The role of young users in determining long term care expenditure in Norway

<i>Aims</i>: In Norway, it is the responsibility of the country's 429 municipalities to provide long term care (LTC) services to their residents. Recent years have seen a sharp rise in the number of LTC users under the age of 65. This paper aims to explore the effect of this rise on LTC expenditure. <i>Methods</i>: Panel data models are used on data from municipalities from 1986 to 2011. An instrumental variable approach is also utilised to account for possible endogeneity related to the number of young users. <i>Results</i>: The number of young users appears to have a strong effect on LTC expenditure. There is also evidence of municipalities exercising discretion in defining eligibility criteria for young users in order to limit expenditure. Conclusions: The rise in the number of young LTC users presents a long-term challenge to the sustainability of LTC financing. The current budgeting system does not appear to fully compensate municipalities for expenditure on young LTC users. This may put strain on the financing of services for older users

Evaluation of an integrated system for classification, assessment and comparison of services for long-term care in Europe: the eDESDE-LTC study

The harmonization of European health systems brings with it a need for tools to allow the standardized collection of information about medical care. A common coding system and standards for the description of services are needed to allow local data to be incorporated into evidence-informed policy, and to permit equity and mobility to be assessed. The aim of this project has been to design such a classification and a related tool for the coding of services for Long Term Care (DESDE-LTC), based on the European Service Mapping Schedule (ESMS). Methods. The development of DESDE-LTC followed an iterative process using nominal groups in 6 European countries. 54 researchers and stakeholders in health and social services contributed to this process. In order to classify services, we use the minimal organization unit or "Basic Stable Input of Care" (BSIC), coded by its principal function or "Main Type of Care" (MTC). The evaluation of the tool included an analysis of feasibility, consistency, ontology, inter-rater reliability, Boolean Factor Analysis, and a preliminary impact analysis (screening, scoping and appraisal). Results: DESDE-LTC includes an alpha-numerical coding system, a glossary and an assessment instrument for mapping and counting LTC. It shows high feasibility, consistency, inter-rater reliability and face, content and construct validity. DESDE-LTC is ontologically consistent. It is regarded by experts as useful and relevant for evidence-informed decision making. Conclusion: DESDE-LTC contributes to establishing a common terminology, taxonomy and coding of LTC services in a European context, and a standard procedure for data collection and international comparison

The Spanish Long-term Care System. ENEPRI Research Report No. 88, 15 June 2010

Launched in January 2009, ANCIEN is a research project that runs for a 44-month period and involves 20 partners from EU member states. The project principally concerns the future of long-term care (LTC) for the elderly in Europe and addresses two questions in particular: 1) How will need, demand, supply and use of LTC develop? 2) How do different systems of LTC perform? This case study on Spain is part of the first stage in the project aimed at collecting the basic data and necessary information to portray long-term care in each country of the EU. It will be followed by analysis and projections of future scenarios on long-term care needs, use, quality assurance and system performance. State-of-the-art demographic, epidemiologic and econometric modelling will be used to interpret and project needs, supply and use of long-term care over future time periods for different LTC systems

Discovery of low thermal conductivity compounds with first-principles anharmonic lattice dynamics calculations and Bayesian optimization

Compounds of low lattice thermal conductivity (LTC) are essential for seeking thermoelectric materials with high conversion efficiency. Some strategies have been used to decrease LTC. However, such trials have yielded successes only within a limited exploration space. Here we report the virtual screening of a library containing 54,779 compounds. Our strategy is to search the library through Bayesian optimization using for the initial data the LTC obtained from first-principles anharmonic lattice dynamics calculations for a set of 101 compounds. We discovered 221 materials with very low LTC. Two of them have even an electronic band gap < 1 eV, what makes them exceptional candidates for thermoelectric applications. In addition to those newly discovered thermoelectric materials, the present strategy is believed to be powerful for many other applications in which chemistry of materials are required to be optimized.Comment: 6 pages, 4 figure

The market potential for privately financed long term care products in the UK

This paper considers the market potential for privately financed long term care products in the UK. It finds that since the present market is undeveloped there is scope to increase the range of products available to suit people with different means and circumstances. Currently the UK spends about £19 billion on long term care (LTC) of which around a third is privately funded and two thirds publicly funded. The cost of informal care for older people is estimated to be worth £58 billion a year making a total of £77 billion. The paper finds that very few people can afford to pay for LTC out of their own pockets from income alone, but that this number is increased if savings are taken into account and significantly increased if housing wealth is included as well. Insurance for LTC is normally considered to be part of the product mix usually associated with the private funding of LTC. However, as the US market demonstrates, LTC insurance products can be complex and difficult to understand and yet still not meet all needs, whilst US research suggests that policies are also over priced and unaffordable for many. In this paper the case is made for other kinds of products which produce an income at the point of need and therefore make a contribution towards LTC costs. These products include equity release, ‘top up insurance’, disability linked annuities, and immediate needs annuities. Although they may not cover all possible risks, and therefore all needs, they would bring much needed new money into LTC as well as lead to an increase in personal responsibility. With large numbers of older people on very low incomes not everybody would be able to afford these products and so the concept of LTC bonds is considered. These would work like premium bonds and pay prizes but would only be cashable at the point of need. Taken together all of the products considered would extend choice and there would be something to meet most circumstances. The government’s role would be five fold: (1) to facilitate the introduction of the LTC products and provide regulation; (2) to provide appropriate incentives for people to take them up; (3) to clarify the role of the state in terms of the minimum entitlement people can expect; (4) to make it easier to get advice and direction at points of initial contact, for example with social and health care services; and (5) to cover risks that the market cannot handle

Aged-Care Support in Japan: Perspectives and Challenges

This study explores economic aspects of the market for long term care (LTC) with a special focus on Japan. First, we describe the LTC system in Japan as presently implemented, and we highlight some aspects of the program that are novel and potentially of interest to other countries seeking models for long-term care provision. Next, we discuss alternative projections of Japanese LTC utilization and costs. Finally, since Japan appears likely to experience important shortfalls in LTC in the future, we discuss whether such services might be more efficiently organized and financed under alternate forms of provision.

Social Long Term Care Insurance and Redistribution

We study the role of social long term care (LTC) insurance when income taxation and private insurance markets are imperfect. Policy instruments include public provision of LTC as well as a subsidy on private insurance. The subsidy scheme may be linear or nonlinear. For the linear part we consider a continuous distribution of types, characterized by earnings and survival probabilities. In the nonlinear part, society consists of three types: poor, middle class and rich. The first type is too poor to provide for dependence; the middle class type purchases private insurance and the high income type is self-insured. The main questions are at what level LTC should be provided to the poor and whether it is desirable to subsidize private LTC for the middle class. Interestingly, the results are similar under both linear and nonlinear schemes. First, in both cases, a (marginal) subsidy of private LTC insurance is not desirable. As a matter of fact, private insurance purchases should typically be taxed (at least at the margin). Second, the desirability of public provision of LTC services depends on the way the income tax is restricted. In the linear case, it may be desirable only if no demogrant (uniform lump-sum transfer) is available. In the nonlinear case, public provision is desirable when the income tax is sufficiently restricted. Specifically, this is the case when the income is subject only to a proportional payroll tax while the LTC reimbursement policy can be nonlinear.long term care, social insurance

Investigating the market potential for customised long term care insurance products

Previous economic research into long-term care (LTC) has mainly been focussed on one issue: the reasons why the LTC insurance market has not been successful. In this contribution, we analyse the prospects for a new type of insurance policy, which offers a top-up on the resources already available to the individual. We abstract from most problems inherent in LTC insurance markets and derive premium rates for various types of insurance policies. Generally, we find that the top-up option reduces premium rates considerably, to the point where it might be expected that a substantial number of people would take up policies, were they available

Providing Long-term Care without Crowding-out Family Support and Private Insurance

In this paper we are interested in the organization of long-term care within a given population. Three care financers are identified: the family, the government and the care receiver who can buy a dependency insurance. Our interest lies in the effect of governmental intervention on the demand/supply of these three forms of LTC i.e. how state intervention affects the provision of LTC by the market and the family. Knowing that, we search for an efficient organization of LTC.