Every ageing society is renegotiating the same settlement, and the evidence is about which arrangements hold. Japan's mandatory long-term care insurance, running since 2000, has survived by raising premiums and tightening eligibility; Germany's has raised contributions repeatedly; the Netherlands spends more per head than almost anyone and is now trying to shift care home. England has abandoned a lifetime cap on care costs and commissioned another review, due to report in stages to 2028. Across countries the direction is the same: more care at home, more reliance on unpaid carers, and a workforce increasingly recruited from abroad. What the evidence does not yet show is outcomes. Spending and coverage are well measured; the health of people receiving care, and of those providing it unpaid, is not, and evaluations of funding reforms against those outcomes are rare. The unpaid-care literature is the least settled: the health effects on carers are real but their size and direction depend on who is measured.