extending public insurance to everyone needing LTSS, and the Dutch reform, which rolled back Europe’s older funding system. Although universal systems save health systems money and improve the financial well-being of families, attention should be paid to subsidy designs, the role of needs tests to modulate demand, and the development of home- and community-based services.