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

Cost of Illness in the Netherlands: description, comparison and projection

Over the past decades health economics has emerged as a new scientific discipline. From the very beginning the field has continued to expand and take on increasing significance. An important focus is on the economic evaluation of health care facilities withln the area of Medical Technology Assessment (MTA) or Health Technology Assessment (HTA). Other topics studied by health economists regard among others the demand for care, the role of health insurance, the industrial organisation of the health care sector and the international comparison of health care systems. Cost-of-illness (COI) studies have also attracted the attention of health economists. Since the pioneering work of Dorothy Rice in the United States in the Sixties [Rice 1966], co

Determinants of first-time utilization of long-term care services in the Netherlands:An observational record linkage study

Background: Since in an ageing society more long-term care (LTC) facilities are needed, it is important to understand the main determinants of first-time utilization of (LTC) services. Methods: The Andersen service model, which distinguishes predisposing, enabling and need factors, was used to develop a model for first-time utilization of LTC services among the general population of the Netherlands. We used data on 214,821 persons registered in a database of general practitioners (NIVEL Primary Care Database). For each person the medical history was known, as well as characteristics such as ethnicity, income, home-ownership, and marital status. Utilization data from the national register on long-term care was linked at a personal level. Generalized Linear Models were used to determine the relative importance of factors of incident LTC-service utilization. Results: Top 5 determinants of LTC are need, measured as the presence of chronic diseases, age, household size, household income and homeownership. When controlling for all other determinants, the presence of an additional chronic disease increases the probability of utilizing any LTC service by 45% among the 20+ population (OR = 1.45, 95% CI: 1.41–1.49), and 31% among the 65+ population (OR = 1.31, 95% CI: 1.27–1.36). With respect to the 20+ population, living in social rent (OR = 2.45, 95% CI = 2.25–2.67, ref. = home-owner) had a large impact on utilizing any LTC service. In a lesser degree this was the case for living alone (OR = 1.63, 95% CI = 1.52–1.75, ref. = not living alone). A higher household income was linked with a lower utilization of any LTC service. Conclusions: All three factors of the Anderson model, predisposing, enabling, and need determinants influence the likelihood of future LTC service utilization. This implies that none of these factors can be left out of the analysis of what determines this use. New in our analysis is the focus on incident utilization. This provides a better estimate of the effects of predictors than a prevalence based analysis, as there is less confounding by changes in determinants occurring after LTC initiation. Especially the need of care is a strong factor. A policy implication of this relative importance of health status is therefore that LTC reforms should take health aspects into account. (aut. ref.

Het is niet al goud wat blinkt:Eigen huis, eigen vermogen en eigen bijdragen aan de langdurige zorg

De eigen bijdragen voor langdurige zorg zijn in Nederland in de afgelopen jaren fors gestegen. Nadat sinds de jaren 1990 vooral het inkomen (inclusief dat uit vermogen) bepalend was voor de hoogte van de eigen bijdrage, telt nu ook het vermogen zelf weer mee als mogelijke financieringsbron daarvan. In dit NEA paper bekijken we welke personen meer zijn gaan betalen. Om dat na te gaan, maken we gebruik van een unieke koppeling van gegevens uit verschillende bronnen op individueel niveau. Onze conclusies zijn als volgt: hoewel eigen bijdragen aan de langdurige zorg een aantrekkelijke mogelijkheid lijken voor het inperken van groei in de zorguitgaven, is het niet al goud wat blinkt. Enerzijds komt dat omdat ouderen met een bovenmodaal inkomen veel minder gebruik maken van langdurige zorg vergeleken met ouderen met onder modaal inkomen. Dit betreft zowel zorg zonder verblijf (4 keer minder) als zorg met verblijf (6 keer minder). Daardoor dragen zorggebruikers die minder verdienen en die tot de ‘risicogroepen’ behoren, te weten eenpersoonshuishoudens en huurders, de zwaarste last van de totale uitgaven aan de langdurige zorg. Anderzijds zal de invoering van een extra vermogensbijtelling voor eigen bijdragen aan langdurige zorg vooral zorggebruikers met middeninkomens treffen maar geen hogere inkomensgroepen. De budgettaire opbrengst zal tegenvallen en de solidariteit tussen meer- en minderverdieners zal afnemen