Who Pays for Dementia Care? Only 16% of the Cost Is Medical Care

Dementia cost the world an estimated US$1.3 trillion in 2019, and only 16% of that was medical care. The rest was social and long-term care (34%) and unpaid care by family and friends (50%)^[1]. Because most health systems pay for medical care far more fully than for long-term care, much of the cost of dementia falls on people living with dementia and their families, and how much depends on where they live.

For most people, dementia is not mainly a condition of expensive treatments. It is a condition of growing need for help: with washing and dressing, with meals and medicines, with getting through the night safely. Help at home, a place in a care home and the hours a partner or adult child gives are where most of the money goes. Whether a public system pays for that help, shares the bill or leaves it to the household is a policy choice, and countries have chosen very differently. This study sets out what dementia care costs, how that cost divides, and how countries decide who pays.

Most of the cost of dementia is care, not medicine, and the mix changes with a country’s income

The most complete global estimate, a cost model by Wimo and colleagues published in 2023, puts the global societal cost of dementia in 2019 at US$1,313.4 billion for 55.2 million people with dementia, or US$23,796 per person. Of that total, US$213.2 billion (16%) was direct medical costs, US$448.7 billion (34%) was direct social sector costs, including long-term care, and US$651.4 billion (50%) was the cost of informal, unpaid care^[1]. The World Health Organization uses the same estimate in its 2026 fact sheet^[3].

These are modelled estimates. Wimo and colleagues note that input data were lacking for 77% of countries, mainly low- and middle-income countries, so most national figures were imputed^[1]. Even so, the pattern is consistent. The estimated cost per person, unpaid care included, rises steeply with national income: US$45,500 a year in high-income countries, against US$2,575 in low-income countries.

The mix of costs changes too. In low-income countries, 84.9% of the estimated cost was unpaid care, and social care made up 10.5%. In high-income countries, social sector costs reached 39.9% of the total, and the authors observe that there they are “almost on the same level as the costs of informal care”^[1]. Medical care stayed a minority share everywhere: 15.8% in high-income countries and 4.6% in low-income countries. Where formal care services are thin, the cost does not disappear. It moves into families’ time, as the sibling study on unpaid carers sets out.

National estimates tell the same story: long-term care and unpaid care dwarf medical costs

Four national estimates show the same shape. They use different methods, years, currencies and definitions, and two leave out unpaid care, so they cannot be compared directly or added up. The UK total also includes quality-of-life and economic-cost categories, so the three UK components shown do not sum to £42 billion.

In Japan, an estimate built from national health care and long-term care databases put the cost per person with dementia at JPY 5.95 million in 2014, and projected that total costs would reach JPY 24.3 trillion by 2060, 1.6 times the 2014 level^[4]. In the Netherlands, dementia had the highest health and care spending of any condition in the national cost-of-illness study, equal to 10.6% of all Dutch health and care spending in 2019^[6]. In the UK, the 2024 estimate prepared for Alzheimer’s Society found health care made up only 14% of total costs, and that the costs of social care were driven mainly by residential care^[5].

The same UK study put average annual costs at £28,700 per person with mild dementia, £42,900 with moderate dementia and £80,500 with severe dementia^[5].

Where long-term care is means-tested, families carry much of the cost: the US as a worked case

The US has some of the deepest data on who pays, so it serves here as the worked case of a means-tested system. The Alzheimer’s Association projects that health and long-term care costs for people living with Alzheimer’s and other dementias will reach $409 billion in 2026, not counting unpaid care. Medicare and Medicaid, the two main public programmes, are expected to cover $263 billion (64%), and out-of-pocket spending is expected to be $103 billion^[7]. The association estimates the total lifetime cost of care for a person living with dementia at $405,262 in 2024 dollars, and that 70% of it is borne by families, through out-of-pocket health and long-term care expenses and the value of unpaid care^[7].

Peer-reviewed research using the national Health and Retirement Study shows what that means for households. Among 1,702 Medicare beneficiaries aged 70 and over who died between 2005 and 2010, the average total cost to all payers, including unpaid care, over the last five years of life was $287,038 for people with dementia, compared with $175,136 for people who died of heart disease and $173,383 for those who died of cancer. Average out-of-pocket spending for people with dementia was $61,522, which was 81% higher than for people without dementia ($34,068)^[2]. The authors concluded that “many of the expenses were uncovered”.

The weight of those costs was not shared evenly. Median out-of-pocket spending for people with dementia equalled 32% of the household wealth they had five years before death, against 11% for people without dementia. Among people with dementia, the share was 84% for black people, 48% for people with less than a high school education and 58% for unmarried or widowed women^[2]. An earlier study of the same survey found that, across all causes of death, out-of-pocket spending in the last five years of life exceeded the total household assets held at the start of that period for 25% of people, and that average spending was highest, at $66,155, for people who died of Alzheimer’s disease^[8]. Both cohorts are now old, and the earlier study is in 2008 dollars.

A 2026 policy review describes the US long-term care system as “largely poverty-based, requiring most older adults to spend down their assets to qualify for limited, Medicaid-funded support”, while noting that the use of Medicaid home care services has grown significantly since the 1980s^[9].

Countries decide who pays in very different ways: universal, partly universal or means-tested

A 2026 comparison led by researchers at the Care Policy and Evaluation Centre, London School of Economics, mapped public long-term care coverage across 19 countries, treating England, Scotland and Wales separately. It found that 11 countries have universal systems, though all of them have co-payments; three offer at least some universal benefits; and six offer publicly funded long-term care only to people whose income, assets or both fall below a means-test^[10]. In the universal group, the amount of benefits or co-payments may still be means-tested, but everyone who needs care is covered at least in part.

Groupings as published in Table 1 of Comas-Herrera et al. (2026); France appears in two columns of the published table. In India there is no nationwide long-term care system^[10].

Universal does not mean free. The same review found that countries with very strict means-tests, such as Chile and Cyprus, may charge no co-payments to those who qualify, while Australia, with very broad coverage, has substantial co-payments, limited by annual and lifetime caps. Where charges are means-tested, some countries look only at income, and others also count assets, which may include a person’s home, often only for residential care^[10]. Families can be drawn in directly: in Cyprus, India, Italy, Slovenia and Türkiye, adult children are financially liable for the care and support of their parents, and several systems give fewer benefits or lower priority to people who have a carer^[10].

England is an example of the means-tested model. Its main publicly funded care is means-tested, with only a small attendance allowance and nursing care outside the means-test^[10]. The national charging rules for 2026–27 keep the capital limits of the means-test unchanged, at £14,250 (lower) and £23,250 (upper)^[11]. The 2024 UK cost study found that 63% of the total cost of dementia was borne by people with dementia and their families, and that “many patients must fully self-fund their care”^[5]. Scotland, by contrast, sits in the universal group.

Universal systems carry more of the cost publicly, but unpaid care does not go away

Where long-term care is funded universally, more of the cost of dementia appears in public accounts. In the Netherlands, where access to the main public long-term care scheme is universal^[10], the national cost-of-illness study counted €10.3 billion of health and care spending on dementia in 2019, and 92.5% of it went to care for older people^[6]. Japan, also in the universal group, recorded JPY 6.44 trillion of formal long-term care costs for dementia in 2014, against JPY 1.91 trillion of health care costs^[4].

Universal coverage does not remove the role of families. Japan’s estimate still valued unpaid care at JPY 6.16 trillion, close to the formal long-term care total^[4], and every universal system in the LSE comparison charges co-payments of some kind^[10]. What changes is how much of the care is paid for collectively.

There is some movement. Between 2021 and the end of 2025, the LSE review observed a trend towards wider coverage, with some countries expanding the needs they cover to include dementia and cognitive impairment, or covering people with lower levels of need so that preventative services are within reach^[10]. That matters for dementia in particular. In all the countries studied, needs assessments consider functional ability, and many include cognitive impairment^[10]. For care home provision and quality across countries, see the sibling study on dementia and care homes.

What the evidence asks of us

Dementia is, above all, a long-term care condition, and systems that fund medical care generously but long-term care thinly leave the largest part of the cost with people living with dementia and their families. The evidence asks four things of governments, funders and the organisations that advise them.

• Treat long-term care as part of the dementia response. The WHO’s Global action plan on the public health response to dementia, now extended to 2031, names diagnosis, treatment and care, and support for dementia carers, among its action areas^[3]. With social and long-term care making up 34% of the global cost of dementia and medical care 16%^[1], care funding is where most of the response sits.
• Make sure needs assessments recognise dementia. The trend since 2021 towards covering dementia and cognitive impairment in eligibility rules^[10] is the right direction for systems that have not yet made that change.
• Protect households from catastrophic costs. Where long-term care is means-tested, the US evidence shows the heaviest out-of-pocket burdens falling on the households least able to absorb them, including black people and unmarried or widowed women with dementia^[2]. Spending limits such as Australia’s annual and lifetime caps on certain care fees^[10] show that the exposure can be limited by design.
• Count the costs properly. Input data were missing for 77% of countries in the global cost model^[1], and several national estimates leave out unpaid care. Regular, comparable national estimates that include unpaid care, and record who pays, would let every country see where the cost of dementia actually lands.

None of this is a judgement on families. The gap is in how systems are designed.

Language: this piece uses person-first language ("people living with dementia", "people with dementia"), as most dementia organisations and people with lived experience prefer, and uses clinical terms such as "Alzheimer's disease" or "mild cognitive impairment" only where a study, dataset or diagnosis refers to that specific condition.

Why we're publishing this

Talk of the cost of dementia often stops at a headline total. For people living with dementia and the people who care for them, the more important question is who pays, and that is decided by the design of each country’s health and long-term care system. Dementia charities, carers’ organisations and Alzheimer’s groups make the case for fairer funding every day. This study, part of our Dementia & Health research library, brings the best international estimates together, with their limits stated, so that case can rest on clear evidence. The case is theirs.

How to read this data

Almost every figure here is a modelled estimate. The global model imputed data for most countries, and its results are sensitive to how unpaid care is valued, mainly at average wages in the base case^[1]. The UK figures come from a 2024 study commissioned by Alzheimer’s Society; the US figures are the Alzheimer’s Association’s own projections for 2026; Japan’s estimate refers to 2014 and the Dutch figures to 2019.

The estimates are not comparable with each other. They differ in year, currency, price base and scope. The Dutch and US totals in the national table exclude unpaid care; the Japanese and UK totals include it. They should not be added or ranked.

“Who pays” is measured in different ways. The UK study’s 63% borne by people and families includes the value of unpaid care; the US lifetime figure of 70% does too. The US household-wealth findings come from people who died between 2005 and 2010, and some cost components in that study were imputed^[2]. The LSE system comparison describes rules, not spending, and covers 19 mainly high-income countries; it reflects the position up to the end of 2025^[10]. Country rules change, and regional rules within countries vary.

What is missing. We could not open the OECD’s 2024 report on the affordability of long-term care, Germany’s official long-term care figures or Australia’s national dementia expenditure pages, so they are not used here. Evidence from low- and middle-income countries is especially thin.

Use this data

Free to cite with attribution to Understanding Aging. Charities, carers' groups, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This article summarises published research and statistics for general information. It is not medical, care or financial advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's memory or health, please speak to a GP or another qualified health professional.

Sources

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3. World Health Organization. Dementia: fact sheet. WHO, 3 July 2026. who.int/news-room/fact-sheets/detail/dementia
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11. Department of Health and Social Care. Social care charging for care and support 2026 to 2027: local authority circular. GOV.UK, 17 February 2026. gov.uk/government/publications/social-care-charging-for-local-authorities-2026-to-2027