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Zeng L, Zhong Y, Chen Y, Zhou M, Zhao S, Wu J, Dong B, Dou Q. Effect of long-term care insurance in a pilot city of China: Health benefits among 12,930 disabled older adults. Arch Gerontol Geriatr 2024; 121:105358. [PMID: 38341956 DOI: 10.1016/j.archger.2024.105358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/18/2024] [Accepted: 01/29/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND The surge of disabled older people have brought enormous burdens to society. The aim of this study was to examine the impact of long-term care insurance (LTCI) implementation on mortality and changes in physical ability among disabled older adults. METHODS This was a prospective observational study based on data from the government-led LTCI program in a pilot city of China from 2017 to 2021. Administrative data included the application survey of activities of daily living (ADL), the baseline characteristics and all-cause mortality. Return visit surveys of ADL were conducted between August 2021 and December 2021. A regression discontinuity model was used to analyze the impact of LTCI on mortality. RESULTS A total of 12,930 individuals older than 65 years were included in this study, and 10,572 individuals were identified with severe disability and participated in the LTCI program. LTCI implementation significantly reduced mortality by 5.10 % (95 % CI, -9.30 % to -0.90 %) and extended the survival time by 33.74 days (95 % CI, 13.501 to 53.970). The ADL scores of the LTCI group dropped by 2.5 points on average, while the ADL scores of those did not participated in LTCI dropped by 25.0 points. The heterogeneity analysis revealed that the impact of LTCI on mortality reduction was more significant among females, individuals of lower age, those who were married, cared for by family members, and who lived in districts with rich care resources. CONCLUSIONS LTCI implementation had a favorable impact on the mortality and physical ability of participants.
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Affiliation(s)
- Lijun Zeng
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yue Zhong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuxiao Chen
- School of Politics and Public Administration, Zhengzhou University, Zhengzhou, China
| | - Mei Zhou
- School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China
| | - Shaoyang Zhao
- School of Economics, Sichuan University, Chengdu, China
| | - Jinhui Wu
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu 610041, China
| | - Birong Dong
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu 610041, China
| | - Qingyu Dou
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu 610041, China.
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Luo Y, Yuan K, Li Y, Liu Y, Pan Y. The "spillover effect" of long-term care insurance in China on spouses' health and well-being. Soc Sci Med 2024; 340:116487. [PMID: 38096600 DOI: 10.1016/j.socscimed.2023.116487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/20/2023] [Accepted: 11/29/2023] [Indexed: 01/23/2024]
Abstract
This study examined the spillover effect of long-term care insurance (LTCI) on the health outcomes and well-being of spouses for Chinese middle and old-aged adults with expected LTC demand or actual care burdens. Using panel data from the China Health and Retirement Longitudinal Study between 2011 and 2018, we investigated the impact of the introduction of LTCI pilots across several cities on old individuals by using the difference-in-differences (DID) approach. We found a spillover effect of LTCI on the health and well-being outcomes of spouses of middle and old-aged individuals with functional limitations. It might due to the fact that LTCI could relieve economic burden by reducing out-of-pocket medical expenditures, which further affects health and well-being of spouses. The spillover effect on health and well-being was found to be stronger for male spouses and low-educated spouses. Spouses of the individuals aged below 80 years old and those live without adult children were more likely to benefit from the introduction of LTCI. Moreover, providing combination benefits seems to make spouses better off than offering direct services. Therefore, the results implied that the expansion of LTCI not only helped the care recipients themselves but could also improve the health and well-being of the spouses of functionally impaired older adults.
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Affiliation(s)
- Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China
| | - Kexin Yuan
- School of Software and Microelectronics, Peking University, Beijing, China
| | - Yuxiao Li
- School of Applied Economics, Renmin University of China, Beijing, China
| | - Yating Liu
- School of Nursing, Peking University, China
| | - Yao Pan
- School of Economics, Zhongnan University of Economics and Law, Wuhan, China.
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Yi Y, Liu J, Jiang L. Does home and community-based services use reduce hospital utilization and hospital expenditure among disabled elders? Evidence from China. Front Public Health 2023; 11:1266949. [PMID: 37965517 PMCID: PMC10642179 DOI: 10.3389/fpubh.2023.1266949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/02/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction In the background of aging in place, home and community-based services (HCBS) have been playing an increasingly important role in long-term care (LTC) security systems. However, it is still uncertain whether and how HCBS use affects hospital utilization and the corresponding expenditures. Methods Using data from the China Health and Retirement Longitudinal Survey (CHARLS) and the China City Statistical Yearbook, the instrumental variable (IV) approach is applied to identify the causal effects of HCBS use on hospital utilization and hospital expenditure among disabled elders. Results We find that HCBS use significantly reduces the probability of being hospitalized, the times of hospitalization, and the length of inpatient stay, as well as the total, out-of-pocket and reimbursement inpatient expenditures, demonstrating not only the substitution impact of HCBS for hospital care but also the effectiveness of medical expenditure control in LTC security systems. Heterogeneity analysis shows that the impacts of HCBS use on hospital utilization and hospital expenditure concentrate on disabled elders who are younger, male, living in urban areas, or from higher-income households; both healthcare and spiritual consolation services have significant negative effects, while the anticipated effects of daily care service use are not supported. The possible mechanisms are the substitution of HCBS for hospital care and the improvements in both the physical and psychological health of disabled elders. However, the mechanism of adverse events decrease is not verified, which needs to be investigated further with more proxy variables. Conclusion This study provides empirical evidence that HCBS use can not only reduce hospital utilization and hospital expenditure among disabled elders but also improve their physical and psychological health. Policy designs should emphasize the orientation of HCBS, ensure the fundamental and central position of HCBS in the formal care service system, pay more attention to the accessibility and affordability of HCBS for fragile groups, and diversify and optimize the development of the health service and the spiritual consolation service.
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Affiliation(s)
| | | | - Ling Jiang
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
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Effects of public long-term care insurance on the medical service use by older people in South Korea. HEALTH ECONOMICS, POLICY, AND LAW 2023; 18:154-171. [PMID: 36189771 DOI: 10.1017/s174413312200024x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Public long-term care insurance (LTCI), which provides home and institutional care benefits, was introduced in July 2008 in South Korea. This study aims to evaluate the effects of the introduction of LTCI on older people's medical service use, including outpatient visits, inpatient services and longer stays (181 days or longer) in hospitals by implementing a quasi-experiment design with a generalised difference-in-difference method. The results showed that the introduction of LTCI did not change the use of outpatient medical services, although the medical costs of older people who used medical services at least once decreased by 9.4%. For the inpatient services, hospitalisation rates declined by 2.7% as a result of the LTCI. Length of stay and inpatient expenses decreased by 15.6 and 9.5%, respectively. For older people of LTC grade 2, eligible for long-term care facilities (LTCF), prolonged hospitalisation rates decreased by 1.6% due to the LTCI. In conclusion, the introduction of LTCI in South Korea has contributed to decreasing the use of inpatient services and longer stays in hospitals, which suggests that the utilisation of LTCF has become a substitute for some social admissions in hospitals.
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Fan H, Wang Y, Gao J, Peng Z, Coyte PC. The Effect of a Long-Term Care Insurance Program on Subjective Well-Being of Older Adults with a Disability: Quasi-Experimental Evidence from China. J Appl Gerontol 2023; 42:438-446. [PMID: 36366866 DOI: 10.1177/07334648221138282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
China launched its long-term care insurance (LTCI) program for older adults in 2016. Although the scheme has shown some promising outcomes, little is known about whether it improves subjective well-being. This study explored this topic among older persons with a disability and identified the underlying mechanisms associated with the channel of this effect using data from a national survey. The LTCI program was shown to improve the subjective well-being among older persons with a disability and this effect increased over time. The LTCI program has great positive effect among women and those who lived alone compared to their counterparts. Mechanism analysis revealed that the main channel by which the LTCI program has positive effect occurred through the satisfaction of long-term care needs and improved self-reported health. This study suggests promising benefits of the LTCI program for older Chinese adults.
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Affiliation(s)
- Hongli Fan
- School of Insurance, 47855Shandong University of Finance and Economics, Jinan, China
| | - Yingcheng Wang
- School of Insurance, 47855Shandong University of Finance and Economics, Jinan, China
| | - Jinyan Gao
- School of Insurance, 47855Shandong University of Finance and Economics, Jinan, China
| | - Zixuan Peng
- Institute of Health Policy, Management and Evaluation, 7938University of Toronto, Toronto, ON, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, 7938University of Toronto, Toronto, ON, Canada
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Ma G, Xu K. Value-Based Health Care: Long-Term Care Insurance for Out-of-Pocket Medical Expenses and Self-Rated Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:192. [PMID: 36612515 PMCID: PMC9819384 DOI: 10.3390/ijerph20010192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/08/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Long-term care insurance (LTCI) is a significant approach in the effort to actively manage aging and the currently unmet need for aged care in China. Based on data from the 2011, 2013, 2015, and 2018 phases of the China Health and Retirement Longitudinal Study, we used the propensity score matching-difference in difference (PSM-DID) approach to explore the impact of LTCI on out-of-pocket medical expenses and self-rated health. Results showed that LTCI can significantly reduce out-of-pocket medical expenses by 37.16% (p < 0.01) per year and improve self-rated health by 5.73% (p < 0.01), which conforms to the spirit of “value-based health care”. The results were found to be stable in the robustness tests conducted. Currently, China is at the intersection of “low-value-based health care” and “value-based health care”. Improving the health level of aged individuals while keeping medical costs under reasonable control is crucial for formulating and implementing a new round of healthcare reform in China.
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Affiliation(s)
| | - Kun Xu
- Correspondence: ; Tel.: +86-198-1075-0586
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Leniz J, Evans CJ, Yi D, Bone AE, Higginson IJ, Sleeman KE. Formal and Informal Costs of Care for People With Dementia Who Experience a Transition to Hospital at the End of Life: A Secondary Data Analysis. J Am Med Dir Assoc 2022; 23:2015-2022.e5. [PMID: 35820492 DOI: 10.1016/j.jamda.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/26/2022] [Accepted: 06/12/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To explore formal and informal care costs in the last 3 months of life for people with dementia, and to evaluate the association between transitions to hospital and usual place of care with costs. DESIGN Cross-sectional study using pooled data from 3 mortality follow-back surveys. SETTING AND PARTICIPANTS People who died with dementia. METHODS The Client Service Receipt Inventory survey was used to derive formal (health, social) and informal care costs in the last 3 months of life. Generalized linear models were used to explore the association between transitions to hospital and usual place of care with formal and informal care costs. RESULTS A total of 146 people who died with dementia were included. The mean age was 88.1 years (SD 6.0), and 98 (67.1%) were female. The usual place of care was care home for 85 (58.2%). Sixty-five individuals (44.5%) died in a care home, and 85 (58.2%) experienced a transition to hospital in the last 3 months. The mean total costs of care in the last 3 months of life were £31,224.7 (SD 23,536.6). People with a transition to hospital had higher total costs (£33,239.2, 95% CI 28,301.8-39,037.8) than people without transition (£21,522.0, 95% CI 17,784.0-26,045.8), mainly explained by hospital costs. People whose usual place of care was care homes had lower total costs (£23,801.3, 95% CI 20,172.0-28,083.6) compared to home (£34,331.4, 95% CI 27,824.7-42,359.5), mainly explained by lower informal care costs. CONCLUSIONS AND IMPLICATIONS Total care costs are high among people dying with dementia, and informal care costs represent an important component of end-of-life care costs. Transitions to hospital have a large impact on total costs; preventing these transitions might reduce costs from the health care perspective, but not from patients' and families' perspectives. Access to care homes could help reduce transitions to hospital as well as reduce formal and informal care costs.
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Affiliation(s)
- Javiera Leniz
- King's College London, Cicely Saunders Institute of Palliative Care, Polity and Rehabilitation, London, United Kingdom.
| | - Catherine J Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Polity and Rehabilitation, London, United Kingdom
| | - Deokhee Yi
- King's College London, Cicely Saunders Institute of Palliative Care, Polity and Rehabilitation, London, United Kingdom
| | - Anna E Bone
- King's College London, Cicely Saunders Institute of Palliative Care, Polity and Rehabilitation, London, United Kingdom
| | - Irene J Higginson
- King's College London, Cicely Saunders Institute of Palliative Care, Polity and Rehabilitation, London, United Kingdom
| | - Katherine E Sleeman
- King's College London, Cicely Saunders Institute of Palliative Care, Polity and Rehabilitation, London, United Kingdom
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Deng X, Liao J, Peng R, Chen J. The Impact of Long-Term Care Insurance on Medical Utilization and Expenditures: Evidence from Jingmen, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12275. [PMID: 36231574 PMCID: PMC9564761 DOI: 10.3390/ijerph191912275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/27/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this study was to evaluate the impact of long-term care insurance (LTCI) on medical utilization and expenditures in Jingmen, a pilot city of China. The propensity score matching-difference in difference (PSM-DID) approach was employed to examine the expenses and frequency of inpatient and outpatient services before and after the implementation of the LTCI based on the 2015-2018 panel data from the China Health and Retirement Longitudinal Study (CHARLS). The results showed that the annual expenditure and frequency of the inpatient services of Jingmen residents were reduced by 1923 Yuan (287.0 USD) and 0.24 times, respectively. The impact of the LTCI varied between urban and rural areas. The annual expenditure and frequency of inpatient services in rural areas were reduced by 1600 Yuan (238.8 USD) and 0.30 times, which were lower than those (3400 Yuan (507.5 USD) and 0.20 times) in urban areas. The monthly outpatient expenses and frequency in rural areas were reduced by 300 Yuan (44.8 USD) and 0.14 times, but increased by 555 Yuan (82.8 USD) and 0.07 times in urban area. The findings indicated that the implementation of the LTCI can reduce the medical utilization and expenses, and it had a greater effect in rural areas than in urban areas. It is suggested to promote the LTCI nationwide, and more policy preference should be given to the development of the LTCI in rural areas.
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Álvarez-Bustos A, Rodríguez-Sánchez B, Carnicero-Carreño JA, Sepúlveda-Loyola W, Garcia-Garcia FJ, Rodríguez-Mañas L. Healthcare cost expenditures associated to frailty and sarcopenia. BMC Geriatr 2022; 22:747. [PMID: 36096728 PMCID: PMC9469617 DOI: 10.1186/s12877-022-03439-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 08/31/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives Frailty and sarcopenia have been related with adverse events, including hospitalization. However, its combined effect with hospitalization-related outcomes, including costs, has not been previously investigated. Our purpose was to explore how frailty, sarcopenia and its interaction could impact on healthcare expenditures. Methods 1358 community-dwelling older adults from the Toledo Study of Healthy Ageing (TSHA) were included. Sarcopenia was measured using the Foundation for the National Institutes of Health criteria fitted to our cohort. Frailty was defined according to Frailty Trait Scale 5 (FTS5) and the Frailty Index fitted to the cut-off points of TSHA population. Hospitalization costs were taken from hospital records and costs were attributed according to Diagnostic-Related Groups, using as the cost base year 2015. Two-part regression models were used to analyze the relationship between frailty and sarcopenia and hospital admission, number of hospitalizations, length of stay and hospitalization costs. Results Sarcopenia was associated only with the probability of being admitted to hospital. Frailty was also associated with higher hospital use, regardless of the frailty tool used, but in addition increased hospital admission costs at follow-up by 23.72% per year and by 19.73% in the full model compared with non-frail individuals. The presence of sarcopenia did not increase the costs of frailty but, by opposite, frailty significantly increased the costs in people with sarcopenia, reaching by 46–56%/patient/year at follow-up. Older adults with frailty and sarcopenia had a higher risk of hospitalization, disregarding the tool used to assess frailty, and higher hospitalization costs (FTS5) in the full model, at the cross-sectional and at the follow-up level. Conclusions Frailty is associated with increased hospitalization costs and accounts for the potential effects of sarcopenia. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03439-z.
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Affiliation(s)
- Alejandro Álvarez-Bustos
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain
| | - Beatriz Rodríguez-Sánchez
- Department of Applied Economics, Public Economics and Political Economy, Faculty of Law, University Complutense of Madrid, Madrid, Spain
| | - Jose A Carnicero-Carreño
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain.,Biomedical Research Foundation, Getafe University Hospital, Getafe, Spain
| | - Walter Sepúlveda-Loyola
- Faculty of Health and Social Sciences, Universidad de Las Americas, Santiago, Chile.,Masters and PhD Programme in Rehabilitation Sciences, Londrina State University (UEL) and University North of Paraná (UNOPAR), Londrina, Brazil
| | - Francisco J Garcia-Garcia
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain.,Geriatrics Department, Virgen del Valle Hospital, Toledo, Spain
| | - Leocadio Rodríguez-Mañas
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain. .,Geriatrics Department, Hospital Universitario de Getafe, Getafe University Hospital, Ctra de Toledo km 12,500, 28905, Getafe, Spain.
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Moura A. Do subsidized nursing homes and home care teams reduce hospital bed-blocking? Evidence from Portugal. JOURNAL OF HEALTH ECONOMICS 2022; 84:102640. [PMID: 35691072 DOI: 10.1016/j.jhealeco.2022.102640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 05/22/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
Excessive length of hospital stay is among the leading sources of inefficiency in healthcare. When a patient is clinically fit to be discharged but requires support outside the hospital, which is not readily available, they remain hospitalized until a safe discharge is possible -a phenomenon called bed-blocking. I study whether the availability of subsidized nursing homes and home care teams reduces hospital bed-blocking. Using individual data on the universe of inpatient admissions at Portuguese hospitals during 2000-2015, I find that the entry of home care teams in a region reduces bed-blocking by 4 days per episode, on average. Nursing home entry only reduces bed-blocking among patients with high care needs or when the intensity of entry is high. Reductions in bed-blocking do not harm patients' health. The beds freed up by reducing bed-blocking are used to admit additional elective patients.
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Affiliation(s)
- Ana Moura
- OPEN Health, Rotterdam, The Netherlands.
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11
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Chen H, Ning J. The Impacts of Long-Term Care Insurance on Health Care Utilization and Expenditure: Evidence From China. Health Policy Plan 2022; 37:717-727. [PMID: 35032390 DOI: 10.1093/heapol/czac003] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/01/2021] [Accepted: 01/15/2022] [Indexed: 11/14/2022] Open
Abstract
Long-term care insurance (LTCI) is one of the important institutional responses to the growing care needs of the ageing population. Although previous studies have evaluated the impacts of LTCI on health care utilization and expenditure in developed countries, whether such impacts exist in developing countries is unknown. The Chinese government has initiated policy experimentation on LTCI to cope with the growing and unmet need for aged care. Employing a quasi-experiment design, this study aims to examine the policy treatment effect of LTCI on health care utilization and out-of-pocket health expenditure in China. The Propensity Score Matching with Difference-in-difference approach was used to analyse the data obtained from four waves of China Health and Retirement Longitudinal Study (CHARLS). Our findings indicated that, in the aspect of health care utilization, the introduction of LTCI significantly reduced the number of outpatient visits by 0.322 times (p<0.05), the number of hospitalizations by 0.158 times (p<0.01), and the length of inpatient stay during last year by 1.441 days (p<0.01). In the aspect of out-of-pocket health expenditure, we found that LTCI significantly reduced the inpatient out-of-pocket health expenditure during last year by 533.47 yuan (p<0.01), but it did not exhibit an impact on the outpatient out-of-pocket health expenditure during last year. LTCI also had a significantly negative impact on the total out-of-pocket health expenditure by 512.56 yuan. These results are stable in the robustness tests. Considering the evident policy treatment effect of LTCI on health care utilization and out-of-pocket health expenditure, the expansion of LTCI could help reduce the needs for health care services and contain the increases in out-of-pocket health care expenditure in China.
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Affiliation(s)
- He Chen
- School of Public Administration and Policy, Renmin University of China, No. 59, Zhongguancun Road, Beijing, Haidian 100872, China
| | - Jing Ning
- School of Government, University of International Business and Economics, No. 10, Huixin Dongjie, Beijing, Chaoyang 100029, China
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Defining Pooled' Place-Based' Budgets for Health and Social Care: A Scoping Review. Int J Integr Care 2022; 22:16. [PMID: 36186513 PMCID: PMC9479665 DOI: 10.5334/ijic.6507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/23/2022] [Indexed: 01/26/2023] Open
Abstract
Introduction Current descriptions of pooled budgets in the literature pose challenges to good quality evaluation of their contribution to integrated care. Addressing this gap is increasingly important given the shift from early models of integrated care targeting segments of the population, to more recent approaches that aim to target 'places', broader geographically defined populations. This review draws on the current international evidence to describe practical examples of pooled health and social care budgets, highlighting specific place-based approaches. Methods We initially conducted a scoping review, a systematic database search ('Medline', 'Embase', 'Econ Lit' and 'Google Scholar') complemented by further snowballing for academic and 'grey literature' publications (1995 - 2020). Results were analysed thematically according to budget characteristics and macro-environment, with additional specific case studies. Results Thirty-six primary studies were included, describing ten broad models of pooled budgets across seven countries. Most budgets targeted specific sub-populations rather than an entire geographically defined population. Specific budget structures varied and were generally under-described. The closest place-based models were for small populations and implemented in a national health system, or insurance-based with natural geographical boundaries. Conclusion Despite their increasing relevance in the current political debate, pooled place-based budgets are still at an early stage of implementation and research. Adequate description is required for future meta-analysis of effectiveness on outcomes.
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Chen S, Li L, Yang J, Jiao L, Golden T, Wang Z, Liu H, Wu P, Bärnighausen T, Geldsetzer P, Wang C. The impact of long-term care insurance in China on beneficiaries and caregivers: A systematic review. JOURNAL OF GLOBAL HEALTH ECONOMICS AND POLICY 2021; 1:e2021014. [PMID: 35083471 PMCID: PMC8788994 DOI: 10.52872/001c.29559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND China's long-term care insurance (LTCI) policy has been minimally evaluated. This systematic review aimed to assess the impact of China's LTCI pilot on beneficiaries and their caregivers. METHODS This review is based on a search of peer-reviewed studies in English (Embase, MEDLINE, Web of Science) and Chinese (China National Knowledge Infrastructure [CNKI], VIP, Wanfang) databases from January 2016 through July 2020, with all studies published in English or Chinese included. We included quantitative analyses of beneficiary-level data that assessed the impact of LTCI on beneficiaries and their caregivers, with no restriction placed on the outcomes studied. RESULTS Nine studies met our inclusion criteria. One study was a randomised trial and two used quasi-experimental approaches. Four studies examined LTCI's effect on beneficiaries' quality of life, physical pain, and health service utilisation; one study reported the effect on beneficiaries' healthcare expenditures; and one study evaluated the impact on caregivers' care tasks. These studies generally found LTCI to be associated with an improvement in patients' quality of life (including decreased physical pain), a reduction in the number of outpatient visits and hospitalisations, decreased patient-level health expenditures (e.g. one study reported a reduction in the length of stay, inpatient expenditures, and health insurance expenditures in tertiary hospitals by 41.0%, 17.7%, and 11.4%, respectively), and reduced informal care tasks for caregivers. In addition, four out of four studies that evaluated this outcome found that beneficiaries' overall satisfaction with LTCI was high. CONCLUSION The current evidence base for the effects of LTCI in China on beneficiaries and their caregivers is sparse. Nonetheless, the existing studies suggest that LTCI has positive effects on beneficiaries and their caregivers. Further rigorous research on the impacts of LTCI in China is needed to inform the future expansion of the program.
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Affiliation(s)
- Simiao Chen
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University; Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Linye Li
- Chinese Academy of Social Sciences
| | - Juntao Yang
- State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College
| | | | - Todd Golden
- Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Zhuoran Wang
- Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Haitao Liu
- Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Peixin Wu
- Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University; Chinese Academy of Medical Sciences and Peking Union Medical College; Department of Global Health and Population, Harvard School of Public Health
| | - Pascal Geldsetzer
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University; Division of Primary Care and Population Health, Department of Medicine, Stanford University
| | - Chen Wang
- Chinese Academy of Medical Sciences and Peking Union Medical College; National Clinical Research Center for Respiratory Diseases, Beijing, China; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital
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14
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Lau YS, Malisauskaite G, Brookes N, Hussein S, Sutton M. Complements or substitutes? Associations between volumes of care provided in the community and hospitals. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:1167-1181. [PMID: 34138375 PMCID: PMC8526459 DOI: 10.1007/s10198-021-01329-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 05/27/2021] [Indexed: 06/12/2023]
Abstract
Policymakers often suggest that expansion of care in community settings may ease increasing pressures on hospital services. Substitution may lower overall health system costs, but complementarity due to previously unidentified needs might raise them. We used new national data on community and primary medical care services in England to undertake system-level analyses of whether activity in the community acts as a complement or a substitute for activity provided in hospitals. We used two-way fixed effects regression to relate monthly counts of community care and primary medical care contacts to emergency department attendances, outpatient visits and admissions for 242 hospitals between November 2017 and September 2019. We then used national unit costs to estimate the effects of increasing community activity on overall system expenditure. The findings show community care contacts to be weak substitutes with all types of hospital activity and primary care contacts are weak substitutes for emergency hospital attendances and admissions. Our estimates ranged from 28 [95% CI 21, 45] to 517 [95% CI 291, 7265] community care contacts and from 34 [95% CI 17, 1283] to 1655 [95% CI - 1995, 70,145] GP appointments to reduce one hospital service visit. Primary care and planned hospital services are complements. Increases in community services and primary care activity are both associated with increased overall system expenditure of £34 [95% CI £156, £54] per visit for community care and £41 [95% CI £78, £74] per appointment in general practice. Expansion of community-based services may not generate reductions in hospital activity and expenditure.
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Affiliation(s)
- Yiu-Shing Lau
- Health Organisation, Policy and Economics, University of Manchester, Manchester, UK.
| | | | - Nadia Brookes
- Centre for Health Services Studies, University of Kent, Kent, UK
| | - Shereen Hussein
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Matt Sutton
- Health Organisation, Policy and Economics, University of Manchester, Manchester, UK
- Melbourne Institute: Applied Economic and Social Research, University of Melbourne, Melbourne, Australia
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15
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Martin S, Longo F, Lomas J, Claxton K. Causal impact of social care, public health and healthcare expenditure on mortality in England: cross-sectional evidence for 2013/2014. BMJ Open 2021; 11:e046417. [PMID: 34654700 PMCID: PMC8559090 DOI: 10.1136/bmjopen-2020-046417] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The first objective is to estimate the joint impact of social care, public health and healthcare expenditure on mortality in England. The second objective is to use these results to estimate the impact of spending constraints in 2010/2011-2014/2015 on total mortality. METHODS The impact of social care, healthcare and public health expenditure on mortality is analysed by applying the two-stage least squares method to local authority data for 2013/2014. Next, we compare the growth in healthcare and social care expenditure pre-2010 and post-2010. We use the difference between these growth rates and the responsiveness of mortality to changes in expenditure taken from the 2013/2014 cross-sectional analysis to estimate the additional mortality generated by post-2010 spending constraints. RESULTS Our most conservative results suggest that (1) a 1% increase in healthcare expenditure reduces mortality by 0.532%; (2) a 1% increase in social care expenditure reduces mortality by 0.336%; and (3) a 1% increase in local public health spending reduces mortality by 0.019%. Using the first two of these elasticities and data on the change in spending growth between 2001/2002-2009/2010 and 2010/2011-2014/2015, we find that there were 57 550 (CI 3075 to 111 955) more deaths in the latter period than would have been observed had spending growth during this period matched that in 2001/2002-2009/2010. CONCLUSIONS All three forms of public healthcare-related expenditure save lives and there is evidence that additional social care expenditure is more than twice as productive as additional healthcare expenditure. Our results are consistent with the hypothesis that the slowdown in the rate of improvement in life expectancy in England and Wales since 2010 is attributable to spending constraints in the healthcare and social care sectors.
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Affiliation(s)
- Stephen Martin
- Department of Economics and Related Studies, University of York, York, UK
| | | | - James Lomas
- Centre for Health Economics, University of York, York, UK
| | - Karl Claxton
- Centre for Health Economics & Department of Economics, University of York, York, UK
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16
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Longo F, Claxton K, Lomas J, Martin S. Does public long-term care expenditure improve care-related quality of life of service users in England? HEALTH ECONOMICS 2021; 30:2561-2581. [PMID: 34318556 DOI: 10.1002/hec.4396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 06/07/2021] [Accepted: 06/27/2021] [Indexed: 06/13/2023]
Abstract
Public long-term care (LTC) systems provide services to support people experiencing difficulties with their activities of daily living. This study investigates the marginal effect of changes in public LTC expenditure on care-related quality of life (CRQoL) of existing service users in England. The public LTC program for people aged 18 or older in England is called Adult Social Care (ASC) and it is provided and managed by local authorities. We collect data on the outcomes and characteristics of public ASC users, on public ASC expenditure, and on the characteristics of local authorities across England in 2017/18. We employ an instrumental variable approach using conditionally exogenous elements of the public funding system to estimate the effect of public ASC expenditure on user CRQoL. Our findings show that by increasing public ASC expenditure by £1000 per user, on average, local authorities increase user CRQoL by 0.0030. These results suggest that public ASC is effective in increasing users' quality of life but only to a relatively small extent. When combined with the other potential effects of LTC expenditure (e.g., on informal carers, mortality), this study can inform policy makers in the United Kingdom and internationally about whether social care provides good value for money.
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Affiliation(s)
| | - Karl Claxton
- Centre for Health Economics, University of York, York, UK
- Department of Economics and Related Studies, University of York, York, UK
| | - James Lomas
- Centre for Health Economics, University of York, York, UK
| | - Stephen Martin
- Department of Economics and Related Studies, University of York, York, UK
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17
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Kverndokk S, Melberg HO. Using fees to reduce bed-blocking: a game between hospitals and long-term care providers. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:931-949. [PMID: 33895904 DOI: 10.1007/s10198-021-01299-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
In several countries, a fee has been introduced to reduce bed-blocking in hospitals. This paper studies the implications of this fee for the strategic decisions of the hospitals and the long-term care providers. We introduce a Stackelberg game where the hospital is the leader and the care provider the follower. The policy reduces the treatment time at the hospital but does not necessarily lead to less bed-blocking, as this depends on the treatment time and bed-blocking before the reform. We test the results with data from the Norwegian Coordination Reform introduced in 2012 and find that this reform led to a large reduction in bed-blocking. The direct effect was even larger than a naïve comparison would suggest because hospitals began to report patients as ready to be discharged earlier than before the reform. Confronted with the theoretical predictions, this would mean that hospital services in average were set relatively close to the minimum levels before the reform.
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Affiliation(s)
- Snorre Kverndokk
- The Ragnar Frisch Centre for Economic Research, Gaustadallèen 21, 0349, Oslo, Norway.
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18
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Zhao P, Wang LY, Zhao L. Can Sound Health Insurance Increase the Internal Circulation in the Economy of China? Front Public Health 2021; 9:710633. [PMID: 34336780 PMCID: PMC8319645 DOI: 10.3389/fpubh.2021.710633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/02/2021] [Indexed: 11/13/2022] Open
Abstract
In 2020, President Xi Jinping put forward a constructing cycle that has been given priority in this study. This particular cycle, when considered within the inner loop and outer loop, promotes the guiding ideology of the new development pattern of the binary economy that exists in recent times. Therefore, to gauge the extent of the promotion of domestic production and consumption, from the perspectives of medical expenses, this study refers to the bootstrap rolling window causality method, which considers the evidence-based medical spending on the consumption Granger causality. The results show that the Granger causality exists between medical expenditure and consumption expenditure at different time interval endpoints. In contrast, however, the variable of consumption does not produce Granger causality between medical expenditure and consumption. In this regard, a series of measures, such as increasing medical insurance expenditure, improvement of the medical insurance system, reduction of the housing price rise, and increasing government investment have been proposed to promote the development of the domestic circular economy.
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Affiliation(s)
- Peng Zhao
- School of Economics and Management, Nanning Normal University, Nanning, China.,Postdoctoral Fellow, Central University of Finance and Economics, Beijing, China
| | - Li-Yong Wang
- School of International Trade and Economics, Central University of Finance and Economics, Beijing, China
| | - Li Zhao
- School of Continuing Education, Nanning Normal University, Nanning, China
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19
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Crawford R, Stoye G, Zaranko B. Long-term care spending and hospital use among the older population in England. JOURNAL OF HEALTH ECONOMICS 2021; 78:102477. [PMID: 34153887 DOI: 10.1016/j.jhealeco.2021.102477] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 05/15/2023]
Abstract
This paper examines the impact of changes in public long-term care spending on the use of public hospitals among the older population in England. Mean per-person long-term care spending fell by 31% between 2009/10 and 2017/18, but cuts varied considerably geographically. We instrument public long-term care spending with predicted spending based on historical national funding shares and national spending trends. We find that reductions in public long-term care spending led to substantial increases in the number of emergency department (ED) visits made by patients aged 65 and above, explaining between a quarter and a half of the growth in ED use among this population over this period, and to an increase in the share of patients revisiting the ED within seven days. However, there was no impact on wider use of inpatient or outpatient services (which are more expensive to provide), and consequently little impact on overall hospital costs.
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Affiliation(s)
- Rowena Crawford
- Institute for Fiscal Studies, 7 Ridgmount Street, London WC1E 7AE, UK.
| | - George Stoye
- Institute for Fiscal Studies, 7 Ridgmount Street, London WC1E 7AE, UK.
| | - Ben Zaranko
- Institute for Fiscal Studies, 7 Ridgmount Street, London WC1E 7AE, UK.
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20
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Moon S, Park HJ, Sohn M. The impact of long-term care service on total lifetime medical expenditure among older adults with dementia. Soc Sci Med 2021; 280:114072. [PMID: 34077879 DOI: 10.1016/j.socscimed.2021.114072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/11/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
Along with the rapid increase in older adult population in South Korea, the management of dementia is becoming important. Higher dementia prevalence inevitably leads to an excessive burden on medical expenditure throughout one's life, so the catastrophic health expenditure for dementia should be protected in the aspect of both nation and family. Therefore, this study attempted to estimate the lifetime medical expenditures (LE) of older adults with dementia, and confirmed if the long-term care insurance (LTCI) is effective in reducing their medical expenses. The study analyzed LE of adults, aged over 70 years, using a cohort database and simulated the total LE per capita. In order to compare the differences in LE due to dementia, propensity score matching (PSM) was performed. As of 2015, the total LE per capita for older adults with dementia and without dementia was estimated to be 76,973 thousand won ($65,427) and 31,105 thousand won ($26,439). Older adults with dementia had 2.4 times more expenditure than those without dementia. In particular, the LE per capita for hospitalization of dementia patients was 63,945 thousand won ($54,353), which was about 5 times higher than LE per capita for outpatient treatment. In addition, as a result of confirming the political effectiveness of LTCI, the LE for older adults with dementia, who had not used the long-term care service (LTCS), was estimated to be about 85,769 thousand won ($72,904). Conversely, LTCS users were estimated to spend 70,487 thousand won ($59,914), which means that LTCS non-users spent about 22% more on total LE than LTCS users. Non-users spent about half of their LE after the age of 80. Based on these findings, this study confirmed that the LTCI system had the desired effect of reducing the total LE for older adults with dementia.
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Affiliation(s)
- Sungje Moon
- Research Institute for Healthcare Policy, Korean Medical Association, Seoul, Republic of Korea
| | - Hee Jung Park
- Department of Dental Hygiene, College of Health Science, Kangwon National University, Gangwon-do, Republic of Korea.
| | - Minsung Sohn
- Department of Health and Care Administration, The Cyber University of Korea, Seoul, Republic of Korea.
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21
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Yang W, Chang S, Zhang W, Wang R, Mossialos E, Wu X, Cui D, Li H, Mi H. An Initial Analysis of the Effects of a Long-Term Care Insurance on Equity and Efficiency: A Case Study of Qingdao City in China. Res Aging 2021; 43:156-165. [PMID: 32096450 PMCID: PMC7961619 DOI: 10.1177/0164027520907346] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Finding a suitable mechanism to finance long-term care (LTC) is a pressing policy concern for many countries. Using Qingdao city in China as a case study, this article presents an initial assessment of a newly piloted LTC insurance by evaluating its effects on equity and efficiency in financing. Drawing data from 47 in-depth interviews conducted in 2016, this study found that there remain sizable disparities in financial burden among insurance participants, despite an emphasis on ensuring equitable access to care. Although the insurance brought cost savings to the health care sector, the LTC providers are incentivized to provide care at the least cost, even when such care is deemed inadequate due to the fixed payment for their services. This article offers critical insights into the potentials and challenges of applying the LTC insurance model in a developing country, where critical lessons can be drawn for public LTC insurance in other countries.
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Affiliation(s)
- Wei Yang
- Department of Global Health & Social Medicine, 4616King's College London, United Kingdom
| | - Shuang Chang
- Department of Computer Science, 13290Tokyo Institute of Technology, Japan
| | - Wenbo Zhang
- Department of Social Policy, Institute of Sociology, 12470Chinese Academy of Social Sciences, Beijing, China
| | - Ruobing Wang
- London School of Economics and Political Science, United Kingdom
| | - Elias Mossialos
- London School of Economics and Political Science, United Kingdom
| | - Xun Wu
- The Hong Kong University of Science and Technology, Kowloon, Hong Kong
| | - Dan Cui
- Global Health Institute, 12390Wuhan University, China
| | - Hao Li
- Global Health Institute, 12390Wuhan University, China
| | - Hong Mi
- 12377Zhejiang University, Hangzhou, China
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22
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Liu D, Pace ML, Goddard M, Jacobs R, Wittenberg R, Mason A. Investigating the relationship between social care supply and healthcare utilization by older people in England. HEALTH ECONOMICS 2021; 30:36-54. [PMID: 33098348 DOI: 10.1002/hec.4175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 09/03/2020] [Accepted: 10/02/2020] [Indexed: 06/11/2023]
Abstract
Since 2010, adult social care spending in England has fallen significantly in real terms whilst demand has risen. Reductions in social care supply may also have impacted demand for NHS services, particularly for those whose care is provided at the interface of the health and care systems. We analyzed a panel dataset of 150 local authorities (councils) to test potential impacts on hospital utilization by people aged 65 and over: emergency admission rates for falls and hip fractures ("front-door" measures); and extended stays of 7 days or longer; and 21 days or longer ("back-door" measures). Changes in social care supply were assessed in two ways: gross current expenditure (per capita 65 and over) adjusted by local labor costs and social care workforce (per capita 18 and over). We ran negative binomial models, controlling for deprivation, ethnicity, age, unpaid care, council class, and year effects. To account for potential endogeneity, we ran instrumental variable regressions and dynamic panel models. Sensitivity analysis explored potential effects of funding for integrated care (the Better Care Fund). There was no consistent evidence that councils with higher per capita spend or higher social care staffing rates had lower hospital admission rates or shorter hospital stays.
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Affiliation(s)
- Dan Liu
- Centre for Health Economics, University of York, York, UK
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, Sydney, New South Wales, Australia
| | | | - Maria Goddard
- Centre for Health Economics, University of York, York, UK
| | - Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
| | | | - Anne Mason
- Centre for Health Economics, University of York, York, UK
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23
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Boo S, Lee J, Oh H. Cost of Care and Pattern of Medical Care Use in the Last Year of Life among Long-Term Care Insurance Beneficiaries in South Korea: Using National Claims Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239078. [PMID: 33291790 PMCID: PMC7730132 DOI: 10.3390/ijerph17239078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/16/2022]
Abstract
In Korea, a substantial proportion of long-term care insurance (LTCI) beneficiaries die within 1 year of seeking the benefit. This study was conducted to evaluate the pattern of medical care use and care cost during the last year of life among Korean LTCI beneficiaries between 2009 and 2013 using the national claims data. The National Health Insurance’s Senior (NHIS-Senior) cohort was used for this retrospective study. The participants were LTCI beneficiaries aged 65 or over as of 2008 who died between 2009 and 2013 (N = 30,433). Medical costs during the last year of life were highest for those who used both medical care services and long-term care (LTC) services and increased as death approached. About half of the participants were hospitalized at the time of death. The use of LTC services at the time of death increased from 13.0 to 22.8%, while those who died at home decreased from 34 to 20%. This study suggests that the use of LTC services did not reduce medical costs by substituting unnecessary inpatient hospitalization. Quality of dying should be considered one of the goals of older adult care, and provisions should be made for palliative care at home or LTC facilities.
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Affiliation(s)
- Sunjoo Boo
- Research Institute of Nursing Science, College of Nursing, Ajou University, Suwon 16499, Korea
- Correspondence: (S.B.); (H.O.)
| | - Jungah Lee
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 71, Daehak-ro, Jongno-gu, Seoul 03082, Korea;
| | - Hyunjin Oh
- College of Nursing, Gachon University, Incheon 98105, Korea
- Correspondence: (S.B.); (H.O.)
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24
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Walsh B, Lyons S, Smith S, Wren MA, Eighan J, Morgenroth E. Does formal home care reduce inpatient length of stay? HEALTH ECONOMICS 2020; 29:1620-1636. [PMID: 32924255 DOI: 10.1002/hec.4158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 07/03/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
Formal home care is an appropriate substitute for acute hospital care for many older people. However, limited empirical evidence exists on the extent of substitution between the supply of home care and hospital use. This study examines whether patients from areas with a better supply of home care have lower inpatient length of stay (LOS). We link administrative data on over 300,000 public hospital inpatient admissions in Ireland between 2012 and 2015 to region-year panel data on public home care supply. In addition to modeling average LOS, we estimate unconditional quantile regressions to examine whether home care supply has a disproportionately strong impact on long LOS. We find that inpatients from areas with higher per capita home care supply have lower average LOS; a 10% increase in home care is associated with a 1.2%-2.1% reduction in LOS. This result is driven by the subset of patients with the longest LOS, likely delayed discharges. Stronger results were found for stroke and hip fracture patients, who might be expected to have higher than average propensity to use home care services, and for patients from a region that experienced an unusually large increase in home care supply.
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Affiliation(s)
- Brendan Walsh
- Economic and Social Research Institute, Dublin, Ireland
- Department of Economics, Trinity College Dublin, Dublin, Ireland
| | - Seán Lyons
- Economic and Social Research Institute, Dublin, Ireland
- Department of Economics, Trinity College Dublin, Dublin, Ireland
| | - Samantha Smith
- Centre for Health Policy & Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Maev-Ann Wren
- Economic and Social Research Institute, Dublin, Ireland
- Department of Economics, Trinity College Dublin, Dublin, Ireland
| | - James Eighan
- Economic and Social Research Institute, Dublin, Ireland
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25
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Sinn CLJ, Heckman G, Poss JW, Onder G, Vetrano DL, Hirdes J. A comparison of 3 frailty measures and adverse outcomes in the intake home care population: a retrospective cohort study. CMAJ Open 2020; 8:E796-E809. [PMID: 33262118 PMCID: PMC7721251 DOI: 10.9778/cmajo.20200083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In Ontario, Canada, nearly all home care patients are assessed with a brief clinical assessment (interRAI Contact Assessment [interRAI CA]) on admission. Our objective was to compare 3 frailty measures that can be operationalized using the interRAI CA. METHODS We conducted a retrospective cohort study using linked patient-level assessment and administrative data for all Ontario adult (≥ 18 yr) home care patients assessed with the interRAI CA in 2014. We employed multivariable logistic models to compare the Changes in Health, End-stage disease and Signs and Symptoms Scale for the Contact Assessment (CHESS-CA), Assessment Urgency Algorithm (AUA) and the Frailty Index for the Contact Assessment (FI-CA) that was created for this study. Our outcomes of interest were death, hospital admission and emergency department visits within 90 days, and assessor-rated need for comprehensive geriatric assessment (CGA). RESULTS In 2014, there were 228 679 unique adult home care patients in Ontario assessed with the interRAI CA. Controlling for age, sex and health region, being in a higher frailty level defined by any measure increased the likelihood of experiencing adverse outcomes. Among all assessments, CHESS-CA was best suited for predicting death and hospital admission, and either AUA or FI-CA for predicting perceived need for CGA. Previous emergency department visits were more predictive of future visits than frailty. Model fit was independent of whether the assessment was completed over the phone or in person. INTERPRETATION Frailty measures from the interRAI CA identified patients at higher risk for death, hospital admission and perceived need for CGA. In jurisdictions where the CHESS-CA and AUA are already built into the electronic home care platform, such as Ontario, patients identified as high risk should be prioritized for proactive referral and care planning, and may benefit from greater involvement of primary care and other health professionals in the circle of care.
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Affiliation(s)
- Chi-Ling Joanna Sinn
- School of Public Health and Health Systems (Sinn, Heckman, Poss, Hirdes), University of Waterloo; Research Institute for Aging (Heckman), Waterloo, Ont.; Department of Cardiovascular, Metabolic and Aging Diseases (Onder), Istituto Superiore di Sanità, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Vetrano), Università Cattolica del Sacro Cuore, Rome, Italy; Aging Research Center (Vetrano), Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - George Heckman
- School of Public Health and Health Systems (Sinn, Heckman, Poss, Hirdes), University of Waterloo; Research Institute for Aging (Heckman), Waterloo, Ont.; Department of Cardiovascular, Metabolic and Aging Diseases (Onder), Istituto Superiore di Sanità, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Vetrano), Università Cattolica del Sacro Cuore, Rome, Italy; Aging Research Center (Vetrano), Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Jeffrey W Poss
- School of Public Health and Health Systems (Sinn, Heckman, Poss, Hirdes), University of Waterloo; Research Institute for Aging (Heckman), Waterloo, Ont.; Department of Cardiovascular, Metabolic and Aging Diseases (Onder), Istituto Superiore di Sanità, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Vetrano), Università Cattolica del Sacro Cuore, Rome, Italy; Aging Research Center (Vetrano), Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Graziano Onder
- School of Public Health and Health Systems (Sinn, Heckman, Poss, Hirdes), University of Waterloo; Research Institute for Aging (Heckman), Waterloo, Ont.; Department of Cardiovascular, Metabolic and Aging Diseases (Onder), Istituto Superiore di Sanità, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Vetrano), Università Cattolica del Sacro Cuore, Rome, Italy; Aging Research Center (Vetrano), Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Davide Liborio Vetrano
- School of Public Health and Health Systems (Sinn, Heckman, Poss, Hirdes), University of Waterloo; Research Institute for Aging (Heckman), Waterloo, Ont.; Department of Cardiovascular, Metabolic and Aging Diseases (Onder), Istituto Superiore di Sanità, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Vetrano), Università Cattolica del Sacro Cuore, Rome, Italy; Aging Research Center (Vetrano), Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - John Hirdes
- School of Public Health and Health Systems (Sinn, Heckman, Poss, Hirdes), University of Waterloo; Research Institute for Aging (Heckman), Waterloo, Ont.; Department of Cardiovascular, Metabolic and Aging Diseases (Onder), Istituto Superiore di Sanità, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Vetrano), Università Cattolica del Sacro Cuore, Rome, Italy; Aging Research Center (Vetrano), Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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DeVolder R, Serra-Sastre V, Zamora B. Examining the variation across acute trusts in patient delayed discharge. Health Policy 2020; 124:1226-1232. [PMID: 32712011 DOI: 10.1016/j.healthpol.2020.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 11/27/2022]
Abstract
Delayed transfers of care, or delayed discharges, adversely affect patient care and increase costs to England's National Health Service. The main objective of this paper is to explain variation in the probability of delayed discharge from an acute trust and patient perspective. A novel approach is employed in using the Adult Inpatient Survey over the period 2007-2014. We use a two stage regression model to assess the impact of various patient, acute hospital trust, and regional characteristics on the probability of delayed discharge. In the first stage we model the patient-level probability of delayed discharge and estimate hospital trust-specific fixed-effects. Stage two includes multiple linear regressions to explain acute trust fixed effects from stage one by using acute trust characteristics and regional observable characteristics as explanatory variables. Results indicate the probability of delayed discharge varies among acute trusts and patients. Patient-mix complexity, staff skill-mix, size and scope of acute trust are among those factors affecting the trust-specific discharge efficiency.
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Affiliation(s)
- Russell DeVolder
- Office of Health Economics, Southside, 7th Floor, 105 Victoria Street, London SW1E 6QT, United Kingdom.
| | - Victoria Serra-Sastre
- Department of Economics, City, University of London, Rhind Building Room D313, Northampton Square, London EC1V 0HB, United Kingdom; Department of Health Policy, London School of Economics and Political Science, United Kingdom.
| | - Bernarda Zamora
- Office of Health Economics, Southside, 7th Floor, 105 Victoria Street, London SW1E 6QT, United Kingdom.
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Feng J, Wang Z, Yu Y. Does long-term care insurance reduce hospital utilization and medical expenditures? Evidence from China. Soc Sci Med 2020; 258:113081. [PMID: 32540515 DOI: 10.1016/j.socscimed.2020.113081] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/10/2020] [Accepted: 05/21/2020] [Indexed: 11/26/2022]
Abstract
This study examines the effect of long-term care insurance (LTCI) on hospital utilization and expenditures among the elderly in China. We exploit the introduction of public LTCI in Shanghai, China, and implement a difference-in-difference technique to disentangle the effects of LTCI. We find that the introduction of LTCI significantly reduces the length of stay, inpatient expenditures, and health insurance expenditures in tertiary hospitals by 41.0%, 17.7%, and 11.4%, respectively. We find a greater effect on people over 80 years old. Outpatient visits in tertiary hospitals decrease by 8.1% per month after LTCI. The possible mechanisms are the substitution of long term care for hospitalization and health improvement. Our cost-effectiveness analysis indicates that every extra 1 yuan spent in LTCI will generate a decrease of 8.6 yuan in health insurance expenditures.
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Affiliation(s)
- Jin Feng
- School of Economics, Fudan University, Room 415, 600 Guoquan Road, Yangpu District, Shanghai, 200433, China.
| | - Zhen Wang
- School of Economics, Fudan University, Room 213, 600 Guoquan Road, Yangpu District, Shanghai, 200433, China.
| | - Yangyang Yu
- School of Public Economics & Administration, Shanghai University of Finance & Economics, Room 210, Fenghuang Buidling, 111 Wuchuan Road, Yangpu District, Shanghai, 200433, China.
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Effects of Copayment in Long-Term Care Insurance on Long-Term Care and Medical Care Expenditure. J Am Med Dir Assoc 2020; 21:640-646.e5. [DOI: 10.1016/j.jamda.2019.08.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 11/21/2022]
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Investing in social care to reduce healthcare utilisation. Br J Gen Pract 2020; 70:4-5. [DOI: 10.3399/bjgp20x707249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Kümpel C. Do financial incentives influence the hospitalization rate of nursing home residents? Evidence from Germany. HEALTH ECONOMICS 2019; 28:1235-1247. [PMID: 31523874 DOI: 10.1002/hec.3930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 06/10/2019] [Accepted: 06/17/2019] [Indexed: 06/10/2023]
Abstract
Efficient health-care provision for nursing home residents is a concern in many OECD (Organization for Economic Cooperation and Development) countries. This paper analyzes whether nursing homes respond to financial incentives when deciding whether to hospitalize their residents. In Germany, reimbursements for nursing homes are reduced after a defined number of days when a resident stays in a hospital instead of a nursing home. As a result of a federal law introduced in 2008, some German states had to change the point at which reimbursements to nursing homes are reduced so that reductions are made from Day 4 instead of Day 1 of a resident's absence. This exogenously raised an incentive for the nursing homes affected to hospitalize residents especially for an expected short-term stay. This analysis exploits the introduction of the law in a difference-in-difference approach, using market-wide German-DRG files covering all hospital patients discharged from hospitals to nursing homes from 2007 to 2011. The results suggest an increase of approximately 11% in short-term hospital stays as a consequence of the longer reimbursement period introduced by the law.
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Affiliation(s)
- Christian Kümpel
- Hamburg Center for Health Economics, Universität Hamburg, Hamburg, Germany
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Spiers G, Matthews FE, Moffatt S, Barker R, Jarvis H, Stow D, Kingston A, Hanratty B. Does older adults' use of social care influence their healthcare utilisation? A systematic review of international evidence. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e651-e662. [PMID: 31314142 DOI: 10.1111/hsc.12798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 06/10/2023]
Abstract
Improving our understanding of the complex relationship between health and social care utilisation is vital as populations age. This systematic review aimed to synthesise evidence on the relationship between older adults' use of social care and their healthcare utilisation. Ten databases were searched for international literature on social care (exposure), healthcare use (outcome) and older adults (population). Searches were carried out in October 2016, and updated May 2018. Studies were eligible if they were published after 2000 in a high income country, examined the relationship between use of social care and healthcare utilisation by older adults (aged ≥60 years), and controlled for an indicator of need. Study quality and bias were rated using the National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Study data were extracted and a narrative synthesis was conducted. Data were not suitable for quantitative synthesis. Thirteen studies were identified from 12,065 citations. Overall, the quality and volume of evidence was low. There was limited evidence to suggest that longer lengths of stay in care homes were associated with a lower risk of inpatient admissions. Residents of care homes with onsite nursing had fewer than expected admissions to hospital, compared to people in care homes without nursing, and adjusting for need. Evidence for other healthcare use outcomes was even more limited and heterogeneous, with notable gaps in primary care. We conclude that older adults' use of care homes may moderate inpatient admissions. In particular, the presence of registered nurses in care homes may reduce the need to transfer residents to hospital. However, further evidence is needed to add weight to this conclusion. Future research should build on this evidence and address gaps regarding the influence of community based social care on older adults' healthcare use. A greater focus on primary care outcomes is imperative.
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Affiliation(s)
- Gemma Spiers
- Institute for Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona E Matthews
- Institute for Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Suzanne Moffatt
- Institute for Health & Society, Newcastle University, Royal Victoria Infirmary, Newcastle University, Newcastle upon Tyne, UK
| | - Robert Barker
- Institute for Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Helen Jarvis
- Institute for Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Stow
- Institute for Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Kingston
- Institute for Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Institute for Health & Society, Newcastle University, Newcastle upon Tyne, UK
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Seamer P, Brake S, Moore P, Mohammed MA, Wyatt S. Did government spending cuts to social care for older people lead to an increase in emergency hospital admissions? An ecological study, England 2005-2016. BMJ Open 2019; 9:e024577. [PMID: 31028036 PMCID: PMC6501965 DOI: 10.1136/bmjopen-2018-024577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Government spending on social care in England reduced substantially in real terms following the economic crisis in 2008, meanwhile emergency admissions to hospitals have increased. We aimed to assess the extent to which reductions in social care spend on older people have led to increases in emergency hospital admissions. DESIGN We used negative binomial regression for panel data to assess the relationship between emergency hospital admissions and government spend on social care for older people. We adjusted for population size and for levels of deprivation and health. SETTING Hospitals and adult social care services in England between April 2005 and March 2016. PARTICIPANTS People aged 65 years and over resident in 132 local councils. OUTCOME MEASURES Primary outcome variable-emergency hospital admissions of adults aged 65 years and over. Secondary outcome measure-emergency hospital admissions for ambulatory care sensitive conditions (ACSCs) of adults aged 65 years and over. RESULTS We found no significant relationship between the changes in the rate of government spend (£'000 s) on social care for older people within councils and our primary outcome variable, emergency hospital admissions (Incidence rate ratio (IRR) 1.009, 95% CI 0.965 to 1.056) or our secondary outcome measure, admissions for ACSCs (IRR 0.975, 95% CI 0.917 to 1.038). CONCLUSIONS We found no evidence to support the view that reductions in government spend on social care since 2008 have led to increases in emergency hospital admissions in older people. Policy makers may wish to review schemes, such as the Better Care Fund, which are predicated on a relationship between social care provision and emergency hospital admissions of older people.
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Affiliation(s)
- Paul Seamer
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Simon Brake
- Warwick Medical School, University of Warwick, Coventry, UK
- Head Office, NHS Walsall Clinical Commissioning Group, Walsall, UK
| | - Patrick Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Mohammed A Mohammed
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Steven Wyatt
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
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Forder J, Gousia K, Saloniki EC. The impact of long-term care on primary care doctor consultations for people over 75 years. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:375-387. [PMID: 30187252 PMCID: PMC6438947 DOI: 10.1007/s10198-018-0999-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 08/14/2018] [Indexed: 06/08/2023]
Abstract
Many countries are adopting policies to create greater coordination and integration between acute and long-term care services. This policy is predicated on the assumption that these service areas have interdependent outcomes for patients. In this paper, we study the interdependencies between the long-term (home care) services and consultations with a primary care doctor, as used by people over 75 years. Starting with a model of individual's demand for doctor consultations, given supply, we formalize the hypothesis that exogenous increases to home care supply will reduce the number of consultations where these services are technical substitutes. Furthermore, greater coordination of public service planning and use of pooled budgets could lead to better outcomes because planners can account for these externalities. We test our main hypothesis using data from the British Household Panel Study for 1991-2009. To address potential concerns about endogeneity, we use a set of instrumental variables for home care motivated by institutional features of the social care system. We find that there is a statistically significant substitution effect between home care and doctor visits, which is robust across a range of specifications. This result has implications for policies that consider increased coordination between health care and social care systems.
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Affiliation(s)
- Julien Forder
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, CT2 7NX, UK
| | - Katerina Gousia
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, CT2 7NX, UK.
- Centre for Health Services Studies, University of Kent, Canterbury, Kent, CT2 7NX, UK.
| | - Eirini-Christina Saloniki
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, CT2 7NX, UK
- Centre for Health Services Studies, University of Kent, Canterbury, Kent, CT2 7NX, UK
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Spiers G, Matthews FE, Moffatt S, Barker RO, Jarvis H, Stow D, Kingston A, Hanratty B. Impact of social care supply on healthcare utilisation by older adults: a systematic review and meta-analysis. Age Ageing 2019; 48:57-66. [PMID: 30247573 PMCID: PMC6322507 DOI: 10.1093/ageing/afy147] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/20/2018] [Accepted: 08/29/2018] [Indexed: 11/13/2022] Open
Abstract
Objective to investigate the impact of the availability and supply of social care on healthcare utilisation (HCU) by older adults in high income countries. Design systematic review and meta-analysis. Data sources medline, EMBASE, Scopus, Health Management Information Consortium, Cochrane Database of Systematic Reviews, NIHR Health Technology Assessment, NHS Economic Evaluation Database, Database of Abstracts of Reviews of Effectiveness, SCIE Online and ASSIA. Searches were carried out October 2016 (updated April 2017 and May 2018). (PROSPERO CRD42016050772). Study selection observational studies from high income countries, published after 2000 examining the relationship between the availability of social care (support at home or in care homes with or without nursing) and healthcare utilisation by adults >60 years. Studies were quality assessed. Results twelve studies were included from 11,757 citations; ten were eligible for meta-analysis. Most studies (7/12) were from the UK. All reported analysis of administrative data. Seven studies were rated good in quality, one fair and four poor. Higher social care expenditure and greater availability of nursing and residential care were associated with fewer hospital readmissions, fewer delayed discharges, reduced length of stay and expenditure on secondary healthcare services. The overall direction of evidence was consistent, but effect sizes could not be confidently quantified. Little evidence examined the influence of home-based social care, and no data was found on primary care use. Conclusions adequate availability of social care has the potential to reduce demand on secondary health services. At a time of financial stringencies, this is an important message for policy-makers.
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Affiliation(s)
- G Spiers
- Institute of Health & Society, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - F E Matthews
- Institute of Health & Society, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - S Moffatt
- Institute for Health & Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Newcastle upon Tyne, UK
| | - R O Barker
- Institute of Health & Society, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - H Jarvis
- Institute of Health & Society, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - D Stow
- Institute of Health & Society, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - A Kingston
- Institute of Health & Society, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - B Hanratty
- Institute of Health & Society, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
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35
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Choi JW, Park EC, Lee SG, Park S, Ryu HG, Kim TH. Does long-term care insurance reduce the burden of medical costs? A retrospective elderly cohort study. Geriatr Gerontol Int 2018; 18:1641-1646. [PMID: 30311345 DOI: 10.1111/ggi.13536] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/08/2018] [Accepted: 08/25/2018] [Indexed: 11/27/2022]
Abstract
AIM To examine whether long-term care insurance (LTCI) reduces medical utilization and the burden of medical costs of beneficiaries. METHODS The elderly cohort database of the National Health Insurance Service during 2005-2013 was used. The participants were 3029 beneficiaries who received consecutive LTCI services. We carried out a 1:3 case-control match on the propensity score to select a comparison group, and the final participants were 12 116 people, including 9087 who formed the control group. The dependent variables were semi-annually measured medical utilizations (inpatient, outpatient and drug prescription) and the burden of medical costs at the individual level. This study applied the method of generalized estimating equations to the data. RESULTS The present study showed that the number of hospitalizations of beneficiaries significantly decreased compared with non-beneficiaries (ratio 0.95, 95% CI 0.95-0.96). Similarly, the length of stay of beneficiaries also showed a significant reduction compared with non-beneficiaries (ratio 0.76, 95% CI 0.73-0.79). The number of outpatient visits and receipt of drug prescriptions of beneficiaries and non-beneficiaries increased marginally. The burden of medical costs of beneficiaries reduced considerably compared with non-beneficiaries (ratio 0.80, 95% CI 0.77-0.83). CONCLUSIONS The study results show that the burden of medical costs for LTCI beneficiaries were significantly reduced compared with non-beneficiaries, despite the rise in medical costs among older adults. The positive effect of LTCI supports continuous implementation and expansion of the LTCI service for non-beneficiaries who require care assistance. Geriatr Gerontol Int 2018; 18: 1641-1646.
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Affiliation(s)
- Jae Woo Choi
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, Korea
| | - Eun-Cheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Gyu Lee
- Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Sohee Park
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Hwang-Gun Ryu
- Department of Health Care Administration, Kosin University, Busan, Korea
| | - Tae Hyun Kim
- Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul, Korea
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Keegan C, Brick A, Walsh B, Bergin A, Eighan J, Wren MA. How many beds? Capacity implications of hospital care demand projections in the Irish hospital system, 2015-2030. Int J Health Plann Manage 2018; 34:e569-e582. [PMID: 30277279 DOI: 10.1002/hpm.2673] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 11/10/2022] Open
Abstract
Existing Irish hospital bed capacity is low by international standards while Ireland also reports the highest inpatient bed occupancy rate across OECD countries. Moreover, strong projected population growth and ageing is expected to increase demand for hospital care substantially by 2030. Reform proposals have suggested that increased investment and access to nonacute care may mitigate some increased demand for hospital care over the next number of years, and it is in this context that the Irish government has committed to increase the supply of public hospital beds by 2600 by 2027. Incorporating assumptions on the rebalancing of care to nonhospital settings, this paper analyses the capacity implications of projected demand for hospital care in Ireland to 2030. This analysis employs the HIPPOCRATES macrosimulation projection model of health care demand and expenditure developed in the ESRI to project public and private hospital bed capacity requirements in Ireland to 2030. We examine 6 alternative projection scenarios that vary assumptions related to population growth and ageing, healthy ageing, unmet demand, hospital occupancy, hospital length of stay, and avoidable hospitalisations. We project an increased need for between 4000 and 6300 beds across public and private hospitals (an increase of between 26.1% and 41.1%), of which 3200 to 5600 will be required in public hospitals. These findings suggest that government plans to increase public hospital capacity over the 10 years to 2027 by 2600 may not be sufficient to meet demand requirements to 2030, even when models of care changes are accounted for.
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Affiliation(s)
- Conor Keegan
- Economic and Social Research Institute, Dublin 2, Ireland
| | - Aoife Brick
- Economic and Social Research Institute, Dublin 2, Ireland
| | - Brendan Walsh
- Economic and Social Research Institute, Dublin 2, Ireland
| | - Adele Bergin
- Economic and Social Research Institute, Dublin 2, Ireland
| | - James Eighan
- Economic and Social Research Institute, Dublin 2, Ireland.,Indecon International Economic Consultancy Group, Dublin 2, Ireland
| | - Maev-Ann Wren
- Economic and Social Research Institute, Dublin 2, Ireland
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Fernandez JL, McGuire A, Raikou M. Hospital coordination and integration with social care in England: The effect on post-operative length of stay. JOURNAL OF HEALTH ECONOMICS 2018; 61:233-243. [PMID: 30077497 PMCID: PMC6158346 DOI: 10.1016/j.jhealeco.2018.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/02/2017] [Accepted: 02/05/2018] [Indexed: 06/01/2023]
Abstract
In spite of significant policy interest in improving the integration of health and social care services, little is known about the economics of coordination across the two sectors. We specify a Markov queuing model and use data collected from administrative records to estimate the link between two proxy indicators of across-sector complexity of discharge arrangements and post-operative length of stay in hospital for older people undergoing hip replacements. The results suggest that the number of local authorities involved in care planning and commissioning of social care services for discharges from a given hospital is significantly positively correlated with longer post-operative lengths of stay. A particularly strong effect is found between variability through time in the number of authorities involved in discharges from a given hospital and lengths of stay. The results suggest that improving information systems and joint assessment processes used during the discharge of patients with social care needs is likely to achieve significant efficiency gains in the health care system as a whole.
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Affiliation(s)
| | | | - Maria Raikou
- LSE Health, LSE, UK; Department of Economics, University of Piraeus, Athens, Greece
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38
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Kim JH, Lee Y. Implementation of long-term care and hospital utilization: Results of segmented regression analysis of interrupted time series study. Arch Gerontol Geriatr 2018; 78:221-226. [PMID: 30015058 DOI: 10.1016/j.archger.2018.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 07/08/2018] [Accepted: 07/08/2018] [Indexed: 11/19/2022]
Abstract
This population-based time series study aimed to examine the effects of the long-term care insurance (LTCI) program on hospital utilization in Korea. Health insurance claim data and LTCI data were combined into a database of 92,596 individuals who were enrolled in Health Insurance at baseline. They were made of people who applied to LTCI program at least once since July 2008, and their hospital utilization records since 2002 were observed. Estimates of length of hospital stay (LOS) after the introduction of LTCI program were calculated using a segmented regression analysis. Although average LOS in hospitals implementation was lower pre-implementation period than post-implementation (16.865 days, SD: 4.864; 26.078 days, SD: 2.215, respectively, p < .0001), a decreasing trend was observed along the post-implementation period. The estimate for baseline trend, which reflect a trend in LOS before LTCI implementation, was 0.219 days (p < .0001). The estimate for Level change after intervention which is only indicated as the change of LOS was 2.821 days at the time of LTCI implementation, and was statistically significant (p < .0001). The estimate for Trend change after intervention, reflecting the trend in LOS after LTCI implementation, was -0.313, indicating a decreasing trend in LOS of -0.094 days (p = 0.0055), compared with the baseline trend. LTCI program was significantly associated with a decreasing trend in LOS. The results suggest that the introduction of LTCI program may have played a role in reducing LOS in older adults.
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Affiliation(s)
- Jae-Hyun Kim
- Department of Health Administration, Dankook University College of Health Science, Cheonan, Republic of Korea; Institute of Health Promotion and Policy, Danook University, Cheonan, Republic of Korea
| | - Yunhwan Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea; Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea.
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Dahlberg L, Agahi N, Schön P, Lennartsson C. Planned and Unplanned Hospital Admissions and Their Relationship with Social Factors: Findings from a National, Prospective Study of People Aged 76 Years or Older. Health Serv Res 2018; 53:4248-4267. [PMID: 29952093 PMCID: PMC6232498 DOI: 10.1111/1475-6773.13001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine the relationship between social factors and planned and unplanned hospital admissions among older people. DATA SOURCES/STUDY SETTING 2011 data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) and data from the Swedish National Patient Register until December 31, 2012. STUDY DESIGN The study had a prospective design. Data were analyzed via Cox proportional hazard regressions with variables entered as blocks (social factors, sociodemographic and ability factors, health factors). DATA COLLECTION Data were collected via interviews with people aged 76+ (n = 931). PRINCIPAL FINDINGS Living in institutions was negatively associated with planned admissions (hazard ratio (HR): 0.29; confidence interval (CI): 0.09-0.88), while being in receipt of home help was positively associated with unplanned admissions (HR: 1.57; CI: 1.15-2.14). Low levels of social contacts and social activity predicted unplanned admissions in bivariate analyses only. Higher ability to deal with public authorities was positively associated with planned admissions (HR: 1.77; CI: 1.13-2.78) and negatively associated with unplanned admissions, although the latter association was only significant in the bivariate analysis. CONCLUSIONS Hospital admissions are not only due to health problems but are also influenced by the social care situation and by the ability to deal with public authorities.
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Affiliation(s)
- Lena Dahlberg
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Neda Agahi
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - Pär Schön
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - Carin Lennartsson
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden
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Gaughan J, Gravelle H, Santos R, Siciliani L. Long-term care provision, hospital bed blocking, and discharge destination for hip fracture and stroke patients. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2017; 17:10.1007/s10754-017-9214-z. [PMID: 28247174 PMCID: PMC5703024 DOI: 10.1007/s10754-017-9214-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 02/13/2017] [Indexed: 05/28/2023]
Abstract
We examine the relationship between long-term care supply (care home beds and prices) and (i) the probability of being discharged to a care home and (ii) length of stay in hospital for patients admitted to hospital for hip fracture or stroke. Using patient level data from all English hospitals and allowing for a rich set of demographic and clinical factors, we find no association between discharge destination and long-term care beds supply or prices. We do, however, find evidence of bed blocking: hospital length of stay for hip fracture patients discharged to a care home is shorter in areas with more long-term care beds and lower prices. Length of stay is over 30% shorter in areas in the highest quintile of care home beds supply compared to those in the lowest quintile.
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Affiliation(s)
- James Gaughan
- Centre for Health Economics, University of York, York, UK.
| | - Hugh Gravelle
- Centre for Health Economics, University of York, York, UK
| | - Rita Santos
- Centre for Health Economics, University of York, York, UK
| | - Luigi Siciliani
- Centre for Health Economics, University of York, York, UK
- Department of Economics and Related Studies, University of York, York, UK
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Yang W, Jingwei He A, Fang L, Mossialos E. Financing institutional long-term care for the elderly in China: a policy evaluation of new models. Health Policy Plan 2016; 31:1391-1401. [PMID: 27375127 DOI: 10.1093/heapol/czw081] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2016] [Indexed: 11/13/2022] Open
Abstract
A rapid ageing population coupled with changes in family structure has brought about profound implications to social policy in China. Although the past decade has seen a steady increase in public funding to long-term care (LTC), the narrow financing base and vast population have created significant unmet demand, calling for reforms in financing. This paper focuses on the financing of institutional LTC care by examining new models that have emerged from local policy experiments against two policy goals: equity and efficiency. Three emerging models are explored: Social Health Insurance (SHI) in Shanghai, LTC Nursing Insurance (LTCNI) in Qingdao and a means-tested model in Nanjing. A focused systematic narrative review of academic and grey literature is conducted to identify and assess these models, supplemented with qualitative interviews with government officials from relevant departments, care home staff and service users. This paper argues that, although SHI appears to be a convenient solution to fund LTC, this model has led to systematic bias in affordable access among participants of different insurance schemes, and has created a powerful incentive for the over-provision of unnecessary services. The means-tested method has been remarkably constrained by narrow eligibility and insufficiency of funding resources. The LTCNI model is by far the most desirable policy option among the three studied here, but the narrow definition of eligibility has substantively excluded a large proportion of elders in need from access to care, which needs to be addressed in future reforms. This paper proposes three lines of LTC financing reforms for policy-makers: (1) the establishment of a prepaid financing mechanism pooled specifically for LTC costs; (2) the incorporation of more stringent eligibility rules and needs assessment; and (3) reforming the dominant fee-for-service methods in paying LTC service providers.
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Affiliation(s)
- Wei Yang
- Centre for Health Services Research Personal Social Services Research Unit, University of Kent, UK .,Department of Social Science, Health and Medicine, King's College London
| | - Alex Jingwei He
- Department of Asian and Policy Studies, the Education University of Hong Kong
| | - Lijie Fang
- Department of Social Policy, The Chinese Academy of Social Science, Beijing, China
| | - Elias Mossialos
- Department of Social Policy, The London School of Economics and Political Science, London, UK
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Sirven N, Rapp T. The Dynamics of Hospital Use among Older People Evidence for Europe Using SHARE Data. Health Serv Res 2016; 52:1168-1184. [PMID: 27319798 DOI: 10.1111/1475-6773.12518] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Hospital services use, which is a major driver of total health expenditures, is expected to rise over the next decades in Europe, especially because of population aging. The purpose of this article is to better understand the dynamics of older people's demand for hospital care over time in a cross-country setting. DATA SOURCE We used data from the Survey on Health, Ageing, and Retirement in Europe (SHARE), in 10 countries between 2004 and 2011. STUDY DESIGN We estimated a dynamic panel model of hospital admission for respondents aged 50 years or more. PRINCIPAL FINDINGS Following prior research, we found evidence of state dependence in hospital use over time. We also found that rise in frailty-among other health covariates-is a strong predictor of increased hospital use. Progression by one point on the frailty scale [0;5] is associated with an additional risk of about 2.1 percent on average. CONCLUSIONS Our results support promotion of early detection of frailty in primary care, and improvement of coordination between actors within the health system, as potential strategies to reduce avoidable or unnecessary hospital use among frail elderly.
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Affiliation(s)
- Nicolas Sirven
- LIRAES (EA4470) & Chaire AGEINOMIX, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Thomas Rapp
- Harvard T.H. Chan School of Public Health, Department of Health Policy and Management, Kresge 431-677 Huntington Avenue, Boston, MA, 02115.,LIRAES (EA4470) & Chaire AGEINOMIX, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
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Raine R, Fitzpatrick R, Barratt H, Bevan G, Black N, Boaden R, Bower P, Campbell M, Denis JL, Devers K, Dixon-Woods M, Fallowfield L, Forder J, Foy R, Freemantle N, Fulop NJ, Gibbons E, Gillies C, Goulding L, Grieve R, Grimshaw J, Howarth E, Lilford RJ, McDonald R, Moore G, Moore L, Newhouse R, O’Cathain A, Or Z, Papoutsi C, Prady S, Rycroft-Malone J, Sekhon J, Turner S, Watson SI, Zwarenstein M. Challenges, solutions and future directions in the evaluation of service innovations in health care and public health. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04160] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
HeadlineEvaluating service innovations in health care and public health requires flexibility, collaboration and pragmatism; this collection identifies robust, innovative and mixed methods to inform such evaluations.
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Affiliation(s)
- Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Ray Fitzpatrick
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Helen Barratt
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames, Department of Applied Health Research, University College London, London, UK
| | - Gywn Bevan
- Department of Management, London School of Economics and Political Science, London, UK
| | - Nick Black
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ruth Boaden
- Alliance Manchester Business School, University of Manchester, Manchester, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, Manchester, UK
| | - Peter Bower
- National Institute for Health Research (NIHR) School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jean-Louis Denis
- Canada Research Chair in Governance and Transformation of Health Organizations and Systems, École Nationale d’Administration Publique, Ville de Québec, QC, Canada
| | - Kelly Devers
- Health Policy Centre, Urban Institute, Washington, DC, USA
| | - Mary Dixon-Woods
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), University of Sussex, Brighton, UK
| | - Julien Forder
- School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK
| | - Robbie Foy
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Nick Freemantle
- Department of Primary Care and Population Health, University College London, London, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, London, UK
| | - Elizabeth Gibbons
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Clare Gillies
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands and NIHR Research Design Service East Midlands, University of Leicester, Leicester, UK
| | - Lucy Goulding
- King’s Improvement Science, Centre for Implementation Science, King’s College London, London, UK
| | - Richard Grieve
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jeremy Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Emma Howarth
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, University of Cambridge, Cambridge, UK
| | | | - Ruth McDonald
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Graham Moore
- School of Social Sciences, Cardiff University, Cardiff, UK
| | - Laurence Moore
- Medical Research Council (MRC)/Chief Scientist Office (CSO) Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Robin Newhouse
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Alicia O’Cathain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Zeynep Or
- Institut de Recherche et Documentation en Économie de la Santé, Paris, France
| | - Chrysanthi Papoutsi
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, Imperial College London, London, UK
| | | | | | - Jasjeet Sekhon
- Department of Political Science and Statistics, University of California Berkeley, Berkeley, CA, USA
| | - Simon Turner
- Department of Applied Health Research, University College London, London, UK
| | | | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Department of Family Medicine, Western University, London, ON, Canada
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Rapp T, Chauvin P, Sirven N. Are public subsidies effective to reduce emergency care? Evidence from the PLASA study. Soc Sci Med 2015; 138:31-7. [PMID: 26043434 DOI: 10.1016/j.socscimed.2015.05.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Elderly people facing dependence are exposed to the financial risk of long lasting care expenditures. This risk is high for people facing cognitive, functional and behavioral problems. In the short-term, dependent elderly people face increased non-medical care expenditures. In the long-term, they face increased medical care expenditures, which are driven by emergency care events such as: emergency hospitalization, emergency medical visits, and emergency institutionalizations. In France, providing public financial assistance has been shown to improve dependent people's access to non-medical care services. However, the impact of public financial assistance on emergency care use has not been explored yet. Our study aims at determining whether financial assistance on non-medical care provision decreases the probability of emergency care rates using data of 1131 French patients diagnosed with Alzheimer's disease, collected between 2003 and 2007. Using instrumental variables to deal with the presence of a potential endogeneity bias, we find that beneficiaries of long-term care subsidies have a significantly lower rate of emergency care than non-beneficiaries. Failing to control for endogeneity problems would lead to misestimate the impact of long-term care subsidies on emergency care rates. Finding that home care subsidies has a protective effect for emergency care confirmed the efficacy of this public policy tool.
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Affiliation(s)
- Thomas Rapp
- LIRAES (EA 4470) & Chaire AGEINOMIX, Université Paris Descartes, Sorbonne Paris Cité, France.
| | - Pauline Chauvin
- LIRAES (EA 4470) & Chaire AGEINOMIX, Université Paris Descartes, Sorbonne Paris Cité, France
| | - Nicolas Sirven
- LIRAES (EA 4470) & Chaire AGEINOMIX, Université Paris Descartes, Sorbonne Paris Cité, France
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Kasteridis P, Mason AR, Goddard MK, Jacobs R, Santos R, McGonigal G. The influence of primary care quality on hospital admissions for people with dementia in England: a regression analysis. PLoS One 2015; 10:e0121506. [PMID: 25816231 PMCID: PMC4376688 DOI: 10.1371/journal.pone.0121506] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 02/01/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To test the impact of a UK pay-for-performance indicator, the Quality and Outcomes Framework (QOF) dementia review, on three types of hospital admission for people with dementia: emergency admissions where dementia was the primary diagnosis; emergency admissions for ambulatory care sensitive conditions (ACSCs); and elective admissions for cataract, hip replacement, hernia, prostate disease, or hearing loss. METHODS Count data regression analyses of hospital admissions from 8,304 English general practices from 2006/7 to 2010/11. We identified relevant admissions from national Hospital Episode Statistics and aggregated them to practice level. We merged these with practice-level data on the QOF dementia review. In the base case, the exposure measure was the reported QOF register. As dementia is commonly under-diagnosed, we tested a predicted practice register based on consensus estimates. We adjusted for practice characteristics including measures of deprivation and uptake of a social benefit to purchase care services (Attendance Allowance). RESULTS In the base case analysis, higher QOF achievement had no significant effect on any type of hospital admission. However, when the predicted register was used to account for under-diagnosis, a one-percentage point improvement in QOF achievement was associated with a small reduction in emergency admissions for both dementia (-0.1%; P=0.011) and ACSCs (-0.1%; P=0.001). In areas of greater deprivation, uptake of Attendance Allowance was consistently associated with significantly lower emergency admissions. In all analyses, practices with a higher proportion of nursing home patients had significantly lower admission rates for elective and emergency care. CONCLUSION In one of three analyses at practice level, the QOF review for dementia was associated with a small but significant reduction in unplanned hospital admissions. Given the rising prevalence of dementia, increasing pressures on acute hospital beds and poor outcomes associated with hospital stays for this patient group, this small change may be clinically and economically relevant.
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Affiliation(s)
| | - Anne R Mason
- Centre for Health Economics, University of York, York, United Kingdom
| | - Maria K Goddard
- Centre for Health Economics, University of York, York, United Kingdom
| | - Rowena Jacobs
- Centre for Health Economics, University of York, York, United Kingdom
| | - Rita Santos
- Centre for Health Economics, University of York, York, United Kingdom
| | - Gerard McGonigal
- Department of Medicine for the Elderly, York Teaching Hospital NHS Foundation Trust, York, United Kingdom
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Gaughan J, Gravelle H, Siciliani L. Testing the bed-blocking hypothesis: does nursing and care home supply reduce delayed hospital discharges? HEALTH ECONOMICS 2015; 24 Suppl 1:32-44. [PMID: 25760581 PMCID: PMC4406135 DOI: 10.1002/hec.3150] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 11/13/2014] [Accepted: 11/20/2014] [Indexed: 05/28/2023]
Abstract
Hospital bed-blocking occurs when hospital patients are ready to be discharged to a nursing home, but no place is available, so that hospital care acts as a more costly substitute for long-term care. We investigate the extent to which greater supply of nursing home beds or lower prices can reduce hospital bed-blocking using a new Local Authority (LA) level administrative data from England on hospital delayed discharges in 2009-2013. The results suggest that delayed discharges respond to the availability of care home beds, but the effect is modest: an increase in care home beds by 10% (250 additional beds per LA) would reduce social care delayed discharges by about 6-9%. We also find strong evidence of spillover effects across LAs: more care home beds or fewer patients aged over 65 years in nearby LAs are associated with fewer delayed discharges.
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Affiliation(s)
- James Gaughan
- Centre for Health Economics, University of YorkYork, UK
| | - Hugh Gravelle
- Centre for Health Economics, University of YorkYork, UK
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Mason A, Goddard M, Weatherly H, Chalkley M. Integrating funds for health and social care: an evidence review. J Health Serv Res Policy 2015; 20:177-88. [PMID: 25595287 PMCID: PMC4469543 DOI: 10.1177/1355819614566832] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Integrated funds for health and social care are one possible way of improving care for people with complex care requirements. If integrated funds facilitate coordinated care, this could support improvements in patient experience, and health and social care outcomes, reduce avoidable hospital admissions and delayed discharges, and so reduce costs. In this article, we examine whether this potential has been realized in practice. METHODS We propose a framework based on agency theory for understanding the role that integrated funding can play in promoting coordinated care, and review the evidence to see whether the expected effects are realized in practice. We searched eight electronic databases and relevant websites, and checked reference lists of reviews and empirical studies. We extracted data on the types of funding integration used by schemes, their benefits and costs (including unintended effects), and the barriers to implementation. We interpreted our findings with reference to our framework. RESULTS The review included 38 schemes from eight countries. Most of the randomized evidence came from Australia, with nonrandomized comparative evidence available from Australia, Canada, England, Sweden and the US. None of the comparative evidence isolated the effect of integrated funding; instead, studies assessed the effects of 'integrated financing plus integrated care' (i.e. 'integration') relative to usual care. Most schemes (24/38) assessed health outcomes, of which over half found no significant impact on health. The impact of integration on secondary care costs or use was assessed in 34 schemes. In 11 schemes, integration had no significant effect on secondary care costs or utilisation. Only three schemes reported significantly lower secondary care use compared with usual care. In the remaining 19 schemes, the evidence was mixed or unclear. Some schemes achieved short-term reductions in delayed discharges, but there was anecdotal evidence of unintended consequences such as premature hospital discharge and heightened risk of readmission. No scheme achieved a sustained reduction in hospital use. The primary barrier was the difficulty of implementing financial integration, despite the existence of statutory and regulatory support. Even where funds were successfully pooled, budget holders' control over access to services remained limited. Barriers in the form of differences in performance frameworks, priorities and governance were prominent amongst the UK schemes, whereas difficulties in linking different information systems were more widespread. Despite these barriers, many schemes - including those that failed to improve health or reduce costs - reported that access to care had improved. Some of these schemes revealed substantial levels of unmet need and so total costs increased. CONCLUSIONS It is often assumed in policy that integrating funding will promote integrated care, and lead to better health outcomes and lower costs. Both our agency theory-based framework and the evidence indicate that the link is likely to be weak. Integrated care may uncover unmet need. Resolving this can benefit both individuals and society, but total care costs are likely to rise. Provided that integration delivers improvements in quality of life, even with additional costs, it may, nonetheless, offer value for money.
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Affiliation(s)
- Anne Mason
- Senior Research Fellow, Centre for Health Economics (CHE), University of York, UK
| | - Maria Goddard
- Professor and Director of CHE, Centre for Health Economics (CHE), University of York, UK
| | - Helen Weatherly
- Senior Research Fellow, Centre for Health Economics (CHE), University of York, UK
| | - Martin Chalkley
- Professor, Centre for Health Economics (CHE), University of York, UK
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“Ageing in Place” Policy in Japan: Association Between the Development of an Integrated Community Care System and the Number of Nursing Home Placements Under the Public Long-Term Care Insurance Program Among Municipal Governments. AGEING INTERNATIONAL 2015. [DOI: 10.1007/s12126-014-9215-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hyun KR, Kang S, Lee S. Does long-term care insurance affect the length of stay in hospitals for the elderly in Korea?: a difference-in-difference method. BMC Health Serv Res 2014; 14:630. [PMID: 25528468 PMCID: PMC4297445 DOI: 10.1186/s12913-014-0630-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 12/02/2014] [Indexed: 11/10/2022] Open
Abstract
Background This study examines the effects of long-term care insurance (LTCI) on the length of stay (LoS) of senior citizens under the national health insurance of Korea. Methods The subjects include 3,903,448 people aged 65 and over as of July 1, 2008 when the LTCI was introduced in Korea. This study uses their panel data which traced the records of medical services and LTCI services for the same people from 2007 to 2010, and applies a difference-in-difference approach on LTCI users from levels 1, 2, and 3 who are the treatment group and non-LTCI users who are the control group. Results We found that the LoS of LTCI users is 1.27 days greater than that of non-LTCI users, but the LoS of level 1 and level 2 beneficiaries decreases by 8.35 and 2.84 days, respectively, whereas the LTCI does not reduce the LoS of level 3 beneficiaries. Conclusions The reason why there is an effect on the LoS of level 1 and 2 beneficiaries is that these groups could choose to utilize institutional care services provided by the LTCI, and out-of-pocket costs of institutions are lower than that of hospitals. However, the reason why there is no effect on the LoS of level 3 beneficiaries is that they are not permitted to use the institutional care services in the Korean LTCI policy. Therefore, we recommend a modification in the LTCI system that facilitates the use of long-term care institutional services by level 3 beneficiaries without conflicting Korea’s LTCI principle to promote home-based care services instead of the institutional care services.
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Affiliation(s)
- Kyung-Rae Hyun
- Health Insurance Policy Research Institute, National Health Insurance Service, Mapo-gu, Seoul, South Korea.
| | - Sungwook Kang
- School of Public Health, Daegu Haany University, Gyeongsan-si, Gyeongsangbuk-Do, South Korea.
| | - Sunmi Lee
- Health Insurance Policy Research Institute, National Health Insurance Service, Mapo-gu, Seoul, South Korea.
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Abstract
Abstract
Long-term care expenditure is expected to rise, driven by an ageing population. Given that public long-term care expenditure is high in many OECD countries, governments are increasingly concerned about its future growth. This study focuses on three relevant issues. First, we discuss factors that affect the growth of long-term expenditure and its projections. These include demographics, the balance in provision between informal and formal care, whether higher life expectancy translates into higher disability, the interrelation between health and long-term care, and whether long-term care suffers from Baumol’s disease. Second, given that a significant proportion of long-term care expenditure is nursing- and care-home expenditure, we discuss the role of government regulation aimed at ensuring that individuals receive appropriate quality of care in such institutions. We focus in particular on price regulation, competition, and the non-profit sector; these have been the subject of considerable empirical work (mainly in the United States). Third, we discuss the relative merits of public and private insurance. Countries differ greatly in their approach. Some countries have nearly exclusively public insurance but in others this is small. We consider the conditions under which public insurance can overcome the limitations of a private insurance market.
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