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Yokoyama D, Tamura S, Fujisaki K, Mitsuyama K, Sato T, Kobayashi K, Otani T. Influence of caregiver understanding of their capability to perform activities of daily living, disease comprehension, and attitudes on occupational low back pain: a cross-sectional study. J Phys Ther Sci 2024; 36:577-582. [PMID: 39239402 PMCID: PMC11374168 DOI: 10.1589/jpts.36.577] [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: 05/29/2024] [Accepted: 06/16/2024] [Indexed: 09/07/2024] Open
Abstract
[Purpose] The aim in this study was to evaluate the impact of caregiver understanding of their ability to perform activities of daily living (ADLs), movement abilities, diseases, and attitudes on the prevalence of occupational low back pain. [Participants and Methods] A cross-sectional survey was conducted of caregivers of older adults living in residential care facilities. Of the 150 questionnaires distributed, 71 were valid. The survey collected data on demographics, low back pain status using a numerical rating scale, and familiarity with ten ADLs and five diseases (stroke, rheumatoid arthritis, fractures, Parkinson's disease, and dementia). [Results] In this study, 52% of the participants reported lower back pain. Significant factors included an understanding of repositioning in ADLs, familiarity with stroke and rheumatoid arthritis, and attitudes toward using patients' residual functions. Participants with limited knowledge of repositioning and stroke, a better understanding of rheumatoid arthritis, and those who did not consider residual function were more prone to lower back pain. [Conclusion] Our findings highlight the importance of enhancing caregiver education on ADL movements and disease specifics, particularly stroke and rheumatoid arthritis, and promoting the use of patients' residual capabilities. Improved training and information sharing among caregivers may reduce the risk of occupational low back pain.
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Affiliation(s)
- Daiki Yokoyama
- Department of Physical Therapy, Ota College of Medical Technology: 1373 Higashinagaoka-cho, Ota-shi, Gunma 373-0812, Japan
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Japan
| | - Shuntaro Tamura
- Department of Physical Therapy, Ota College of Medical Technology: 1373 Higashinagaoka-cho, Ota-shi, Gunma 373-0812, Japan
| | - Kazuki Fujisaki
- Department of Physical Therapy, Ota College of Medical Technology: 1373 Higashinagaoka-cho, Ota-shi, Gunma 373-0812, Japan
| | - Kenichiro Mitsuyama
- Department of Rehabilitation, Long-term Care Health Facility Yamazakura, Japan
| | - Tomohiko Sato
- Department of Physical Therapy, Ota College of Medical Technology: 1373 Higashinagaoka-cho, Ota-shi, Gunma 373-0812, Japan
| | - Kazura Kobayashi
- Department of Occupational Therapy, Ota College of Medical Technology, Japan
| | - Tomohiro Otani
- Department of Physical Therapy, Ota College of Medical Technology: 1373 Higashinagaoka-cho, Ota-shi, Gunma 373-0812, Japan
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de Bresser J, Knoef M, van Ooijen R. Preferences for in-kind and in-cash home care insurance. JOURNAL OF HEALTH ECONOMICS 2022; 84:102626. [PMID: 35569208 DOI: 10.1016/j.jhealeco.2022.102626] [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: 07/09/2021] [Revised: 04/09/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
We study preferences for different types of home care insurance using a discrete choice experiment. We consider domestic, personal, and social care, a home care annuity, and a lump-sum for home adaptations. To understand variation in preferences, we relate willingness to pay to personal circumstances, preferences, and expectations. We find that the majority value in-kind and in-cash insurance above the actuarial premium. While most respondents value coverage for basic levels of support, we find diminishing marginal utility for higher levels of support. For in-kind care, willingness to pay is positively associated with respondent characteristics: being single, household income, home ownership, risk aversion, low bequest motives, expected length of home care use, expected expenditures when in need of care, and low expected availability of informal care. In contrast, in-cash support is valued regardless of respondent characteristics, possibly because its inherent flexibility. These results contribute to the design of insurance schemes for home care.
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Affiliation(s)
| | - Marike Knoef
- Tilburg Universiy, P.O. Box 90153, Tilburg 5000 LE, the Netherlands; Leiden University, P.O. Box 9520, Leiden 2300 RA, the Netherlands
| | - Raun van Ooijen
- University of Groningen, University Medical Center Groningen, P.O. Box 30001, Groningen 9700 RB, the Netherlands.
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3
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Community-Based Advanced Case Management for Patients with Complex Multimorbidity and High Medical Dependence: A Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137807. [PMID: 35805465 PMCID: PMC9265887 DOI: 10.3390/ijerph19137807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022]
Abstract
This longitudinal study aimed to evaluate a community-based and nurse-led advanced case management model centered on disease management. Participants were chronically ill patients aged 20 years and older who were highly dependent on medical care. The case management group (CMG) received nurse-led advanced case management, and the comparison group (CG) was selected by matching estimated propensity scores with the CMG. We compared the changes in medico-economic indicators between the two groups and analyzed the physical and psychological indicators of the CMG over time. The CMG comprised 51 participants, of which eight dropped out by 12 months after registration. After 1:1 propensity score matching, there were 40 participants in the CMG and CG, respectively. At 12 months after the registration, there was no significant difference between the two groups and no change in the CMG. At 24 months after the registration, the CMG’s medical and long-term care costs decreased significantly, while the CG’s costs increased. Moreover, there was a significant reduction in the number of hospital days and hospital admissions in the CMG. Our findings revealed that nurse-led advanced case management could be useful for patients with complex needs to avoid hospitalization due to exacerbations.
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Gong N, Meng Y, Hu Q, Du Q, Wu X, Zou W, Zhu M, Chen J, Luo L, Cheng Y, Zhang M. Obstacles to access to community care in urban senior-only households: a qualitative study. BMC Geriatr 2022; 22:122. [PMID: 35164708 PMCID: PMC8842867 DOI: 10.1186/s12877-022-02816-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 02/01/2022] [Indexed: 01/02/2023] Open
Abstract
Background The increased number of older adults living alone has created a substantial care need. However, the utilization rate of services and facilities to meet these needs are surprisingly low. Many of older adults experience difficulties accessing these services, although it remains unclear how these obstacles impede access to services. This study explored the obstacles and difficulties experienced by urban older adults in seeking community care. Methods A phenomenological study was carried out and participatory observation and in-depth interviews were employed to investigate the process of seeking care of older adults in urban communities. A total of 18 urban community-dwelling older adults aged 75 years and over were included. Data collected were analysed by content analysis. Results We identified the pathways by which senior-only households sought community care and encountered obstacles. (1) lack of community care information: older adults did not know where and how to get services, even though the care institutions scattered throughout the community; (2) limited mobility: older adults often suffered from various chronic diseases, which physically hindered their access to care resources; (3) complex process of achieving care: the functional fragmentation and geographical dispersion of care institutions made the care-seeking process challenging and confusing for older adults; (4) incomprehension of needs expression: limited interaction time and communication barriers between staff of institutions and the older adults were the final obstacle. Only by surmounting these obstacles one by one can older adults access the care resources effectively. Conclusions When older adults in the community initiated calls for help, they encountered several obstacles. Their physiological and social disadvantages limited their ability to seek care physically. Lack of integration and clear guidance in the process of providing community care exacerbated these difficulties. Reform of care services should focus on the visibility and accessibility of services for older adults. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02816-y.
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Affiliation(s)
- Ni Gong
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
| | - Ya Meng
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Qin Hu
- School of Sociology and Anthropology, Sun Yat-sen University, Xingang West Road, Haizhu District, Guangzhou, 510399, Guangdong, China
| | - Qianqian Du
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Xiaoyu Wu
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Wenjie Zou
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Mengyao Zhu
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Jiayan Chen
- Qizhi Social Work Service Center, Tianhe District, Guangzhou, Guangdong, China
| | - Lan Luo
- Hongshan Street Community Health Service Center, Huangpu District, Guangzhou, Guangdong, China
| | - Yu Cheng
- School of Sociology and Anthropology, Sun Yat-sen University, Xingang West Road, Haizhu District, Guangzhou, 510399, Guangdong, China.
| | - Meifen Zhang
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China.
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A Study of the Key Sustainable Factors of Taiwan’s Community Care Centers. SUSTAINABILITY 2022. [DOI: 10.3390/su14031413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In response to the aging society, community care centers have been widely established in Taiwan to take care of the elderly. However, these centers are primarily managed by nonprofit organizations that rely on government subsidies, thus, they lack managerial autonomy. By investigating the key factors influencing the sustainability of community care centers, this study aimed to assist organizations with reducing the risk of managerial uncertainty and promoting the sustainable development of the aging ecosystem. The modified Delphi method and fuzzy analytic hierarchy process were used to construct the key sustainable factors and rank their importance. Four major dimensions, which were management capability, financial and other resource utilization capability, professional care service capability, and customer value creation, along with 21 criteria, were summarized. Management capability had the greatest influence, followed by financial and other resource utilization capability; financial soundness occupied first place in the overall ranking among the criteria. Based on this study’s results, it is recommended that when evaluating the units managing the community care centers, their management capability and financial and other resource utilization capability should be evaluated first to reduce the dependence on the government and achieve the goal of sustainability.
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Villalobos Dintrans P, Browne J, Madero-Cabib I. It Is Not Just Mortality: A Call From Chile for Comprehensive COVID-19 Policy Responses Among Older People. J Gerontol B Psychol Sci Soc Sci 2021; 76:e275-e280. [PMID: 32735013 PMCID: PMC7454906 DOI: 10.1093/geronb/gbaa092] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Indexed: 11/16/2022] Open
Abstract
Objective Provide a synthesis of the COVID-19 policies targeting older people in Chile, stressing their short- and long-term challenges. Method Critical analysis of the current legal and policy measures, based on national-level data and international experiences. Results Although several policies have been enacted to protect older people from COVID-19, these measures could have important unintended negative consequences in this group’s mental and physical health, as well as financial aspects. Discussion A wider perspective is needed to include a broader definition of health—considering financial scarcity, access to health services, mental health issues, and long-term care—in the policy responses to COVID-19 targeted to older people in Chile.
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Affiliation(s)
| | - Jorge Browne
- Sección de Geriatría, Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ignacio Madero-Cabib
- Instituto de Sociología & Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile.,Millennium Nucleus for the Study of the Life Course and Vulnerability (MLIV), Santiago, Chile
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7
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De La Peña JI, Fernández-Ramos MC, Garayeta A. Cost-Free LTC Model Incorporated into Private Pension Schemes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2268. [PMID: 33668892 PMCID: PMC7956306 DOI: 10.3390/ijerph18052268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 11/23/2022]
Abstract
Long-term care coverage is not integrated into an individual's retirement strategy. It is an additional public health service that is not considered into private pension funds. Nevertheless, this coverage is not sufficient due to the problems of financial sustainability of the public pension systems. However, there are large sums in pension plans dedicated to paying retirement pensions that can be transformed into support for long-term care coverage. This paper develops a mechanism of pension transformation through the different mortality of the beneficiary when becoming a dependent beneficiary. This mechanism allows the beneficiary to convert their pension to LTC support at their own choice, without increasing the cost of the private pension scheme. The proposed model provides consistency in the pension that a retiree receives and adapts it to a retiree's life expectancy: the retiree receives a higher pension when he/she needs it most.
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Affiliation(s)
- J. Iñaki De La Peña
- Faculty of Business and Economics, University of the Basque Country, 48015 Bilbao, Spain;
| | | | - Asier Garayeta
- Faculty of Business and Economics, University of the Basque Country, 48015 Bilbao, Spain;
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8
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An J, Kim S. Medical cost trends under national health insurance benefit extension in Republic of Korea. Int J Health Plann Manage 2020; 35:1351-1370. [PMID: 32754947 DOI: 10.1002/hpm.3018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 04/13/2020] [Accepted: 06/05/2020] [Indexed: 11/10/2022] Open
Abstract
This study examines whether the burden of medical expenses on households has gradually decreased since South Korea began implementing benefit expansion policies to strengthen health insurance coverage. Using Korea's Household Income & Expenditure Survey from 1995 to 2014, the annual average monthly household expenditures and the catastrophic health expenditure (CHE) indicator were analyzed. The latter is an indicator of household impoverishment resulting from out-of-pocket healthcare expenditures exceeding a defined threshold proportion of the household's income. Through descriptive and frequency data analyses and using P-values, the annual trends and differences in absolute values and share of CHE prevalence across households were measured. The study finds that the proportion of income spent on medical expenses increased from 2.47% (1995) to 4.94% (2014) on average. CHE also increased 3.6 times, 6.3 times, 9.8 times, and 11.1 times for assumed threshold sizes of 10%, 20%, 30%, and 40%, respectively. The lowest income group had the highest increase in CHE incidence. These results suggest that the benefit extension policy has lowered medical use thresholds and led to an increase in medical resource use. Therefore, the Ministries of Health and Welfare, and of Economy and Finance should collaborate to design policies for vulnerable groups.
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Affiliation(s)
- Jinha An
- Department of Public Health, Graduate School, The Catholic University of Korea, Republic of Korea
| | - Sukil Kim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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9
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Gori C. Long-term Care Financing: Inserting Politics and Resource Allocation in the Debate Comment on "Financing Long-term Care: Lessons From Japan". Int J Health Policy Manag 2020; 9:77-79. [PMID: 32124591 PMCID: PMC7054648 DOI: 10.15171/ijhpm.2019.88] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/09/2019] [Indexed: 12/02/2022] Open
Abstract
The ageing of the countries’ populations, and in particular the growing number of the very old, is increasing the need for long-term care (LTC). Not surprisingly, therefore, the financing of LTC systems has become a crucial topic across the Organisation for Economic Co-operation and Development (OECD). In the last three decades, various financing policies have been carried out in different countries and the related international debate has grown. The latter has so far focused mostly on the different alternatives to collect economic resources to pay for care. The international debate needs now to focus also on other issues, so far less discussed. One is the politics of LTC: the degree and nature of the political interest in LTC, that affects the size and profile of public financing. The other is resource allocation: how different services and benefits are distributed among people with different care needs, that determines if resources made available are optimized. If we do not pay more attention to these issues – inextricably connected to policies aimed to collect funds – our understanding of LTC financing will remain inevitably limited.
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Affiliation(s)
- Cristiano Gori
- Department of Sociology and Social Research, University of Trento, Trento, Italy
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10
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Affiliation(s)
- Pablo Villalobos Dintrans
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA
- Facultad de Ciencias Médicas, Programa Centro de Salud Pública, Universidad de Santiago, Chile
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11
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Hirth RA, Acharya Y, Levy HG, Langa KM. Does Home Equity Affect Decisions on Long-Term Care Insurance Purchases? Evidence From the United States. Res Aging 2019; 41:602-628. [PMID: 30803354 DOI: 10.1177/0164027519830078] [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: 11/15/2022]
Abstract
The low uptake of private long-term care insurance (LTCI) by the elderly in the United States, despite visible risks, has left economists puzzled. Prior studies have hypothesized that home equity can be a substitute for LTCI and hence may partly explain the low uptake. We test this hypothesis empirically. We utilize exogenous variation in house prices at the level of the metropolitan statistical area (MSA) as an instrument for home equity for individuals residing in that MSA and data from the Health and Retirement Study. In the most robust specifications, we find no evidence that the elderly change their decision on LTCI based on variation in their home equity, and even specifications requiring stronger identification assumptions imply only small effect magnitudes. Home equity as a substitute for LTCI does not appear to be a major contributing factor to low LTCI take up.
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Affiliation(s)
- Richard A Hirth
- 1 Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Yubraj Acharya
- 2 Department of Health Policy and Administration, College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
| | - Helen G Levy
- 3 Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth M Langa
- 4 Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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12
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Dintrans PV. Is aging a problem?: Dependency, long-term care, and public policies in Chile. Rev Panam Salud Publica 2018; 42:e168. [PMID: 31093196 PMCID: PMC6385727 DOI: 10.26633/rpsp.2018.168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 06/18/2018] [Indexed: 11/24/2022] Open
Abstract
Chile is facing changes associated with the demographic transition. So far, these challenges have been framed as age related. This has contributed to approaching a broad set of issues from a narrow perspective. The focus on aging has fragmented a multidisciplinary problem into different parts-particularly health and social policies-with different actors dealing with it from the perspective of their own sector. This process has generated an incomplete picture, preventing the definition and measurement of dependency and long-term care, and hindering a coordinated response to these issues. This article advocates for a change in the definition of the problem, by adopting the concept of long-term care, in order to gain a deeper and more comprehensive perspective on the issues arising from the situation that Chile is experiencing.
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Villalobos Dintrans P. Long-term care systems as social security: the case of Chile. Health Policy Plan 2018; 33:1018-1025. [DOI: 10.1093/heapol/czy083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Pablo Villalobos Dintrans
- Department of Global Health and Population, Harvard University, T. H. Chan School of Public Health, 655 Huntington Ave., Boston, MA, USA
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14
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Social Insurance Accounting for a Notional Defined Contribution Scheme Combining Retirement and Long-Term Care Benefits. SUSTAINABILITY 2018. [DOI: 10.3390/su10082832] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper develops a social insurance accounting model for a notional defined contribution (NDC) scheme combining retirement and long-term care (LTC) contingencies. The procedure relies on standard double-entry bookkeeping and enables us to compile a “Swedish” type actuarial balance sheet (ABS) following a framework equivalent to an open group approach. This methodology is suitable for reporting the system’s solvency status and can show periodical changes in the system’s financial position by means of an income statement. The information underpinning the actuarial valuation is based on events and transactions that are verifiable at the valuation date, without considering expected future trends. The paper also contains an illustrative example to make it easier for policymakers to understand the main advantages and difficulties of our proposal. The policy conclusions stress the need to properly report social insurance benefits to enhance transparency and sustainability and to improve decision-making because it is in the public interest to do so.
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15
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Changing long-term care provision at the local level in times of austerity – a qualitative study. AGEING & SOCIETY 2018. [DOI: 10.1017/s0144686x18000430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTIn the first decade of the century, long-term care (LTC) policies for dependent older people in Italy were improved with respect to both the availability of public funds and the quality of services. At the turn of the decade, however, cost-containment and austerity measures were imposed as an overall priority for the public sector and this goal also affected the LTC sector. This article explores the effects produced by cost-containment policies, which widened the gap between care needs and available public funding, on the provision of LTC services at the local level in Italy during the economic crisis. The study is based on 34 semi-structured interviews with services managers employed in Italy's publicly funded LTC system. Data were analysed with the framework analysis method and six cross-cutting thematic categories were identified that depict, according to the interviewees, the main transformations that occurred in the provision of LTC at the local level as a consequence of cost-containment policies. ‘Uncertainty’ refers to the inability to predict what direction the LTC system is going to take in the foreseeable future. ‘Short-termism’ illustrates the pressure to focus excessively on day-to-day service delivery at the expense of a medium- to long-term view of their future. ‘Endangering quality’ describes the risk of not being able to maintain the level of quality of care achieved so far. ‘Allocative tensions’ refers to the tensions due to the increasing requirement to ration the provision of public LTC services. ‘Unequal re-familiarisation’ represents the very different impacts of the trend of re-familiarisation depending on families’ financial situation. ‘Inappropriate care’ depicts the rising number of older people receiving public care interventions that are not appropriate to meet their needs.
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16
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Adult children stepping in? Long-term care reforms and trends in children's provision of household support to impaired parents in the Netherlands. AGEING & SOCIETY 2017. [DOI: 10.1017/s0144686x17000836] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTRecent long-term care (LTC) reforms in the Netherlands are illustrative of those taking place in countries with a universalistic LTC model based on extensive provision of state-supported services. They entail a shift from de-familialisation, in which widely available state-supported LTC services relieve family members from the obligations to care for relatives in need, to supported familialism, in which family involvement in care-giving is fostered through support and recognition for families in keeping up their caring responsibilities. Using data from four waves of the Netherlands Kinship Panel Study (N = 2,197), we show that between 2002 and 2014 the predicted probability that adult children provide occasional household support to impaired parents rose substantially. Daughters more often provided household support to parents than did sons, but no increase in the gender gap over time was found. We could not attribute the increase in children's provision of household support to drops in the use of state-supported household services. The finding that more and more adult children are stepping in to help their ageing parents fits a more general trend in the Netherlands of increasing interactions in intergenerational families.
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17
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Expectations and realities in welfare technologies. TRANSFORMING GOVERNMENT- PEOPLE PROCESS AND POLICY 2017. [DOI: 10.1108/tg-09-2016-0057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The paper aims to add knowledge on the status of the welfare technology field. Politicians in mature economies expect welfare technologies – especially digital technologies – to contribute to bridging the gap between an increasing number of elderly and a shrinking work force. Theoretically, the paper deals with welfare technologies in a digital infrastructure perspective.
Design/methodology/approach
A multilevel and comparative study was conducted to understand the interplay of high-level policies and implementation projects and highlight key issues through comparative analysis of different national approaches. Japan and Norway were the chosen countries because they are both in the forefront in the use of welfare technologies.
Findings
Findings reveal similarities between the two countries, which are echoed in many other countries: although government expectations are high, the field of welfare technology is still in its infancy and only rather simple solutions (such as safety alarms) are widely used. Key differences in innovation strategies for welfare technology in the two countries are highlighted, where Japan seem to be aiming for a vertical integration through large corporations’ solutions, whereas Norway aims for a more open innovation arena through standardization.
Originality/value
From a practical point of view, the two countries have something to learn from each other, but, in particular, both countries are recommended – together with other similar countries – a more platform-oriented approach. Theoretically, it is shown that a successful implementation of welfare technologies should adopt a digital infrastructure approach and exploit the generative mechanisms of this approach.
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Lay-Yee R, Pearson J, Davis P, von Randow M, Kerse N, Brown L. Changing the balance of social care for older people: simulating scenarios under demographic ageing in New Zealand. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:962-974. [PMID: 27709717 DOI: 10.1111/hsc.12394] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2016] [Indexed: 06/06/2023]
Abstract
The demographic ageing of New Zealand society, as elsewhere in the developed world, has dramatically increased the proportion of older people (aged 65 years and over) in the population. This has major policy implications for the future organisation of social care. Our objective was to test the effects on social care use, first, of putative changes in the overall disability profile of older people, and second, of alterations to the balance of their care, i.e. whether it was community-based or residential. In order to undertake these experiments, we developed a microsimulation model of the later life course using individual-level data from two official national survey series on health and disability, respectively, to generate a synthetic version which replicated original data and parameter settings. A baseline projection under current settings from 2001 to 2021 showed moderate increases in disability and associated social care use. Artificially decreasing disability levels, below the baseline projection, only moderately reduced the use of community care (both informal and formal). Scenarios implemented by rebalancing towards informal care use moderately reduced formal care use. However, only moderate compensatory increases in community-based care were required to markedly decrease the transition to residential care. The disability impact of demographic ageing may not have a major negative effect on system resources in developed countries like New Zealand. As well as healthy ageing, changing the balance of social care may alleviate the impact of increasing demand due to an expanding population of older people.
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Affiliation(s)
- Roy Lay-Yee
- Centre of Methods and Policy Application in the Social Sciences (COMPASS), University of Auckland, Auckland, New Zealand
| | - Janet Pearson
- Centre of Methods and Policy Application in the Social Sciences (COMPASS), University of Auckland, Auckland, New Zealand
| | - Peter Davis
- Centre of Methods and Policy Application in the Social Sciences (COMPASS), University of Auckland, Auckland, New Zealand
| | - Martin von Randow
- Centre of Methods and Policy Application in the Social Sciences (COMPASS), University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Laurie Brown
- National Centre for Social and Economic Modelling (NATSEM), University of Canberra, Canberra, ACT, Australia
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Effects of economic recession on elderly patients' perceptions of access to health care and medicines in Portugal. Int J Clin Pharm 2016; 39:104-112. [PMID: 27933488 DOI: 10.1007/s11096-016-0405-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 11/22/2016] [Indexed: 01/09/2023]
Abstract
Background In view of the current financial and demographic situation in Portugal, accessibility to health care may be affected, including the ability to adhere to medication. Objective To evaluate the perceived effects of the crisis on elderly patient's access to medicines and medical care, and its implications on medicine-taking behaviour. Setting Community pharmacy. Method A cross-sectional study was undertaken during April 2013, where elderly patients answered a self-administered questionnaire based on their health-related experiences in the current and previous year. Binary logistic regression was used to ascertain the effects of potential predictors on the likelihood of adherence. Main outcome measures self-reported adherence. Results A total of 1231 questionnaires were collected. 27.3% of patients had stopped using treatments or health services in the previous year for financial motives; mostly private medical appointments, followed by dentist appointments. Almost 30% of patients stopped purchasing prescribed medicines. Over 20% of patients reduced their use of public services. Out-of-pocket expenses with medicines were considered higher in the current year by 40.1% of patients. The most common strategy developed to cope with increasing costs of medicines was generic substitution, but around 15% of patients also stopped taking their medication or started saving by increasing the interdose interval. Conclusion Reports of decreasing costs with medicines was associated with a decreased likelihood of adherence (OR 0.42; 95% CI 0.27-0.65). Lower perceived health status and having 3 or more co-morbidities were associated with lower odds of adhering, whilst less frequent medical appointments was associated with a higher likelihood of exhibiting adherence.
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Santos-Eggimann B, Meylan L. Older Citizens' Opinions on Long-Term Care Options: A Vignette Survey. J Am Med Dir Assoc 2016; 18:326-334. [PMID: 27956072 DOI: 10.1016/j.jamda.2016.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/14/2016] [Accepted: 10/19/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Older citizens are directly concerned, as potential beneficiaries and informal caregivers, by access to long-term care (LTC) services matching their expectations. The aim of this research was to collect their opinions regarding LTC arrangements for a diversity of disability profiles. DESIGN/SETTING/PARTICIPANTS Mailed vignette survey in a representative population-based sample of 3133 community-dwelling persons 68 years or older residing in a Swiss region. MEASUREMENTS All persons received a set of 10 vignettes. For each vignette, they considered 2 social situations successively: a person (1) living with an able-bodied spouse, and (2) living alone or with a spouse unable to help (resulting in 20 vignettes). Subjects selected a care setting (home, sheltered housing, or nursing home) and specified the preferred type of caregivers (spouse, professionals, or both) after community-based care options. Population estimates were based on weighted data accounting for the stratification of the survey sample. RESULTS A total of 2985 participants (95.3%) expressed opinions on 55,178 vignettes (mean 18.5 vignettes, SD 4.1) Institutionalization was selected by 0.8% (95% confidence interval 0.3-1.4) of the population for the vignette of lowest disability with able-bodied spouse and 78.8% (76.1-81.6) for the vignette of highest disability and no possible help from a spouse. Continence, cognitive, and behavioral difficulties further influenced the preferences expressed for LTC options. Community-based LTC choices involved professionals mostly as a complement to informal help by the spouse, except for vignettes describing isolated moderate cognitive impairment or difficulties in instrumental activities of daily living. In these cases, most favored help provided by spouses only. CONCLUSIONS This survey had high acceptance. Responses to variations in the disability and social profile displayed in the vignettes suggested the validity of measurements.
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Affiliation(s)
- Brigitte Santos-Eggimann
- Lausanne University Hospital, Institute of Social and Preventive Medicine, Lausanne, Switzerland.
| | - Lionel Meylan
- Lausanne University Hospital, Institute of Social and Preventive Medicine, Lausanne, Switzerland
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21
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Janssen D, Jongen W, Schröder-Bäck P. Exploring the impact of austerity-driven policy reforms on the quality of the long-term care provision for older people in Belgium and the Netherlands. J Aging Stud 2016; 38:92-104. [DOI: 10.1016/j.jaging.2016.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/26/2016] [Accepted: 05/31/2016] [Indexed: 11/28/2022]
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22
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Matus-Lopez M, Pedraza CC. New Long-Term Care Policies in Latin America: The National System of Care in Uruguay. J Am Med Dir Assoc 2016; 17:663-5. [DOI: 10.1016/j.jamda.2016.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 04/04/2016] [Indexed: 11/27/2022]
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23
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Provision of Health Services: Long-Term Care. Health Serv Res 2016. [DOI: 10.1007/978-1-4614-6419-8_24-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Matus-López M. Tendencias en las políticas de atención a la dependencia de ancianos y sus reformas. CAD SAUDE PUBLICA 2015; 31:2475-81. [DOI: 10.1590/0102-311x00039315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 10/15/2015] [Indexed: 11/22/2022] Open
Abstract
Resumen Una de las mayores preocupaciones respecto a la salud pública de los países de renta media y alta es cómo enfrentar los problemas de dependencia funcional de un número cada vez mayor de personas en la tercera edad. El objetivo de este estudio fue identificar aspectos de convergencia de treinta países que poseen un sistema formal de cuidados. Para eso se realizó una revisión sistemática de artículos, estudios e informes comparativos internacionales, publicados entre 2010 y 2015. Los resultados muestran tres tendencias en la concepción y desarrollo de esas políticas: (a) concentrarse en las personas ancianas o en los ancianos más dependientes, (b) ampliación de la base de financiación en función a la contribución individual, (c) promoción de cuidados en casa y beneficios financieros para la atención en centros especializados (asilos, albergues o similares). Todos ellos tienen efectos positivos sobre la contención de costos, pese a que haya pocas evidencias de impactos sobre la salud de las personas.
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25
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Matus-López M. Thinking about long-term care policies for Latin America. Salud Colect 2015; 11:485-96. [PMID: 26676592 DOI: 10.18294/sc.2015.785] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 08/20/2015] [Indexed: 11/24/2022] Open
Abstract
Latin America is aging. The process is occurring quickly and in unhealthy conditions with low levels of income. The number of older people who can no longer perform their daily activities will dramatically increase in the coming decades. Developed countries have already been facing this phenomenon over the last three decades, but Latin America has neither the resources nor the social protection systems of these countries. Formulating and planning health policies associated with this phenomenon should be a priority of the governments of Latin America. This paper defines what these care policies are, the models of care rich countries have developed, and the cost of such models. The situation in Latin America is then analyzed and conclusions and a series of discussions to address in the near future are proposed.
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Affiliation(s)
- Mauricio Matus-López
- Departamento de Economía, Métodos Cuantitativos e Historia Económica, Universidad Pablo de Olavide, España
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26
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Schipper L, Luijkx KG, Meijboom BR, Schols JMGA. 'It is a completely new world you step into.' How older clients and their representatives experience the operational access to Dutch long-term institutional care. J Aging Stud 2015; 35:211-20. [PMID: 26568230 DOI: 10.1016/j.jaging.2015.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/06/2015] [Accepted: 09/07/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE OF THE STUDY The access process is an important first step in the long-term institutional care for older people. Access can be seen as a concept consisting of three closely related dimensions: availability, affordability and acceptability (three A's). This study takes a new perspective by investigating how older clients experience the access process. DESIGN AND METHODS Data were gathered through interviews with representatives of clients that were recently admitted in a long-term care facility, or if possible with clients themselves. A total of 33 respondents from 4 organizations that provide long-term institutional care were interviewed. RESULTS The first contact with the long-term care provider was made in several different ways. Finding a location nearby family was a common aim, which in urgent situations was not always feasible. Most respondents were satisfied about the process and felt taken care of personally. Yet, many respondents mention the lack of practical information and 'guidance' in the complexity of elder care. For acceptability, having a dedicated liaison in the organization was relevant. IMPLICATIONS The study revealed that the 3A model can be used to understand how older clients or their representatives experience the operational access process to long-term care. Especially the dimensions' availability and acceptability seemed to shape their experience.
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Affiliation(s)
- Lisette Schipper
- Department of Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, The Netherlands; Surplus, Zevenbergen, The Netherlands.
| | - Katrien G Luijkx
- Department of Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, The Netherlands.
| | - Bert R Meijboom
- Department of Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, The Netherlands; Department Organization and Strategy, Tilburg School of Economics and Management, Tilburg University, The Netherlands.
| | - Jos M G A Schols
- Caphri, Department of Family Medicine and Department of Health Services Research, Maastricht University, The Netherlands.
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Matus-Lopez M, Cid Pedraza C. Building Long-Term Care Policies in Latin America: New Programs in Chile. J Am Med Dir Assoc 2015; 16:900.e7-10. [DOI: 10.1016/j.jamda.2015.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 07/31/2015] [Indexed: 11/17/2022]
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Schipper L, Luijkx KG, Meijboom BR, Schalk R, Schols JM. Access to long-term care: perceptions and experiences of older Dutch people. QUALITY IN AGEING AND OLDER ADULTS 2015. [DOI: 10.1108/qaoa-12-2014-0046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Despite the current focus on demand-based care, little is known about what clients consider important when they have a request for formal long-term care services. The paper aims to discuss this issue.
Design/methodology/approach
– Questions about the access process to care services were added to the “Senior Barometer”, a Dutch web-based questionnaire that assesses the opinion of older people about different aspects in life. The questionnaire surveyed both people who already requested care services (“users”), and people that did not (“future clients”).
Findings
– The results show a significant difference in what people expect to be the first step from what users actually did, when requesting formal care services. In addition, there was a significant difference on how “users” and “future clients” rated several access service aspects.
Research limitations/implications
– The results give valuable information on how both “users” and “future clients” value the access process. The findings also provide valuable input for organizations providing long-term care for older clients about the important issues that have to be considered when organizing the access process.
Originality/value
– This study shows what older people in the Netherlands find important during the access process to care and this has not been explored before. The difference between what “users” and “future clients” find of importance in the care access process suggests that it is difficult for people to foresee what will be important once the need for care arrives, or where they will turn to with a request for care services.
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Hayashi M. Japan's long-term care policy for older people: the emergence of innovative "mobilisation" initiatives following the 2005 reforms. J Aging Stud 2015; 33:11-21. [PMID: 25841725 DOI: 10.1016/j.jaging.2015.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 02/16/2015] [Accepted: 02/16/2015] [Indexed: 10/23/2022]
Abstract
Japan leads the global race for solutions to the increasing long-term care demand from an ageing population. Initial responses in 2000 saw the launch of the public Long-Term Care Insurance (LTCI) system which witnessed an unexpectedly substantial uptake - with doubts raised about financial viability and sustainability. The post-2005 LTCI reform led to the adoption of innovations - including the "mobilisation" of active, older volunteers to support their frailer peers. This strategy, within the wider government's "2025 Vision" to provide total care for the entire older population, sought to secure financial viability and sustainability. Drawing on qualitative in-depth interviews with 21 provider organisations this study will examine three "mobilisation" schemes and identify those factors contributing to overall strengths while acknowledging complexities, diversities and challenges the schemes encountered. Initial literature written by mobilisation proponents may have been overly optimistic: this study seeks to balance such views through providing an understanding and analysis of these mobilisation schemes' realities. The findings will provide insights and suggest more caution to policy-makers intending to promote such schemes - in both Japan and in countries considering doing so. Furthermore, more evaluation is required to obtain evidence to support financial feasibility and sustainability.
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Affiliation(s)
- Mayumi Hayashi
- Institute of Gerontology, Department of Social Science, Health & Medicine, Faculty of Social Science & Public Policy, King's College London Strand, London WC2R 2LS, United Kingdom
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Costa-Font J, Courbage C, Swartz K. Financing long-term care: ex ante, ex post or both? HEALTH ECONOMICS 2015; 24 Suppl 1:45-57. [PMID: 25760582 DOI: 10.1002/hec.3152] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 11/20/2014] [Indexed: 05/25/2023]
Abstract
This paper attempts to examine the heterogeneity in the public financing of long-term care (LTC) and the wide-ranging instruments in place to finance LTC services. We distinguish and classify the institutional responses to the need for LTC financing as ex ante (occurring prior to when the need arises, such as insurance) and ex post (occurring after the need arises, such as public sector and family financing). Then, we examine country-specific data to ascertain whether the two types of financing are complements or substitutes. Finally, we examine exploratory cross-national data on public expenditure determinants, specifically economic, demographic and social determinants. We show that although both ex ante and ex post mechanisms exist in all countries with advanced industrial economies and despite the fact that instruments are different across countries, ex ante and ex post instruments are largely substitutes for each other. Expenditure estimates to date indicate that the public financing of LTC is highly sensitive to a country's income, ageing of the population and the availability of informal caregiving.
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Van Houtven CH, Coe NB, Konetzka RT. Family structure and long-term care insurance purchase. HEALTH ECONOMICS 2015; 24 Suppl 1:58-73. [PMID: 25760583 PMCID: PMC4554715 DOI: 10.1002/hec.3145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 11/17/2014] [Accepted: 11/24/2014] [Indexed: 06/04/2023]
Abstract
While it has long been assumed that family structure and potential sources of informal care play a large role in the purchase decisions for long-term care insurance (LTCI), current empirical evidence is inconclusive. Our study examines the relationship between family structure and LTCI purchase and addresses several major limitations of the prior literature by using a long panel of data and considering modern family relationships, such as the presence of stepchildren. We find that family structure characteristics from one's own generation, particularly about one's spouse, are associated with purchase, but that few family structure attributes from the younger generation have an influence. Family factors that may indicate future caregiver supply are negatively associated with purchase: having a coresidential child, signaling close proximity, and having a currently working spouse, signaling a healthy and able spouse, that long-term care planning has not occurred yet or that there is less need for asset protection afforded by LTCI. Dynamic factors, such as increasing wealth or turning 65, are associated with higher likelihood of LTCI purchase.
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Affiliation(s)
- Courtney Harold Van Houtven
- Health Services Research and Development, Durham VA Medical Center
- Department of Medicine, Duke University Medical Center
- Network for Studies of Pensions, Aging and Retirement
| | - Norma B. Coe
- Network for Studies of Pensions, Aging and Retirement
- Department of Health Services, School of Public Health, University of Washington
- National Bureau of Economic Research
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The Japanese voluntary sector's responses to the increasing unmet demand for home care from an ageing population. AGEING & SOCIETY 2014. [DOI: 10.1017/s0144686x14001238] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTAs Japan faces the challenge of the increasing demand for home care from its ageing population in an era of economic constraints, the expectation has evolved that the voluntary sector will fill the shortfall in statutory provision through semi-volunteers providing affordable home care. Drawing on qualitative interviews with managers from 15 voluntary organisations, this article explores their experiences in trying to meet this expectation. Even though most organisations provided supplementary home-care services, the empirical evidence indicates a limited capacity to deliver this expectation, with respondents aware of the deteriorating situation. It has been ascertained that supply mechanisms differ between the traditional voluntary – and the new hybrid – organisations. The former employ ‘cost-efficient’ labour such as ‘paid volunteers’ on below minimum pay rates. In contrast, the ‘hybrids’ use paid employees at regular pay rates, a finding that contradicts optimistic assumptions about the ideological role of ‘traditional’ voluntary organisations. This article suggests the importance of acknowledging diverse responses from the voluntary sector, including the new hybrids with their acknowledgement of voluntary and commercial imperatives. Open mindedness and a preparedness to revise interpretations of the earlier ‘models’ of the voluntary sector are essential. The conclusion proposes that the best strategy to unlock the voluntary sector's full potential to deliver supplementary home care is a multi-platformed approach, with adequate public purse funding, which pragmatically maximises resources.
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Validity, reliability, and feasibility of the German version of the Caregiver Reaction Assessment scale (G-CRA): a validation study. Int Psychogeriatr 2013; 25:1621-8. [PMID: 23886344 DOI: 10.1017/s1041610213001178] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Instruments measuring caregiver reactions usually disregard positive aspects, and focus predominately on home care. The Caregiver Reaction Assessment (CRA) scale is an exception. Until now, no German version has been available. We translated the instrument to German (G-CRA) and evaluated its psychometric properties and feasibility. METHODS Face-to-face interviews with 234 informal caregivers of persons with dementia were performed. Half of the persons with dementia (n = 118) had been recently admitted to institutional long-term care (iLTC); the remainder (n = 116) lived at home. Exploratory factor analysis (EFA) was performed. Subscales were intercorrelated and further correlated with the Zarit Burden Interview (ZBI), the General Health Questionnaire (GHQ-12), and the EuroQuol (EQ-5D). Internal consistency was measured (Cronbach's α), and interviewers (n = 9) appraised feasibility. The time needed to apply the scale was measured in 20 interviews. RESULTS The EFA yielded six factors (Kaiser criterion), but a scree plot supported the five dimensions of the original version that explained 56.2% of variance. Low-to-moderate subscales' inter-correlation was revealed. Highest correlation (r = 0.5) was found between impact on health and impact on daily schedule, indicating slight overlap. Criterion validity was supported by reasonable correlations between subscales and ZBI and GHQ-12 (r = -0.21-0.71). Subscale impact on health was negatively correlated with the EQ-5D. The internal consistency was sufficient (α = 0.67 − 0.78). Interviewers judged the G-CRA to be appropriate. Completion took 6.50 min (median value). CONCLUSIONS Our results suggest that the G-CRA is sufficiently valid and internally reliable. The instrument is applicable in home care and iLTC as well as in the transitional phase.
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