Comparative Barriers and Enablers in ASEAN Long-Term Care Systems: Insights From the 2025 Regional Policy Dialogue and Policy Recommendations for Equitable Active Ageing.
Abstract
Objective
To examine barriers and enablers to equitable long-term care (LTC) across ASEAN-Plus Three (APT) economies and to propose a framework for equitable active ageing, contributing to Sustainable Development Goals 3 and 10.
Methods
A qualitative participatory-observation study was conducted during the 2025 Regional Policy Dialogue on Inclusive and Equitable Care Systems. Reflexive thematic analysis, read through a life-course lens, was applied to three deliberation sessions involving 107 stakeholders from policy, academic, civil-society and provider sectors across diverse welfare regimes.
Results
Three themes were generated: institutional fragmentation converts earlier disadvantage into unequal access; communities absorb shortfalls in formal care without displacing public responsibility; and equity depends on redistributing voice and coordinating responsibility across levels. Costs fall heaviest on women and on rural and low-income older people.
Conclusions
A critical participatory life-course framework can guide LTC redesign through inclusive governance; national coordination hubs are advanced as an author-generated proposal extending participants' calls for coordination.