An early investigation of individual budget expenditures in the era of consumer-directed care

An exploration of healthcare use in older people waiting for and receiving Australian community-based aged care services

AIM

Home care packages (HCPs) facilitate older individuals to remain at home, with longer HCP wait times associated with increased mortality risk. We analyze healthcare cost data pre- and post-HCP access to inform hypotheses around the effects of healthcare use and mortality risk.

METHODS

Regression models were used to assess the impact of delayed HCP access on healthcare costs and to compare costs whilst waiting and in the 6- and 12 month periods post-HCP access for 16 629 older adults.

RESULTS

Average wait time for a HCP was 89.7 days (SD = 125.6) during the study period. Wait-time length had no impact on any healthcare cost category or time period. However, total per day healthcare costs were higher in the 6 and 12 months post-receipt of a HCP (AU$61.5, AU$63, respectively) compared with those in the time waiting for a HCP (AU$48.1). Inpatient care accounted for a higher proportion of total healthcare costs post-HCP (AU$45.1, AU$46.3, respectively) compared with in the wait time (AU$30.6), whilst spending on medical services and pharmaceuticals reduced slightly in the 6 month (AU$7.1, AU$6.3) and 12 month (AU$7.2, AU$6.3) post-HCP periods compared with in the wait time (AU$7.9, AU$7.1).

CONCLUSIONS

Increased spending post-HCP on inpatient care or non-health support afforded by HCPs may offer protective effects for mortality and risk of admission to aged care. Further research should explore the association between delayed access to inpatient care for geriatric syndromes and mortality to inform recommendations on extensions to residential care outreach services into the community to improve the timely identification of the need for inpatient care. Geriatr Gerontol Int 2023; 23: 899-905.

The New Economic Era Analysis of the Structure System of Chinese Household Consumption Expenditure Based on the ELES Model

In recent years, the new economy has entered a phase of rapid development and upgrading China’s service consumption is driving the continuous optimization of the population’s consumption structure. To realize the rationalization of the Chinese household consumption structure, the ELES model is used to analyze the structure system of Chinese household consumption expenditure. This article constructs the ELES model, divides the types of Chinese household consumption expenditure structure systems, establishes consumption expenditure function, analyzes the influencing factors of the consumption expenditure structure system, and obtains the analysis results from static and dynamic aspects. Based on the statistics of Chinese household consumption expenditure data in recent years, this article obtains the analysis results of the consumption expenditure structure system: the basic consumption demand and marginal consumption tendency of food are in the first place, and the consumption expenditure structure system has gradually changed into the development-type and enjoyment-type consumption mode. Through increasing the income of rural residents, guiding reasonable consumption concept, optimizing consumption environment, and so on, we can promote the proposal and implementation of the optimization of China’s household consumption expenditure structure system to improve the rationalization of China’s household consumption structure system.

Barriers to an effective voucher programme for community-based aged care: a professional perspective

Long-term care for older people is increasingly turning to consumer-directed approaches. As a case in point, the Hong Kong Government recently implemented a new voucher programme for community-based aged care based on a consumer-directed approach: the Community Care Service Voucher for the Elderly (CCSV). The objectives of this study were to explore the lived experience of professional workers vis-à-vis the new programme and to identify barriers to effective voucher use by older people in Hong Kong. In-depth individual interviews were conducted with 16 professionals who had primary responsibility for the voucher programme for community-based aged care. The interview guide covered five main areas: (a) professional's perception and experience on the voucher programme; (b) the decision-making process around the voucher programme; (c) personal capacities of older people; (d) family support and social networks; and (e) institutional support. Findings indicate several barriers to effective use of the CCSV including: lack of self-awareness of service needs, lower education level, poor health condition, lack of financial resources, lack of family support, inadequate family involvement in decision-making, lack of peer and professional support, lack of available services and poor service accessibility. Suggestions for strengthening the voucher programme include institution of a case management model and public education. Different factors or elements are required to facilitate older people to make sound and informed choices, and a case manager can assist in combining different resources and forms of support towards effective use of the CCSV.

A preference for quality: Australian general public's willingness to pay for home and residential aged care

In Australia and many other countries internationally, aged care services are provided to older people in their own homes or residential care facilities. The majority of these services are funded by the federal government using taxpayer contributions from the general public. However, the monetary value Australians place on aged care services, and the factors that predict this value, have not been examined. We, therefore, sought to determine the general public's willingness to pay (WTP) for aged care services and examine which factors influence this WTP. A cross-sectional contingent valuation survey was administered to a nationally representative cohort of 10,285 Australians between September and October 2020 from the general population aged 18 years and over. Respondents were asked to indicate their WTP values for satisfactory and high-quality aged care services to be provided in the future. A two-part regression model was used to explain what factors explained variation in WTP. In total, 80% (61%) of respondents were willing to pay to access satisfactory (high) quality home care (counterpart figures for residential care were 64% (45%)). On average, respondents were willing to pay between $126 and $158 ($145 and $237) per week to receive satisfactory-quality (high-quality) home care and between $333 and $520 ($308 and $680) per week for satisfactory-quality (high-quality) residential care. Respondents were willing to pay an additional $120 per week on average to access high-quality aged care. Higher WTP values were generally associated with being younger, male, recent experience with aged care through a close family member accessing aged care and ability to pay. These results suggest general public support for payment of individual co-contributions to access aged care services in the future.

Quality of care experience in aged care: An Australia-Wide discrete choice experiment to elicit preference weights

The quality of aged care provided to older people is a concern for all countries globally. This study adopts a novel first-stage discrete choice experiment (DCE) and a second-stage quality rating task to empirically estimate the relative importance of six key aged care quality criteria from more than 10,000 Australian general population sample. The six attributes or characteristics (each with five levels) compose the new measure, Quality of Care Experience (QCE) in aged care that includes: 'Respect & Dignity', 'Make Own Decisions', 'Skills & Training (of staff)', 'Health & Wellbeing', 'Social Relationships', and 'Lodging Complaints'. The online survey was conducted between September and October 2019. Preference heterogeneity was evident among respondents. The latent class analysis indicates that those more experienced respondents (i.e. have a better knowledge of Australia's current aged care system or they had a close family member who was receiving aged care services) valued more towards the outcomes of the aged care services whilst the inexperienced respondents valued highly towards the process of the aged care services. A preference weighted scoring algorithm was developed for the QCE measure (on a 0-1 scale whereby 0 = lowest quality and 1 = highest quality) and the corresponding quality thresholds for 'Unacceptable/Poor', 'Satisfactory' and 'High/Very High' quality of care were reported based on the second-stage quality rating questions following each DCE task. The impact of different QCE attributes on the quality ratings was non-linear when considering movements from 'Unacceptable/Poor' to 'Satisfactory', and from 'Satisfactory' to 'High/Very High'. This study provides important insights into the general public's perceptions of the relative importance of key quality of care experience criteria in aged care.

Decision-making in home care package spending

Objective

To understand the motivations and drivers of spending decisions made by home care package recipients, in the context of high levels of unspent funds.

Methods

Qualitative study using 30 semi‐structured interviews with 38 home care package clients and/or client representatives in rural and urban Victoria conducted between December 2018 and March 2019. Interview transcripts were analysed to determine themes.

Results

Spending decisions were influenced by assessment and entry experiences, knowledge and understanding of package funds, availability and acceptability of services, and attitudes to spending.

Conclusion

Clients need confidence in their individual funds and their use in order to maximise the potential benefits. Clear, consistent communication at all stages, and additional supports to build consumer capability, will enable clients to better understand packages and their application. This in turn will optimise the capacity of home care package recipients to maximise their health and well‐being.