There is no “perfect model” of social care but Switzerland’s system of higher taxation ranks favourably for quality and accessibility, a report concluded.

Research commissioned by a Holyrood committee scrutinising Scotland’s new National Care System bill compared international models and identifies strengths and weaknesses in each system.

The Swiss model is financed directly by contributions from taxation and a compulsory health insurance system that also funds social care.

Personal contributions account for a high proportion of total financing in Switzerland compared with other countries (30 per cent, while the average internationally is only 13.5%).

The model was found to rank well internationally in “quality of care, access, efficiency, equity, and promotion of healthy lives.”

However, the report found the mix of local and national governance increased the risk of sub-optimal quality of care.

Since the 1990s, changes in policy in Sweden, Finland, Denmark and Norway introduced a more hybrid public-private approach.

Local authorities have the freedom to organise care, but the system is supported by national level legislation.

Care is “heavily subsidised” by the state and local authorities.

READ MORE: Care home providers "ripping off" elderly with £69,000 fees

The report found national level legislation ensures equality of levels of care service provision and quality of services.

However it warns that marketisation has challenged the principle of universalism through the introduction of options to pay for additional services.

In the United States all costs are paid for privately by individuals.

Medicaid does not cover social care and this is associated with widening health inequalities.

The Herald:

The report found that sustainability of the model is “dependent on the wider economy.”

Alaska operates its own version of Medicaid, which covers some of the costs associated with home care.

READ MORE: SNP MSP has 'no confidence whatsoever' in cost plan for new National Care Service 

The Nuka model for Indigenous Alaskans focusses on home care, with multidisciplinary teams providing integrated health and care services in primary care centres and the community. This is associated with significant reductions in emergency department visits and hospital admissions, and improved diagnosis and treatment of chronic diseases.

The research, led by Dr Irena Connon at Dundee University, was commissioned by the Health and Sport Committee as part of its scrutiny of the new National Care Service Bill.

It also examines the expectation in each country that family will be expected to provide care.

It was “high” in EU countries including France and Germany and Japan which provides a basic level of universal care. This raises equality issues,according to the report, given that most care is provided by women.

READ MORE: Mark Smith: What's really wrong with the SNP's plan for social care

The country operates a mandatory social insurance scheme with half the revenue coming from general taxation and the rest coming from premiums and user co-payments.

The Herald:

Countries where they was a low expectation of family care included Australia, Canada, the Nordics and the UK home nations.

In Canada social care is considered an extended health service, provided”at provincial discretion”.
Differences in provincial arrangements have resulted in “unequal care distribution” and health outcomes lag behind other high-income countries.

The Netherlands, Germany, and France operate mandatory social care insurance schemes,which are funded by general taxation at central government level. 

The Herald:

The report warns that social insurance-based schemes are coming under increased pressure from ageing populations with schemes relying on a single source of funding “more vulnerable to economic fluctuations.

It notes that increased integration of health and social care in the UK home nations has had a “relatively limited effect” on reducing health inequalities.

It makes a series of recommendations for Scotland’s new care system including a clear “one system, one budget” approach to reduce complexity.

Integration can help deliver more holistic approaches to care, but “strategies need to be put in place to ensure that social care does not end up in a subordinate position to health care”.

The report comes amid increased concern over the financial projections for Scotland’s new National Care Service.

SNP MSP  Michelle Thomson said last week that she was “completely surprised” by the lack of detail contained in the government’s financial memorandum, published in June.

The total costs of the Bill over the five year period 2022-23 to 2026-27 are estimated at between £644 million and £1,261 million,” said the memorandum.

However a Holyrood analysis of the SNP’s flagship policy to integrate health and social care services,released earlier this month, said it could cost up to £1.3 billion to deliver over the next five years and warned the figure could “change considerably”.

Donna Bell, Director of Social Care and National Care Service Development, said there was “significant work” to be done to examine costs and added that the risks “were very much at the front of our minds.”