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Almuhaisen A, Amuedo-Dorantes C, Furtado D. Immigration enforcement and the institutionalization of elderly Americans. JOURNAL OF HEALTH ECONOMICS 2024; 94:102859. [PMID: 38280239 DOI: 10.1016/j.jhealeco.2024.102859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/29/2024]
Abstract
This paper examines the relationship between immigration enforcement and institutionalization rates of the elderly. Exploiting the staggered implementation of the Secure Communities (SC) immigration enforcement program across U.S. counties from 2008 through 2014, we show that SC led to a 0.26 percentage points (6.8 percent) increase in the likelihood that Americans aged 65 and above live in an institution. Supportive of supply shocks in the household services market as a central mechanism, we find that the elderly who are most likely to purchase domestic worker services are also the most likely to move into nursing homes following the implementation of SC. Additionally, we find suggestive evidence of significant reductions in the work hours of housekeepers, personal care aides, and home health workers hinting at the critical role of negative supply shocks in occupations that facilitate aging in community.
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Affiliation(s)
| | - Catalina Amuedo-Dorantes
- Economics and Business Management Department, University of California Merced, 5200 North Lake Rd., Merced, CA 95343, United States.
| | - Delia Furtado
- Department of Economics, University of Connecticut, Storrs, CT, United States
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Bergeot J, Tenand M. Does informal care delay nursing home entry? Evidence from Dutch linked survey and administrative data. JOURNAL OF HEALTH ECONOMICS 2023; 92:102831. [PMID: 37913647 DOI: 10.1016/j.jhealeco.2023.102831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 05/31/2023] [Accepted: 10/14/2023] [Indexed: 11/03/2023]
Abstract
We assess whether informal care receipt affects the probability of transitioning to a nursing home. Available evidence derives from the US, where nursing home stays are often temporary. Exploiting linked survey and administrative data from the Netherlands, we use the gender mix of children to retrieve exogenous variation in informal care receipt. We find that informal care increases the chance of an admission within a three-year period for individuals with severe functional limitations, and increases the costs incurred on formal home care. For individuals with mild limitations, informal care substantially decreases total care costs, whereas its effect on nursing home admission is unclear. Further, informal care results in lower post-acute care use and hospital care costs, and does not increase mortality. Promoting informal care cannot be expected to systematically result in lower institutionalization rate and care costs, but it may nonetheless induce health benefits for its recipients.
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Affiliation(s)
- Julien Bergeot
- Department of Economics, Ca'Foscari University of Venice, Italy.
| | - Marianne Tenand
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Erasmus Center for Health Economics Rotterdam (EsCHER), The Netherlands; CPB Netherlands Bureau for Economic Policy Analysis, The Netherlands
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3
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Alpert E, Barrow JR, Simon LE. Association of residential care admission with the oral health status of older adults. J Am Geriatr Soc 2023; 71:3635-3637. [PMID: 37294097 DOI: 10.1111/jgs.18455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/07/2023] [Accepted: 05/12/2023] [Indexed: 06/10/2023]
Affiliation(s)
- Elizabeth Alpert
- Harvard School of Dental Medicine, Boston, Massachusetts, USA
- MCPHS University, Forsyth School of Dental Hygiene, Boston, Massachusetts, USA
| | - Jane R Barrow
- Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Lisa E Simon
- Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Brigham and Women's Hospital, Boston, Massachusetts, USA
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Mitchell L, Poss J, MacDonald M, Burke R, Keefe JM. Inter-provincial variation in older home care clients and their pathways: a population-based retrospective cohort study in Canada. BMC Geriatr 2023; 23:389. [PMID: 37365495 DOI: 10.1186/s12877-023-04097-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND In Canada, publicly-funded home care programs enable older adults to remain and be cared for in their home for as long as possible but they often differ in types of services offered, and the way services are delivered. This paper examines whether these differing approaches to care shape the pathway that home care clients will take. Older adult client pathways refer to trajectories within, and out of, the home care system (e.g., improvement, long term care (LTC) placement, death). METHODS A retrospective analysis of home care assessment data (RAI-HC was linked with health administrative data, long-term care admissions and vital statistics in Nova Scotia Health (NSH) and Winnipeg Regional Health Authority (WRHA). The study cohort consists of clients age 60 + years, admitted to home care between January 1, 2011 to December 31, 2013 and up to four years from baseline. Differences in home care service use, client characteristics and their pathways were tested across the two jurisdictions overall, and among the four discharge streams within jurisdictions using t-tests and chi-square tests of significance. RESULTS NS and WHRA clients were similar in age, sex, and marital status. NS clients had higher levels of need (ADL, cognitive impairment, CHESS) at base line and were more likely discharged to LTC (43% compared to 38% in WRHA). Caregiver distress was a factor correlated with being discharged to LTC. While a third remained as home care clients after 4 years; more than half were no longer in the community - either discharged to LTC placement or death. Such discharges occurred on average at around two years, a relatively short time period. CONCLUSIONS By following older clients over 4 years, we provide enhanced evidence of client pathways, the characteristics that influence these paths, as well as the length of time to the outcomes. This evidence is central to identification of clients at risk in the community and aids in planning for future home care servicing needs that will allow more older adults to remain living in the community.
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Affiliation(s)
| | - Jeffrey Poss
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | | | - Rosanne Burke
- Nova Scotia Centre On Aging, Mount Saint Vincent University, Halifax, NS, Canada
| | - Janice M Keefe
- Department of Family Studies and Gerontology and Director, Nova Scotia Centre On Aging, Mount Saint Vincent University, Halifax, NS, Canada
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Wammes JD, Bakx P, Wouterse B, Buurman BM, Murphy TE, MacNeil Vroomen JL. Acute hospital use in older adults following the 2015 Dutch reform of long-term care: an interrupted time series analysis. THE LANCET. HEALTHY LONGEVITY 2023; 4:e257-e264. [PMID: 37269863 DOI: 10.1016/s2666-7568(23)00064-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND In 2015, the Dutch government implemented a long-term care (LTC) reform primarily designed to promote older adults to age-in-place. Increased proportions of older adults living in the community might have resulted in more and longer acute hospitalisations. The aims of this study were to evaluate whether the Dutch 2015 LTC reform was associated with immediate and longitudinal increases in the monthly rate of acute clinical hospitalisation and monthly average hospital length of stay (LOS) in adults aged 65 years or older. METHODS In this interrupted time series analysis of national hospital data (2009-18), we evaluated the association of the Dutch 2015 LTC reform with the monthly rate of acute clinical hospitalisation and monthly average LOS for older adults (aged ≥65 years). Patient-level episodic hospital data were provided by Dutch Hospital Data. Records were included that were defined as an acute clinical hospital admission for which a medical specialist decided treatment was necessary within 24 h. The analysis controlled for population growth (Dutch population data was provided by Statistics Netherlands) and seasonality, and calculated adjusted incident rate ratios (IRR). FINDINGS Before the 2015 LTC reform, the rate of acute monthly hospitalisation was increasing (IRR 1·002 [95% CI 1·001-1·002]). A positive average reform effect was observed (1·116 [1·070-1·165]), accompanied by a negative change in trend (0·997 [0·996-0·998]) that resulted in a decreasing trend over the post-reform period (0·998 [0·998-0·999]). The pre-reform trend of LOS was decreasing (0·998 [0·997-0·998]), and the 2015 reform exhibited a positive change in trend (1·002 [1·002-1·003]) that resulted in a stabilisation of LOS in the post-reform period (0·999 [0·999-1·000]). INTERPRETATION Our findings suggest that the increase in the rate of acute hospitalisation after the reform implementation was temporary, whereas the increase in LOS post-reform appeared to last longer than expected. These results have the potential to inform policy makers about effects of ageing-in-place LTC strategies on health and curative care. FUNDING The Netherlands Organization for Health Research and Development, the Yale Claude Pepper Center, and the National Center for Advancing Translational Sciences, National Institutes of Health. TRANSLATION For the Dutch translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Joost D Wammes
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.
| | - Pieter Bakx
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Bram Wouterse
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Terrence E Murphy
- Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA, USA
| | - Janet L MacNeil Vroomen
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Landon BE, Hatfield LA, Bakx P, Banerjee A, Chen YC, Fu C, Gordon M, Heine R, Huang N, Ko DT, Lix LM, Novack V, Pasea L, Qiu F, Stukel TA, Uyl-de Groot C, Yan L, Weinreb G, Cram P. Differences in Treatment Patterns and Outcomes of Acute Myocardial Infarction for Low- and High-Income Patients in 6 Countries. JAMA 2023; 329:1088-1097. [PMID: 37014339 PMCID: PMC10074220 DOI: 10.1001/jama.2023.1699] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/01/2023] [Indexed: 04/05/2023]
Abstract
Importance Differences in the organization and financing of health systems may produce more or less equitable outcomes for advantaged vs disadvantaged populations. We compared treatments and outcomes of older high- and low-income patients across 6 countries. Objective To determine whether treatment patterns and outcomes for patients presenting with acute myocardial infarction differ for low- vs high-income individuals across 6 countries. Design, Setting, and Participants Serial cross-sectional cohort study of all adults aged 66 years or older hospitalized with acute myocardial infarction from 2013 through 2018 in the US, Canada, England, the Netherlands, Taiwan, and Israel using population-representative administrative data. Exposures Being in the top and bottom quintile of income within and across countries. Main Outcomes and Measures Thirty-day and 1-year mortality; secondary outcomes included rates of cardiac catheterization and revascularization, length of stay, and readmission rates. Results We studied 289 376 patients hospitalized with ST-segment elevation myocardial infarction (STEMI) and 843 046 hospitalized with non-STEMI (NSTEMI). Adjusted 30-day mortality generally was 1 to 3 percentage points lower for high-income patients. For instance, 30-day mortality among patients admitted with STEMI in the Netherlands was 10.2% for those with high income vs 13.1% for those with low income (difference, -2.8 percentage points [95% CI, -4.1 to -1.5]). One-year mortality differences for STEMI were even larger than 30-day mortality, with the highest difference in Israel (16.2% vs 25.3%; difference, -9.1 percentage points [95% CI, -16.7 to -1.6]). In all countries, rates of cardiac catheterization and percutaneous coronary intervention were higher among high- vs low-income populations, with absolute differences ranging from 1 to 6 percentage points (eg, 73.6% vs 67.4%; difference, 6.1 percentage points [95% CI, 1.2 to 11.0] for percutaneous intervention in England for STEMI). Rates of coronary artery bypass graft surgery for patients with STEMI in low- vs high-income strata were similar but for NSTEMI were generally 1 to 2 percentage points higher among high-income patients (eg, 12.5% vs 11.0% in the US; difference, 1.5 percentage points [95% CI, 1.3 to 1.8 ]). Thirty-day readmission rates generally also were 1 to 3 percentage points lower and hospital length of stay generally was 0.2 to 0.5 days shorter for high-income patients. Conclusions and Relevance High-income individuals had substantially better survival and were more likely to receive lifesaving revascularization and had shorter hospital lengths of stay and fewer readmissions across almost all countries. Our results suggest that income-based disparities were present even in countries with universal health insurance and robust social safety net systems.
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Affiliation(s)
- Bruce E. Landon
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Laura A. Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Pieter Bakx
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, England
- Department of Cardiology, University College London Hospitals, London, England
| | - Yu-Chin Chen
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Christina Fu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Michal Gordon
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
| | - Renaud Heine
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Dennis T. Ko
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lisa M. Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Victor Novack
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Laura Pasea
- Institute of Health Informatics, University College London, London, England
| | - Feng Qiu
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Therese A. Stukel
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Carin Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands
| | - Lin Yan
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Gabe Weinreb
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Peter Cram
- ICES, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Texas Medical Branch, Galveston
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Herberg S, Teuteberg F, Zerth J. Case Management für Personen mit Pflegebedarf und
gebrechliche ältere Personen. GESUNDHEITSÖKONOMIE & QUALITÄTSMANAGEMENT 2023. [DOI: 10.1055/a-1989-6370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
ZusammenfassungEine wachsende Fallschwere, höheres Lebensalter und teilweise nicht
vorhandene familiäre Betreuungsnetze führen dazu, dass die
Koordination von medizinisch-pflegerischen Leistungen und sozialen
Unterstützungsleistungen nicht in jedem Fall zu einer adäquaten
Versorgungssituation beitragen. Um Menschen soweit als möglich im
eigenen Lebens- und Betreuungsumfeld zu halten, ist ein adjustierter Care-Mix
zwischen Familienpflege und professioneller Pflege notwendig.Die Betreuung eines vulnerablen Personenkreises durch professionelle wie
informelle Akteure bedarf allerdings einer professionellen Koordination. Das
Prinzip des Case Managements kann in fast idealtypischer Weise eingesetzt
werden, um professionelle und informelle Akteure in einen Care-Prozess zu
integrieren und sowohl medizinische Leistungen als auch Pflege- und
Betreuungsleistungen im dazu nötigen Setting auszubalancieren.Eine stärke Koordination von Pflegeleistungen ist als Notwendigkeit
weithin anerkannt. In verschiedenen Projektansätzen werden
Ansätze wie Case Management, Pflegelosten, professionelle
Krankenhausnachbetreuung und Gemeindeschwesteransätze erprobt und
gelebt.Die Auswertung internationaler Studien im Bereich des Case Managements zeigen
grundsätzlich eine proaktivere Herangehensweise an, mit der Empfehlung,
eine für ein zielführendes Case Management frühzeitigere
und spezifischere Fallauswahl vorzunehmen. Die klare Definition der
Einschlusskriterien, die Konzentration auf Patient*innen mit einer hohen
Wiederaufnahmewahrscheinlichkeit und ein intensives Case Management
können so zu effektiveren Versorgungsergebnissen und reduzierten
Inanspruchnahmen von Leistungen führen.In diesem Beitrag soll die Frage diskutiert werden, ob die bestehenden Beratungs-
und Lotsenangebote gebündelt, fusioniert und zu einer Case
Management-Organisation weiterentwickelt werden können. Insbesondere,
falls sich die bestehenden Angebote überschneiden und vorhandene
Ressourcen nicht ausreichend koordiniert werden.Es sollen insbesondere Organisationsstrukturen aufgezeigt werden, in denen Case
Management langfristig verortet werden könnte. Hier gilt es die
Bedeutung der eigenständigen pflegeinfrastrukturellen Rolle eines
erweiterten Case Managements zu verdeutlichen.
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Flawinne X, Lefebvre M, Perelman S, Pestieau P, Schoenmaeckers J. Nursing homes and mortality in Europe: Uncertain causality. HEALTH ECONOMICS 2023; 32:134-154. [PMID: 36206187 DOI: 10.1002/hec.4613] [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: 02/09/2022] [Revised: 08/09/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
The current health crisis has particularly affected the elderly population. Nursing homes have unfortunately experienced a relatively large number of deaths. On the basis of this observation and working with European data (from SHARE), we want to check whether nursing homes were lending themselves to excess mortality even before the pandemic. Controlling for a number of important characteristics of the elderly population in and outside nursing homes, we conjecture that the difference in mortality between those two samples is to be attributed to the way nursing homes are designed and organized. Using matching methods, we observe excess mortality in Sweden, Belgium, Germany, Switzerland, Czech Republic and Estonia but not in the Netherlands, Denmark, Austria, France, Luxembourg, Italy and Spain. This raises the question of the organization and management of these nursing homes, but also of their design and financing.
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Affiliation(s)
| | | | | | - Pierre Pestieau
- University of Liege, Liege, Belgium
- CORE, University of Louvain, Louvain-la-Neuve, Belgium
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de Graaf L, Roelofs T, Janssen M, Luijkx K. Live and let live: Residents' perspectives on alcohol and tobacco (mis)use in residential care facilities. Int J Older People Nurs 2023; 18:e12508. [PMID: 36229901 PMCID: PMC10078196 DOI: 10.1111/opn.12508] [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: 03/02/2022] [Revised: 06/10/2022] [Accepted: 09/13/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Alcohol and tobacco use could cause health problems in older adults. Older adults who become in need of 24/7 care due to physical and/or neurological disabilities may need to move to a Residential Care Facility (RCF). RCFs aim to provide person-centred care (PCC) to enhance quality of life (QoL) of residents. OBJECTIVES This study aims to explore perspectives of residents on alcohol and tobacco use, which is essential to provide PCC. METHODS A qualitative research design was chosen, and semi-structured interviews were conducted. Residents who use alcohol and/or tobacco and those who do not use these substances were purposively selected in two organisations on two types of units: psychogeriatric units and units providing care for residents with mainly physical disabilities. The results were analysed using thematic analysis. RESULTS Thematic analysis resulted in five themes: Current use and self-reflection, knowledge and attitudes, addiction or habit, policies and availability, dependency versus autonomy. CONCLUSION Residents in this study value their autonomy regarding alcohol and tobacco use. They experience dependency on their (in)formal caregivers to use these substances and acknowledge that their use could cause a nuisance to others, challenging the ability of caregivers to implement PCC. Future research could assess how to integrate providing PCC to residents by offering choices and autonomy, while considering the addictive component of these substances, health and safety risks for all. IMPLICATIONS FOR PRACTICE This study could help care professionals to become aware of the habits and wishes of residents regarding alcohol and tobacco use and to discuss the possibilities and limitations within RCFs.
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Affiliation(s)
- Lisette de Graaf
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.,Mijzo, Waalwijk, The Netherlands
| | - Tineke Roelofs
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.,Mijzo, Waalwijk, The Netherlands
| | - Meriam Janssen
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Katrien Luijkx
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Bonekamp J, Wouterse B. Do different shocks in health matter for wealth? JOURNAL OF HEALTH ECONOMICS 2023; 87:102719. [PMID: 36587495 DOI: 10.1016/j.jhealeco.2022.102719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/03/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
We study the effect of hospital admissions for specific conditions on wealth for the Dutch population aged 70-79. We consider 14 disease groups that affect mortality and disability to different extents. We apply a "difference-in-timing" design comparing individuals admitted in one year to similar individuals admitted later. Because the protection against income risks and medical spending is high, we can identify changes in saving behaviors driven by preferences for consumption, saving, and bequests, rather than by changes in budget constraints. Although the health shocks differ in mortality and disability, we find hardly any impact on wealth across conditions.
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Affiliation(s)
- Johan Bonekamp
- Tilburg University, The Netherlands; Network for Studies on Pensions, Ageing and Retirement, Tilburg, The Netherlands
| | - Bram Wouterse
- Network for Studies on Pensions, Ageing and Retirement, Tilburg, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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11
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Bom J, Bakx P, Rellstab S. Well-being right before and after a permanent nursing home admission. HEALTH ECONOMICS 2022; 31:2558-2574. [PMID: 36057846 PMCID: PMC9826495 DOI: 10.1002/hec.4595] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 05/28/2023]
Abstract
Permanent nursing home (NH) admissions are a frequent and major life event aimed at maintaining quality of life in old age. Yet, insights into the impact of a NH admission on well-being are scarce and inconclusive. We evaluate the effect of a NH admission on domains of well-being among those who are admitted using event study methodology for cross-sections combined with inverse probability weighting. We apply this doubly robust approach to Dutch survey data on well-being linked to extensive administrative data on NH admissions, health, and socio-economic status. We find that a NH admission leads to a temporary increase in loneliness, the risk of anxiety and depression, and a loss of control over one's life. However, these scores revert to pre-admission levels after 6 months. These findings may contribute to better-informed individual-level and policy decisions about potential NH entry and aging in place policies.
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Affiliation(s)
- Judith Bom
- Erasmus School of Health Policy & ManagementErasmus University RotterdamRotterdamthe Netherlands
| | - Pieter Bakx
- Erasmus School of Health Policy & ManagementErasmus University RotterdamRotterdamthe Netherlands
| | - Sara Rellstab
- Department of EconomicsUniversità della Svizzera ItalianaLuganoSwitzerland
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Lopes FV, Bakx P, Harper S, Ravesteijn B, Van Ourti T. The effects of supported housing for individuals with mental disorders. HEALTH ECONOMICS 2022; 31 Suppl 2:115-133. [PMID: 35983703 PMCID: PMC9805038 DOI: 10.1002/hec.4579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 06/21/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
Societies face the challenge of providing appropriate arrangements for individuals who need living support due to their mental disorders. We estimate the effects of eligibility to the Dutch supported housing program (Beschermd Wonen), which offers a structured living environment in the community as an intermediate alternative to independent housing and inpatient care. For this, we use exogenous variation in eligibility based on conditionally random assignment of applications to assessors, and the universe of applications to supported housing in the Netherlands, linked to rich administrative data. Supported housing eligibility increases the probability of moving into supported housing and decreases the use of home care, resulting in higher total care expenditures. This increase is primarily due to the costs of supported housing, but potentially also higher consumption of curative mental health care. Supported housing eligibility reduces the total personal income and income from work. Findings do also suggest lower participation in the labor market by the individuals granted eligibility, but the labor participation of their parents increases in the long-run. Our study highlights the trade-offs of access to supported housing for those at the margin of eligibility, informing the design of long-term mental health care systems around the world.
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Affiliation(s)
- Francisca Vargas Lopes
- Department of Public HealthErasmus MCRotterdamThe Netherlands
- Erasmus Centre for Health Economics RotterdamErasmus University RotterdamRotterdamThe Netherlands
| | - Pieter Bakx
- Erasmus Centre for Health Economics RotterdamErasmus University RotterdamRotterdamThe Netherlands
- Erasmus School of Health Policy and ManagementRotterdamThe Netherlands
| | - Sam Harper
- Department of Public HealthErasmus MCRotterdamThe Netherlands
- Department of Epidemiology, Biostatistics & Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Bastian Ravesteijn
- Erasmus Centre for Health Economics RotterdamErasmus University RotterdamRotterdamThe Netherlands
- Erasmus School of EconomicsErasmus University RotterdamRotterdamThe Netherlands
| | - Tom Van Ourti
- Erasmus Centre for Health Economics RotterdamErasmus University RotterdamRotterdamThe Netherlands
- Erasmus School of Health Policy and ManagementRotterdamThe Netherlands
- Erasmus School of EconomicsErasmus University RotterdamRotterdamThe Netherlands
- Tinbergen InstituteRotterdamThe Netherlands
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Serrano-Alarcón M, Hernández-Pizarro H, López-Casasnovas G, Nicodemo C. Effects of long-term care benefits on healthcare utilization in Catalonia. JOURNAL OF HEALTH ECONOMICS 2022; 84:102645. [PMID: 35667330 DOI: 10.1016/j.jhealeco.2022.102645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 05/16/2022] [Accepted: 05/29/2022] [Indexed: 06/15/2023]
Abstract
This paper estimates effects of long-term care (LTC) benefits on utilization of primary and secondary healthcare in Catalonia (Spain). Identification comes from plausibly exogenous variation in the leniency of LTC needs assessment. We estimate that receiving LTC benefits worth 365 euros per month, on average, reduces the probability of avoidable hospital admissions by 66%, and has no significant effect on planned hospitalisations nor on hospitalisation for any reason. Receiving LTC benefits is estimated to reduce unscheduled primary care visits by 44% and has no significant effect on scheduled visits. These findings have important policy implications suggesting that allocating resources to LTC may not only increase the welfare of LTC beneficiaries but also reduce avoidable and unscheduled utilisation of healthcare.
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Affiliation(s)
- Manuel Serrano-Alarcón
- Dondena Research Centre, Bocconi University, Italy; Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Spain.
| | - Helena Hernández-Pizarro
- Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Spain; School of Business and Social Science, Tecnocampus Universitat Pompeu Fabra, Spain
| | | | - Catia Nicodemo
- Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Spain; Department of Economics, University of Verona, Italy; Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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14
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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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15
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Marier P. How Will COVID-19 Alter the Politics of Long-Term Care? A Comparative Policy Analysis of Popular Reform Options. Can J Aging 2021; 40:1-10. [PMID: 34711297 DOI: 10.1017/s0714980821000489] [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: 11/06/2022] Open
Abstract
This policy analysis reviews three popular proposals with significant political endorsement to enhance long-term care (LTC), here defined broadly to include residential care facilities, home care, and community care, in the wake of the coronavirus disease (COVID-19) crisis: national standards, provincial autonomy, and de-privatization. The proposals are summarized succinctly followed by a neo-institutionalist analysis of the obstacles to enact them based upon a series of interviews conducted prior to COVID-19 with senior civil servants in Canadian provinces for a newly published book (Marier, 2021) and political considerations. While the federal government has pursued the avenue of instituting national standards, the provinces have clearly expressed a desire to secure higher federal health transfers and pursue LTC reforms on their own. Considering the diversity of LTC arrangements across the provinces, which impact the politics of LTC within each jurisdiction, and the presence of many Conservative governments in provincial capitals, Ottawa faces an uphill battle to transform profoundly the LTC landscape.
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Affiliation(s)
- Patrik Marier
- Department of Political Science, Concordia University, Montreal, QC, Canada
- Équipe VIES (Vieillissements, exclusions sociales, et solidarités), Montreal, QC, Canada
- Centre de recherche et d'expertise en gérontologie sociale (CREGÉS), Montreal, QC, Canada
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16
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Tucher E, Keeney T, Bélanger E. Leveraging survey and claims data to identify high-need Medicare beneficiaries in the National Health and Aging Trends Study. J Am Geriatr Soc 2021; 70:522-530. [PMID: 34687550 DOI: 10.1111/jgs.17517] [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: 06/10/2021] [Revised: 09/02/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multiple algorithms have been developed to identify and characterize the high-need (HN) Medicare population. However, they vary in components and yield different populations, and were developed for varying purposes. We compared the performance of existing survey and claims-based definitions in identifying HN beneficiaries and predicting poor outcomes among a community-dwelling population. METHODS A retrospective cohort study using Round 5 (2015) of the National Health and Aging Trends Study (NHATS) linked with Medicare claims. We applied HN definitions from previous studies to our cohort of community-dwelling, fee-for-service beneficiaries (n = 4201) using sampling weights to obtain nationally representative estimates. The Bélanger et al. (2019) definition defines HN as individuals with complex conditions, multi-morbidity, acute and post-acute healthcare utilization, dependency in activities of daily living, and frailty. The Hayes et al. (2016) definition defines HN as individuals with 3+ chronic conditions and a functional limitation. We applied each definition to survey and claims data. Outcomes were hospitalization or mortality in the subsequent year. RESULTS The proportion of NHATS respondents classified as HN varied greatly across definitions, ranging from 3.1% using the claims-based Hayes definition to 32.9% using the survey-based Bélanger definition. HN respondents had significantly higher mortality and hospitalization rates in 2016. Although all definitions had good specificity, none were able to predict outcomes in the following year with good accuracy. CONCLUSIONS While mortality and hospitalization rates were significantly higher among respondents classified as HN, existing claims and survey-based HN definitions were not able to accurately predict future outcomes in a community-dwelling, nationally representative sample measured by the area under the curve.
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Affiliation(s)
- Emma Tucher
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Tamra Keeney
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA.,Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Emmanuelle Bélanger
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.,Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island, USA
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17
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Minderhout RN, Vos HMM, van Grunsven PM, de la Torre y Rivas I, Alkir-Yurt S, Numans ME, Bruijnzeels MA. The Value of Merging Medical Data from Ambulance Services and General Practice Cooperatives Using Triple Aim Outcomes. Int J Integr Care 2021; 21:4. [PMID: 34754280 PMCID: PMC8555478 DOI: 10.5334/ijic.5711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 10/15/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Acute care services are currently overstretched in many high income countries. Overcrowding also plays a major role in acute care in the Netherlands. In a region of the Netherlands, the general practice cooperative (GPC) and ambulance service have begun to integrate their care, and the rapid and complete transfer of information between these two care organisations is now the basis for delivering appropriate care. The primary aim of this mixed-methods study is to evaluate the Netherlands Triage System (NTS) merger project and answering the question: What is the added value of implementing a digital NTS merger in terms of healthcare use and healthcare costs? A secondary question is: What are the experiences of patients and care professionals in different acute healthcare organisations following implementation of the digital NTS merger? METHODS Patients who made an acute care request during the 12 months before the NTS merge intervention (control period) were compared with matched patients in the 12 months following the start of the NTS merge. Outcomes included difference in healthcare use 30 days after an acute event and patient' and care professional' experiences during the intervention period. To assess healthcare costs, we used reference prices updated to 2021. RESULTS Compared to patients in the control period, patients in the intervention period were hospitalized less often (52.9% vs 64.4%, p = 0.061) and had fewer emergency department (ED) visits (58.7% vs 69.3%, p = 0.074) in the 30 days following the acute care request. The ED costs were significantly lower during the intervention period compared to the control period (p = 0.042). Furthermore, patients in the intervention period were very satisfied overall with the acute care network (4.63 of 5) and care professionals were fairly satisfied with the cooperation to date (2.73 of 4). CONCLUSION The Triple Aim for acute care can be met using relatively simple interventions, but medical data merging is a prerequisite for achieving more robust results covering on the various aspects of the Triple Aim. These successes should be communicated so that a common language can be developed that will support the successful further implementation of larger scale initiatives.
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Affiliation(s)
- Rosa Naomi Minderhout
- Department of Public Health and Primary Care/LUMC-Campus The Hague, Leiden University Medical Centre, The Hague, NL
| | - Hedwig M. M. Vos
- Department of Public Health and Primary Care/LUMC-Campus The Hague, Leiden University Medical Centre, The Hague, NL
| | | | | | | | - Mattijs E. Numans
- Department of Public Health and Primary Care/LUMC-Campus The Hague, Leiden University Medical Centre, The Hague, NL
| | - Marc A. Bruijnzeels
- Department of Public Health and Primary Care/LUMC-Campus The Hague, Leiden University Medical Centre, The Hague, NL
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18
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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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19
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D’herde J, Gruijthuijsen W, Vanneste D, Draulans V, Heynen H. "I Could Not Manage This Long-Term, Absolutely Not." Aging in Place, Informal Care, COVID-19, and the Neighborhood in Flanders (Belgium). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126482. [PMID: 34208493 PMCID: PMC8296385 DOI: 10.3390/ijerph18126482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 11/18/2022]
Abstract
Public health and care policies across OECD (Organisation for Economic Co-operation and Development) countries increasingly encourage aging in place, enabled by both formal care networks, and informal (family) care and social solidarity in the neighborhood. However, little is known about how a person’s neighborhood might affect their aging in place. The COVID-19 crisis unintendedly offered a good opportunity to observe the neighborhood’s role in the provision of care. Since formal care services were often limited during the lockdown, informal caregiving may have increased. However, intergenerational contacts in and outside of the household were strongly discouraged by governments worldwide, adding another layer of complexity to caregiving. The aim of this qualitative study was to assess how informal caregivers in Flanders managed to provide care to their care receivers, and what role the neighborhood played in this provision of care. Sixteen qualitative Skype and telephone interviews with informal caregivers were conducted between June and December 2020 to understand their experiences and coping strategies. Overall, most respondents increased their frequency of caregiving during the first lockdown. They took on the extra care needs during the lockdown themselves, and did not actively invoke any kind of neighborhood support. The significance of the neighborhood seemingly remained limited. This was often not because no help was offered, but rather due to a sense of pride or the fear of infection, and an increased effort by family caregivers.
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Affiliation(s)
- Jakob D’herde
- Department of Architecture, KU Leuven, 3001 Heverlee, Belgium;
- Correspondence: (J.D.); (W.G.)
| | - Wesley Gruijthuijsen
- Department of Earth and Environmental Sciences, KU Leuven, 3001 Heverlee, Belgium;
- Correspondence: (J.D.); (W.G.)
| | - Dominique Vanneste
- Department of Earth and Environmental Sciences, KU Leuven, 3001 Heverlee, Belgium;
| | - Veerle Draulans
- Centre for Sociological Research, KU Leuven, 3000 Leuven, Belgium;
| | - Hilde Heynen
- Department of Architecture, KU Leuven, 3001 Heverlee, Belgium;
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20
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Bom J, Stöckel J. Is the grass greener on the other side? The health impact of providing informal care in the UK and the Netherlands. Soc Sci Med 2020; 269:113562. [PMID: 33339683 DOI: 10.1016/j.socscimed.2020.113562] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 02/04/2023]
Abstract
Facing rapidly ageing populations, many Western countries aim to stimulate informal care provision as a way to meet the growing long-term care (LTC) demand. While various studies report the impact of providing informal care on the health of caregivers, it is less clear whether and to what extent this impact differs across countries. Using propensity score matching we match caregivers to similar non-caregiving individuals using four waves of the Dutch Study on Transitions in Employment, Ability and Motivation and the UK Household Longitudinal Study. The samples consist of 8129 Dutch and 7186 UK respondents, among which respectively 1711 and 1713 individuals are identified as caregivers. We explore whether the health impact of providing informal care differs by country once similar caregivers, in terms of the intensity of provided care, are compared. In both countries we find negative mental health effects of providing informal care. While these effects slightly differ by country, the main differences arise between subgroups of caregivers. Individuals that provide more than 20 hours of informal care per week, and those who face a double burden of care and full-time employment experience the most severe negative mental health effects. These results indicate that health effects of providing informal care are mediated by the specific caregiving context, allowing policymakers to use information on this context to provide targeted aid. In addition, it suggests that previously reported differences of caregiving effects across countries could be driven by differences in the population of informal caregivers which are shaped by countries' LTC policies.
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Affiliation(s)
- Judith Bom
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands.
| | - Jannis Stöckel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands
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