England's care system forces more than 220,000 people to pay the full cost of their adult social care, making it an outlier among comparable countries, according to a new report from The King's Fund.

People with savings and assets above £23,250 must fund their own care, which can cost hundreds of thousands of pounds, according to the study. Around 137,000 self-funders live in care homes, which represents a third of residents, while more than 83,000 use home care.

The research, produced with the Global Observatory of Long-Term Care and academics in Australia, Japan and the Netherlands, found only the United States, Cyprus and Wales run similar systems. Elsewhere, everyone in need receives some state funding, with means tests used only to decide how much individuals contribute.

The report calls for England to move to a universal system with income- and asset-based co-payments.

Simon Bottery, Senior Fellow at The King’s Fund and lead author of the report, said: 'Other countries let people into the publicly funded social care system and then use a means test to determine if they should contribute a percentage of the cost. But England excludes some people from getting into the publicly funded system entirely and makes them pay all their costs. For some, it is a near 100% inheritance tax in all but name. That is unfair and needs to change.

'As England moves towards creating a “National Care Service” and awaits the recommendations of the Casey Commission, there is a long-awaited opportunity to tackle the injustice faced by self-funders. The government must not miss this chance to create a fairer care system.’