The relationship between baseline health and longitudinal costs of hospital use

In this paper, we investigate the relationship between baseline health and costs of hospital use over a period of eight years. We combine cross-sectional survey data with information from the Dutch national hospital register. Four different indicators of health (self-perceived health, long-term impairments, ADL limitations and comorbidity) are considered. We find that for ages 50 to 70, differences in hospital costs between good health and bad health are substantial and persist during the whole time period. However, for higher ages expected hospital costs for individuals in bad health decline rapidly and become lower than those for people in good health after about six to seven years. The higher mortality rate among people in bad health is the primary cause here. Our results are confirmed for all four health indicators. We conclude that relying on better health to contain healthcare expenditures is too optimistic, and the interaction between health and mortality should be taken into account when projecting healthcare costs. Healthy ageing is important, but more for health gains than for cost savings

Long-term care use after a stroke or femoral fracture and the role of family caregivers

Background: There has been a shift from institutional care towards home care, and from formal to informal care to contain long-term care (LTC) costs in many countries. However, substitution to home care or informal care might be harder to achieve for some conditions than for others. Therefore, insight is needed in differences in LTC use, and the role of potential informal care givers, across specific conditions. We analyze differences in LTC use of previously independent older patients after a fracture of femur and stroke, and in particular examine to what extent having a partner and children affects LTC use for these conditions. Methods: Using administrative data on Dutch previously independent older people (55+) with a fracture of femur or stroke in 2013, we investigate their LTC use in the year after the condition takes place. We use administrative treatment data to select individuals who were treated by a medical specialist for a stroke or femoral fracture in 2013. Subsequent LTC use is measured as using no formal care, home care, institutional care or being deceased at 13 consecutive four-weekly periods after initial treatment. We relate long-term care use to having a partner, having children, other personal characteristics and the living environment. Results: The probability to use no formal care 1 year after the initial treatment is equally high for both conditions, but patients with a fracture are more likely to use home care, while patients with a stroke are more likely to use institutional care or have died. Having a spouse has a negative effect on home care and institutional care use, but the timing of the effect, especially for institutional care, differs strongly between the two conditions. Having children also has a negative effect on formal care use, and this effect is consistently larger for patients with a fracture than patients with a stroke. Conclusion: As the condition and the effect of potential informal care givers matter for subsequent long-term care use, policy makers should take the expected prevalence of specific conditions within the older people population into account when designing long-term car

Betere risicospreiding van eigen bijdragen bij verpleeghuiszorg

Ouderen betalen een eigen bijdrage voor het gebruik van verpleeghuiszorg. De hoogte van de eigen bijdrage hangt af van iemands financiële middelen, maar inkomen en vermogen worden verschillend belast. Voor ouderen vormt de eigen bijdrage een aanzienlijk financieel risico. Zo kunnen de jaarlijkse kosten voor langdurige verpleeghuiszorg voor ouderen met een middeninkomen oplopen tot ruim 70% van het netto-inkomen en vele jaren duren

The risk protection and redistribution effects of long‐term care co‐payments

Co‐payments for long‐term care (LTC) can impose a substantial financial burden on the elderly. How this burden is distributed across income groups depends on the design of the co‐payment. We estimate the lifecycle dynamics of LTC using Dutch administrative data. These estimates are inputs in a stochastic lifecycle decision model. Using the model, we analyze the welfare effects of the Dutch income‐ and wealth‐ dependent co‐payment system and compare it to alternative systems. We find that the Dutch co‐payment system redistributes income to low‐income groups, who use the most care over their life but contribute the least co‐payments, from high‐income groups, who pay the most. Moreover, the Dutch system protects the middle‐income groups relatively well against financial risk: although alternative co‐payment systems hardly affect these groups average payments, they induce welfare losses of 2% to 4% due to an increased risk of very high co‐paymen

Estimating the Returns to Public R&D Investments: Evidence from Production Function Models

This paper analyses the returns to publicly performed R&D investments in 22 OECD countries. We exploit a dataset containing time-series from 1963 to 2011 and compare the estimates of diferent types of production function models. Robustness analyses are performed to test the sensitivity of the outcomes for particular specifcations, sample selections, assumptions about the construction of R&D stocks, and variable defnitions. Analyses based on Cobb–Douglas and translog production functions mostly yield statistically insignifcant or negative returns. In these models we control for private and foreign R&D investments and the primary production factors. Models including additional controls, such as public capital, the stock of inward and outward foreign direct investment, and the shares of high-tech imports and exports, yield more positive returns. Our fndings suggest that publicly performed R&D investments do not automatically foster GDP and TFP growth in production function models. Furthermore, our estimates suggest that economic returns to publicly performed R&D seem to depend on the specifc national context