This paper analyzes the financing challenges of long-term care (LTC) in Uruguay in a context of population ageing and the expected growth in care needs. Based on an assessment of current coverage, service provision, and financing, it examines the gap between public resources currently devoted to LTC and the resources required to expand coverage. The paper reviews international experiences with ex ante financing mechanisms, focusing on Germany, Japan, South Korea, Luxembourg, and the Netherlands, and also considers the recent reform implemented in Slovenia. The analysis identifies common features of long-term care funds and insurance schemes and examines their implications for coverage, solidarity, labor-market incentives, and financial sustainability. Drawing on this international evidence and on Uruguay’s experience with social funds and insurance mechanisms such as Fonasa, the National Resources Fund, and the Labor Reconversion Fund, the paper discusses alternative financing arrangements for Uruguay. These alternatives combine, with different weights, general revenues, contributions from workers, employers, and pensioners, and user copayments. The analysis considers both insurance-based schemes in which entitlements are linked to contribution histories and mixed models in which access is determined by care needs. It also examines the challenges involved in transitioning from the current system toward more stable sources of financing, including its distributive, labor-market, and intergenerational dimensions. The paper provides elements for the discussion of the institutional and financial design of a long-term care system in Uruguay.
Keywords: long-term care; financing; dependency; population ageing; social protection; National Integrated Care System; Uruguay.
