Health Care Management Science

, Volume 15, Issue 4, pp 385–412 | Cite as

Modeling the demand for long-term care services under uncertain information

  • Teresa Cardoso
  • Mónica Duarte Oliveira
  • Ana Barbosa-Póvoa
  • Stefan Nickel
Article

Abstract

Developing a network of long-term care (LTC) services is currently a health policy priority in many countries, in particular in countries with a health system based on a National Health Service (NHS) structure. Developing such a network requires proper planning and basic information on future demand and utilization of LTC services. Unfortunately, this information is often not available and the development of methods to properly predict demand is therefore essential. The current study proposes a simulation model based on a Markov cycle tree structure to predict annual demand for LTC services so as to inform the planning of these services at the small-area level in the coming years. The simulation model is multiservice, as it allows for predicting the annual number of individuals in need of each type of LTC service (formal and informal home-based, ambulatory and institutional services), the resources/services that are required to satisfy those needs (informal caregivers, domiciliary visits, consultations and beds) and the associated costs. The model developed was validated using past data and key international figures and applied to Portugal at the Lisbon borough level for the 2010–2015 period. Given data imperfections and uncertainties related to predicting future LTC demand, uncertainty was modeled through an integrated approach that combines scenario analysis with probabilistic sensitivity analysis using Monte Carlo simulation. Results show that the model provides information critical for informing the planning and financing of LTC networks.

Keywords

Long-term care Demand Markov model Simulation Uncertainty Portugal 

Abbreviations

AAGR

Average annual growth rate

AC

Ambulatory care

ADL

Activity of daily living

CD

Chronic diseases

CI

Confidence intervals

CS

Chronic patients with symptoms

CWS

Chronic patients without symptoms

D

Dependent individuals

FHC

Formal home-based care

GDP

Gross domestic product

IADL

Instrumental activity of daily living

IC

Institutional care

IHC

Informal home-based care

LOS

Length of stay

LTC

Long-term care

NC

Non-chronic individuals

ND

Non-dependent individuals

NHS

National health service

NHSur

National health survey

NS

Non-single individuals

NVLI

Not very low income

OC

Other causes

PE

Point estimates

PSSRU

Personal social services research unit

RNCCI

Rede nacional de cuidados continuados integrados

S

Single individuals

TC

Total cost

VLI

Very low income

References

  1. 1.
    World Health Organization (2000) Home-based long-term care: report of a WHO study group Technical Report Series, vol 898. World Health Organization, GenevaGoogle Scholar
  2. 2.
    Brodsky J, Clarfield AM (2009) Organization of health services: long term care in health services. In: Carrin G, Buse K, Heggenhougen K, Quah SR (eds) Health systems policy, finance, and organization. 1st edn. Academic Press, pp 351–357Google Scholar
  3. 3.
    Ministry of Health (2006) Decreto-lei nº 101/2006: Cria a Rede Nacional de Cuidados Continuados Integrados [Create the National Network of Long-Term Care]. Diário da República: I Série-A, nº 109 de 6 de JunhoGoogle Scholar
  4. 4.
    Leichsenring K (2004) Developing integrated health and social care services for older persons in Europe. Int J Integr Care 4:e10Google Scholar
  5. 5.
    Sundström G, Malmberg B, Castiello M, Barrio É, Castejon P, Tortosa M, Johansson L (2007) Family care for elders in Europe: policies and practices. In: Szinovacz M, Davey A (eds) Caregiving contexts: cultural, familiar and societal implications. Springer, New York, pp 235–267Google Scholar
  6. 6.
    Comas-Herrera A, Costa-Font J, Gori C, di Maio A, Patxot C, Pickard L, Pozzi A, Rothgang H, Wittenberg R (2003) European study of long-term care expenditure. PSSRU discussion paper 1840. Personal Social Services Research Unit, LondonGoogle Scholar
  7. 7.
    Comas-Herrera A, Wittenberg R, Costa-Font J, Gori C, di Maio A, Patxot C, Pickard L, Pozzi A, Rothang H (2006) Future long-term care expenditure in Germany, Spain, Italy and the United Kingdom. Ageing Soc 26(2):285–302CrossRefGoogle Scholar
  8. 8.
    Inter-American Conference on Social Security (2008) The Americas Social Security Report 2008: organization and management of long-term care programs. CISS, MexicoGoogle Scholar
  9. 9.
    Roberfroid D, Leonard C, Stordeur S (2009) Physician supply forecast: better than peering in a crystal ball? Hum Resour Health 7(10)Google Scholar
  10. 10.
    Barros PP, Machado SR, Simões JA (2011) Portugal: Health system review. Health Systems in Transition 13(4):1–156Google Scholar
  11. 11.
    Chung RY, Tin KYK, Cowling BJ, Chan KP, Chan WM, Lo SV, Leung G (2009) Long-term care cost drivers and expenditure projection to 2036 in Hong Kong. BMC Health Serv Res 9:172CrossRefGoogle Scholar
  12. 12.
    Lane D, Uyeno D, Stark A, Kliewer E, Gutman G (1985) Forecasting demand for long-term care services. Health Serv Res 20(4):435–460Google Scholar
  13. 13.
    Rivlin AM, Wiener JM (1988) Caring for the disabled elderly: who will pay? 1st edn. Brookings Institution, Washington, D.CGoogle Scholar
  14. 14.
    Robinson J (1996) A long-term care status transition model. The old-age crisis - Actuarial opportunities: The 1996 Bowles SymposiumGoogle Scholar
  15. 15.
    Wittenberg R, Pickard L, Comas-Herrera A, Davies B, Darton R (1998) Demand for long-term care: projections of long-term care finance for elderly people. University of Kent, Personal Social Services Research UnitGoogle Scholar
  16. 16.
    Wittenberg R, Pickard L, Comas-Herrera A, Davies B, Darton R (2001) Demand for long term care for older people in England to 2031. Health Stat Q 12:5–17Google Scholar
  17. 17.
    Comas-Herrera A, Pickard L, Wittenberg R, Davies B, Darton R (2003) Future demand for long-term care, 2001 to 2031: projections of demand for older people in England. PSSRU Discussion Paper 1980. Personal Social Services Research Unit, LondonGoogle Scholar
  18. 18.
    Wittenberg R, Comas-Herrera A, King D, Malley J, Pickard L, Darton R (2006) Future demand for long-term care, 2002 to 2041: projections of demand for long-term care for older people in England. PSSRU Discussion Paper 2330. Personal Social Services Research Unit, LondonGoogle Scholar
  19. 19.
    Pickard L, Wittenberg R, Comas-Herrera A, Davies B, Darton R (2000) Relying on informal care in the new century? Informal care for elderly people in England in 2031. Ageing Soc 20(6):745–772CrossRefGoogle Scholar
  20. 20.
    King D, Malley J, Wittenberg R, Darton R, Comas-Herrera A (2010) Projections of demand for residential care for older people in England - Report for BUPA. PSSRU Discussion Paper 2624. Personal Social Services Research Unit, LondonGoogle Scholar
  21. 21.
    Comas-Herrera A, Wittenberg R, Pickard L, Knapp M (2007) Cognitive impairment in older people: future demand for long-term care services and the associated costs. Int J Geriatr Psychiatry 22(10):1037–1045CrossRefGoogle Scholar
  22. 22.
    Wittenberg R, Pickard L, Malley J, King D, Comas-Herrera A, Darton R (2008) Future demand for social care, 2005 to 2041: projections of demand for social care for older people in england - Report to the Strategy Unit (Cabinet Office) and the Department of Health. PSSRU discussion paper 2514. Personal Social Services Research Unit, LondonGoogle Scholar
  23. 23.
    Comas-Herrera A, Casado D, Wittenberg R, King D, Pickard L (2005) Projections of demand for long-term care for older people in Wales to 2030, by local authority. PSSRU discussion paper 2253. Personal Social Services Research Unit, LondonGoogle Scholar
  24. 24.
    Comas-Herrera A, Wittenberg R, King D, Pickard L (2005) Projections of demand for long-term care in Norfolk to 2016. PSSRU discussion paper 2146. Personal Social Services Research Unit, LondonGoogle Scholar
  25. 25.
    King D, Wittenberg R, Comas-Herrera A, Pickard L (2005) Projections of demand for long-term care in Worcestershire to 2011. PSSRU discussion paper 2144. Personal Social Services Research Unit, LondonGoogle Scholar
  26. 26.
    Xie H, Chaussalet TJ, Millard PH (2005) A continuous time Markov model for the length of stay of elderly people in institutional long-term care. J R Stat Soc A 168(1):51–61CrossRefGoogle Scholar
  27. 27.
    Xie H, Chaussalet TJ, Millard PH (2006) A model-based approach to the analysis of patterns of length of stay in institutional long-term care. IEEE Trans Inf Technol Biomed 10(3):512–518CrossRefGoogle Scholar
  28. 28.
    Chahed S, Demir E, Chaussalet TJ, Millard PH, Toffa S (2011) Measuring and modeling occupancy time in NHS continuing healthcare. BMC Health Serv Res 11:155CrossRefGoogle Scholar
  29. 29.
    Costa-Font J, Wittenberg R, Patxot C, Comas-Herrera A, Gori C, di Maio A, Pickard L, Pozzi A, Rothgang H (2008) Projecting long-term care expenditure in four European Union member states: the influence of demographic scenarios. Soc Indic Res 86(2):303–321CrossRefGoogle Scholar
  30. 30.
    Hostetler S (2011) Evaluating long-term care demand, availability and needs: a 50-year outlook. In: Doolen T, Aken EV (eds) Industrial Engineering Research Conference (IERC) 2011. Reno, NevadaGoogle Scholar
  31. 31.
    Karlsson M, Mayhew L, Plumb R, Rickayzen B (2006) Future costs for long-term care: Cost projections for long-term care for older people in the United Kingdom. Health Policy 75(2):187–213CrossRefGoogle Scholar
  32. 32.
    Zuttion R, Bidino RD, Tubaro E, Garbo M, Ponta S, Cecotti E (2008) Projection of demand for long-term care in an Italian region: a macrosimulation approach. In: European Population Conference (EPC), Barcelona, Spain, July 2008Google Scholar
  33. 33.
    Leung E (2003) Projecting the needs and costs of long term care in Australia Research Paper Number 110. Economics and Commerce: Centre for Actuarial Studies, Victoria AustraliaGoogle Scholar
  34. 34.
    Economic Policy Committee and European Commission (2005) The 2005 EPC projection of age-related expenditure: agreed underlying assumptions and projection methodologies. ECFIN/CEFCPE, BrusselsGoogle Scholar
  35. 35.
    Lagergren M (2005) Whither care of older persons in Sweden? - a prospective analysis based upon simulation model calculations, 2000–2030. Health Policy 74(3):325–334CrossRefGoogle Scholar
  36. 36.
    Lagergren M (2007) A simulation model concerning future needs for long-term care for the elderly persons in Sweden. Int Symp Econ Theory & Econom 16:281–296CrossRefGoogle Scholar
  37. 37.
    CORDIS (2001) Europa : CORDIS. Available via http://cordis.europa.eu/search/index.cfm?fuseaction=proj.document&PJ_RCN=6059809. Accessed September 2011
  38. 38.
    INTERLINKS (2011) INTERLINKS. Available via http://interlinks.euro.centre.org/. Accessed September 2011
  39. 39.
    ANCIEN (2011) Assessing Needs of Care in European Nations, ANCIEN Available via http://www.ancien-longtermcare.eu/. Accessed September 2011
  40. 40.
    Parsons S (2011) Qualitative methods for reasoning under uncertainty. The MIT Press, MassachusettsGoogle Scholar
  41. 41.
    Papadopoulos CE, Yeung H (2001) Uncertainty estimation and Monte Carlo simulation method. Flow Meas Instrum 12(4):291–298CrossRefGoogle Scholar
  42. 42.
    Coyte PC, Goodwin N, Laporte A (2008) How can the settings used to provide care to older people be balanced? Health Systems and Policy Analysis, World Health Organization, CopenhagenGoogle Scholar
  43. 43.
    Evashwick CJ (2005) The continuum of long-term care, 3rd edn. Delmar Publishing, New YorkGoogle Scholar
  44. 44.
    Sonnenberg FA, Beck JR (1993) Markov models in medical decision making: a practical guide. Med Decis Making 13(4):322–338CrossRefGoogle Scholar
  45. 45.
    Karnon J, Brown J (1998) Selecting a decision model for economic evaluation: a case study and review. Health Care Manag Sci 1(2):133–140CrossRefGoogle Scholar
  46. 46.
    Briggs A, Sculpher M, Claxton K (2006) Decision modelling for health economic evaluation. Oxford University, USAGoogle Scholar
  47. 47.
    Petrou S, Gray A (2011) Economic evaluation using decision analytical modelling: design, conduct, analysis, and reporting. BMJ 342:d1766CrossRefGoogle Scholar
  48. 48.
    World Health Organization (2002) Current and future long-term care needs. World Health Organization, GenevaGoogle Scholar
  49. 49.
    Ibe OC (2009) Markov processes for stochastic modeling. Elsevier Academic, MassachusettsGoogle Scholar
  50. 50.
    Busse R, Blümel M, Scheller-Kreinsen D, Zentner A (2010) Tackling chronic disease in Europe: strategies, interventions and challenges. World Health Organization, Observatory Studies Series, 20Google Scholar
  51. 51.
    Asthana S, Gibson A (2008) Health care equity, health equity and resource allocation: towards a normative approach to achieving the core principles of the NHS. Radic Stat 96:6–26Google Scholar
  52. 52.
    Lopes M, Mendes F, Escoval A, Agostinho M, Vieira C, Vieira I, Sousa C, Cardozo S, Fonseca A, Novas VC, Eliseu G, Serra I, Morais C (2010) Plano Nacional de Saúde 2011–2016: Cuidados Continuados Integrados em Portugal – analisando o presente, perspectivando o futuro [Health National Plan 2011–2016: Long-term care in Portugal - analyzing the present, predicting the future]. Alto Comissariado da Saúde, ÉvoraGoogle Scholar
  53. 53.
    Ministries of Finance and Public Administration, Labour and Social Security and Health (2006) Define os preços dos cuidados de saúde e de apoio social prestados no âmbito das experiências piloto da Rede Nacional de Cuidados Continuados Integrados [Define the prices for health and social care provided under the pilot experiments of the National Network of Long-Term Care]. Diário da República: I Série, nº181 de 19 de SetembroGoogle Scholar
  54. 54.
    AARP Public Policy Institute (2006) European experiences with long-term care: France, the Netherlands, Norway, and the United Kingdom. Washington, DCGoogle Scholar
  55. 55.
    Portuguese National Institute of Statistics (2011) Portal do Instituto Nacional de Estatística [Statistics Portugal]. Available via www.ine.pt. Accessed October 2011
  56. 56.
    Mission Unit for Integrated Continuing Care (2011) Unidade de Missão para os Cuidados Continuados Integrados [Mission Unit for Integrated Continuing Care]. Available via URL: www.rncci.min-saude.pt. Accessed 2011 December
  57. 57.
    Hughes BB, Kuhn R, Peterson CM, Rothman DS, Solórzano JR (2011) Improving global health: forecasting the next 50 years - Patterns of potential human progress, vol 3. Paradigm, USAGoogle Scholar
  58. 58.
    Merlis M (1999) Financing long-term care in the twenty-first century: the public and private roles. Institute for Health Policy Solutions, The Commonwealth FundGoogle Scholar
  59. 59.
    Cairns AJG, Blake D, Dowd K (2006) A two-factor model for stochastic mortality with parameter uncertainty: theory and calibration. J Risk Ins 73(4):687–718CrossRefGoogle Scholar
  60. 60.
    Mission Unit for Integrated Continuing Care (2010) Relatório de monitorização do desenvolvimento e da actividade da Rede Nacional de Cuidados Continuados Integrados (RNCCI), 1° semestre 2010 [Report monitoring the development and the activity of the National Network of Long-Term Care (RNCCI), 1st semester 2010]. Cuidados Continuados - Saúde e Apoio SocialGoogle Scholar
  61. 61.
    Petty MD (2009) Verification and validation. In: Sokolowski JA, Banks CM (eds) Principles of modeling and simulation - A multidisciplinary approach. Wiley, New Jersey, pp 121–149Google Scholar
  62. 62.
    Gallivan S (2008) Challenging the role of calibration, validation and sensitivity analysis in relation to models of health care processes. Health Care Manag Sci 11(2):208–213CrossRefGoogle Scholar
  63. 63.
    Burke SP, Feder J, Water PNVD (2005) Developing a better long-term care policy: a vision and strategy for America’s future. National Academy of Social Insurance, WashingtonGoogle Scholar
  64. 64.
    McNamara B, Rosenwax LK, Holman DAJ (2006) A method for defining and estimating the palliative care population. J Pain Symptom Manage 32(1):5–12CrossRefGoogle Scholar
  65. 65.
    Mission Unit for Integrated Continuing Care (2010) Três anos de Rede Nacional de Cuidados Continuados Integrados [3 years of National Network of Long-Term Care]. Cuidados Continuados - Saúde e Apoio SocialGoogle Scholar
  66. 66.
    Bullinger M (2003) International comparability of health interview surveys: An overview of methods and approaches. In: Nosikov A, Gudex C (eds) EUROHIS: Developing common instruments for health surveys. Ios Press, Amsterdam, pp 1–11Google Scholar
  67. 67.
    Mission Unit for Integrated Continuing Care (2008) Critérios gerais de referênciação de doentes para unidades de internamento, de ambulatório e equipas da RNCCI [General criteria for the referral of patients to inpatient and outpatient units and RNCCI teams]. Directiva Técnica 1. UMCCI, LisboaGoogle Scholar
  68. 68.
    National Institute of Health Dr. Ricardo Jorge (2006) Base de dados do Inquérito Nacional de Saúde 2005/2006 [National Health Survey Database 2005/2006]. INSA, LisboaGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Teresa Cardoso
    • 1
  • Mónica Duarte Oliveira
    • 1
  • Ana Barbosa-Póvoa
    • 1
  • Stefan Nickel
    • 2
  1. 1.Centre for Management Studies of Instituto Superior TécnicoUniversidade Técnica de LisboaLisbonPortugal
  2. 2.Discrete Optimization and LogisticsKarlsruhe Institute of Technology, Institute of Operations ResearchKarlsruheGermany

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