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Even though most advanced industrialized countries are facing population aging, feminization of the labour market and other social transformations, public long-term care programs for theaged are remarkably diverse across them. This book maintains that political institutions have generated the cross-national variations of public elderly care policy. It argues that when electoral rules and party systems encourage political parties to compete with each other over public policy, the welfare state is likely to promote the development of public elderly care programs. By contrast, when these political institutions foster patronage-based political competition, elderly care programs are less likely to thrive. This book offers a stylized theoretical model for the variation of social protection systems and proves its theoretical claim by combining sophisticated statistical analysis with in-depth historical case studies of Sweden, Japan and the U.S.