94 research outputs found
Out-of-pocket payments for nursing home residents:Balancing financial protection with incentives for efficient use
Nursing homes are expensive. Confronted with population ageing, governments strive to protect older people against excessive out-of-pocket payments, while at the same time trying to limit public spending on care. This column discusses how the design of out-of-pocket payments for nursing home care can contribute to these goals, building on a study looking at a Dutch reform. A sound design should combine an incentive for efficient care use with protection against the accumulation of out-of-pocket payments over many years
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
Quantifying income inequality in years of life lost to COVID-19:a prediction model approach using Dutch administrative data
Background: Low socioeconomic status and underlying health increase the risk of fatal outcomes from COVID-19, resulting in more years of life lost (YLL) among the poor. However, using standard life expectancy overestimates YLL to COVID-19. We aimed to quantify YLL associated with COVID-19 deaths by sex and income quartile, while accounting for the impact of individual-level pre-existing health on remaining life expectancy for all Dutch adults aged 50þ. Methods: Extensive administrative data were used to model probability of dying within the year for the entire 50þ population in 2019, considering age, sex, disposable income and health care use (n ¼ 6 885 958). The model is used to predict mortality probabilities for those who died of COVID-19 (had they not died) in 2020. Combining these probabilities in life tables, we estimated YLL by sex and income quartile. The estimates are compared with YLL based on standard life expectancy and income-stratified life expectancy. Results: Using standard life expectancy results in 167 315 YLL (8.4 YLL per death) which is comparable to estimates using income-stratified life tables (167 916 YLL with 8.2 YLL per death). Considering pre-existing health and income, YLL decreased to 100 743, with 40% of years lost in the poorest income quartile (5.0 YLL per death). Despite individuals in the poorest quartile dying at younger ages, there were minimal differences in average YLL per COVID-19 death compared with the richest quartile. Conclusions: Accounting for prior health significantly affects estimates of YLL due to COVID-19. However, inequality in YLL at the population level is primarily driven by higher COVID-19 deaths among the poor. To reduce income inequality in the health burden of future pandemics, policies should focus on limiting structural differences in underlying health and exposure of lower income groups.</p
Estimating the costs of non-medical consumption in life-years gained for economic evaluations
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