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Quality Assurance for Long-Term Care: The Experiences of England, Australia, Germany and Japan

How do four developed countries—England, Australia, Germany and Japan—seek to assure the quality of their long-term care (LTC) services? This AARP Public Policy Institute Issue Paper examines the LTC quality assurance systems of each of these countries, and discusses the implications of the reported experiences for the United States and other countries. Key findings include:

  • England’s system is characterized by a strong and quite adversarial regulatory approach, albeit one that is trying to make inspections more oriented toward outcomes, more focused on important issues, and more inclusive of users.
  • Australia relies on a consultative relationship between providers and regulators. Education rather than directive regulation is a major focus of the government’s activities. Regulations are, as a matter of principle, very broad and not specific.
  • Germany relies heavily on the enforcement of contracts between providers and heavily regulated nonprofit organizations called “sickness funds” as the principal strategy for quality assurance. These contracts cover broad categories of providers and are not individualized for specific providers.
  • Japan places more emphasis on worker training and informal mechanisms to assure quality. Japan is also experimenting with third-party evaluation in addition to government regulation.

The study concludes that though it is not possible to make objective judgments about the comparative effectiveness of approaches without systematic cross-country data, the United States and other countries can fruitfully learn from the quality initiatives undertaken in each nation studied. (89 pages)

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