Comparative Barriers and Enablers in
ASEAN
Long‐Term Care Systems: Insights From the 2025 Regional Policy Dialogue and Policy Recommendations for Equitable Active Ageing
Ruttiya Bhula‐or, Chadatan Osatis, Orawan Prasitsiriphon, Man Thi Hue Vo, I‐Chun Chen 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.