There are often concerns that population ageing will cause health and long-term care expenditures to grow uncontrollably. A key question facing decision-makers is what, if anything, can be done in response? In this report we consider whether user charges would improve the financial sustainability of home care in Ireland, a country which is ageing at a rate similar to other high income countries.

We find that user charges are an inefficient tool to try to reduce the home care financing gap. Evidence suggests that the revenues raised for home care through user charges are negligible in other high income countries. Additionally, while user charges may cause some people to reduce their demand for care, service-users are typically unable to distinguish between high-value and low-value care. Some service-users who do continue to use services will experience financial hardship if required to pay user charges out-of-pocket, while others will forgo care. In both cases, poorer households are most likely to be affected, however those that forgo care are likely to require more costly health services in the future if and when their health deteriorates, putting additional financial pressures on the State budget. Importantly, Ireland already has an effective mechanism to limit unnecessary use of home care services through its use of mandatory needs assessments to determine eligibility. Supply-side mechanisms, such as better regulation of the provider market or new models of care, may help to improve health financing sustainability.

Home care is more cost-effective than residential care for almost every level of dependency. Increasing the use of home support services is associated with a reduction in more costly care for society and better health for individuals. This implies that home care services might actually be part of the solution rather than the problem in maintaining sustainability of care services.