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Costs and benefits of home care for the elderly versus residential care: a comparison using propensity scores

Abstract

A comparison of the costs of residential care and home care shows that the former is more expensive for society. However, elderly people seem to be happier in residential care. All stakeholders, except the state (and thus the taxpayer), benefit if elderly people enter residential care. This reveals that payment systems in the Netherlands contain adverse incentives stimulating entry into residential care. The research is based on surveys of older people in the Netherlands living at home and those living in residential care homes in the period 2007–2009. Propensity score matching is used to match people living at home with those living in residential care. All costs of living and health care are compared for these two groups.

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Notes

  1. Lechner [13] shows that matching a multinomial probit model is similar to matchings of multiple binomial probit models. And, thus, since the binomial probit model that explains the choice between living at home and living in a residential care home gives a good match, it is valid to not take elderly living in nursing home care into account.

  2. We tried to match people in nursing homes with those living at home, but no match was found. This confirms that living in a nursing home is not a substitute for living at home.

  3. Stata 12.1 and the program psmatch2, v.4.0.6 17 May 2012 (see [14]) was used to perform propensity score matching. This program imposes a common support by dropping treatment observations (i.e. observations from people living in residential care) whose propensity score is higher than the maximum or less than the minimum propensity score of the controls (i.e. people living at home).

References

  1. Colombo, F., Llena-Nozal, A., Mercier, J., Tjadens, F.: Help wanted? Providing and paying for long-term care. OECD health policy studies. OECD, Paris (2011)

    Google Scholar 

  2. OECD: Health at a Glance 2011: OECD indicators. OECD, Paris (2010)

    Google Scholar 

  3. Kendig, H., Browning, C., Pedlow, R., Wells, Y., Thomas, S.: Health, social and lifestyle factors in entry to residential aged care: an Australian longitudinal analysis. Age Ageing 39(3), 342–349 (2010)

    Article  PubMed  Google Scholar 

  4. Luppa, M., Luck, T., Weyerer, S., König, H.H., Brähler, E., Riedel-Heller, S.G.: Prediction of institutionalization in the elderly. A systematic review. Age Ageing 39(1), 31–38 (2010)

    Article  PubMed  Google Scholar 

  5. Luppa, M., Luck, T., Matschinger, H., König, H–.H., Riedel-Heller, S.: Predictors of nursing home admission of individuals without a dementia diagnosis before admission—results from the Leipzig Longitudinal Study of the Aged (LEILA 75+). BMC Health Serv. Res. 10, 186 (2010)

    Article  PubMed Central  PubMed  Google Scholar 

  6. McCann, M., Donelly, M., O’Reilly, D.: Living arrangements, relationship to people in the household and admission to care homes for older people. Age Ageing 40(3), 358–363 (2011)

    Article  PubMed  Google Scholar 

  7. Weissert, W.G., Cready, C.M., Pawelak, J.E.: The past and future of home- and community-based long-term care. Milbank Q. 66(2), 309–388 (1988)

    Article  CAS  PubMed  Google Scholar 

  8. Johri, M., Beland, F., Bergman, H.: International experiments in integrated care for the elderly: a synthesis of the evidence. Int. J. Geriatr. Psychiatry 18(3), 222–235 (2003)

    Article  PubMed  Google Scholar 

  9. Hollander, M.J., Chappell, N.L.: A comparative analysis of costs to government for home care and long-term residential care services, standardized for client care needs. Can. J. Aging 26(Suppl. 1), 149–161 (2007)

    Article  PubMed  Google Scholar 

  10. Chappell, N.L., Havens, B., Hollander, M.J., Miller, J.A., McWilliam, C.: Comparative costs of home care and residential care. Gerontologist 44(3), 389–400 (2004)

    Article  PubMed  Google Scholar 

  11. Naomi, A., Shiroiwa, T., Fukuda, T., Murashima, S.: Institutional care versus home care for the elderly in a rural area: cost comparison in rural Japan. Rural Remote Health 12, 1817 (2012)

    PubMed  Google Scholar 

  12. Van der Ark, L.A.: Mokken scale analysis in R. J. Stat. Softw. 20(11), 1–19 (2007)

    Google Scholar 

  13. Lechner, M: Identification and estimation of causal effects of multiple treatments under the conditional independence assumption. In: Lechner, M., Pfeifer, F. (eds.) (2001) Econometric evaluation of labour market policies in Europe, vol. 13. Springer (2001)

  14. Leuven, E., Sianesi, B.: PSMATCH2: Stata module to perform full Mahalanobis and propensity score matching, common support graphing, and covariate imbalance testing. Version 4.0.6 17may2012, (2003)

  15. Timmermans, J.M. (ed.): Mantelzorg (Informal care). The Netherlands Institute for Social Research (SCP), The Hague (2003)

    Google Scholar 

  16. Sawatzky, J.E., Fowler-Kerry, S.: Impact of caregiving: listening to the voice of informal caregivers. J. Psychiatr. Ment. Health Nurs. 10(3), 277–286 (2003)

    Article  CAS  PubMed  Google Scholar 

  17. Koopmanschap, M., van Exel, J., van den Berg, B., Brouwer, W.: An overview of methods and applications to value informal care in economic evaluations of healthcare. Pharmacoeconomics 26(4), 269–280 (2008)

    Article  PubMed  Google Scholar 

  18. Van den Berg, B., Ferrer-i-Carbonell, A.: Monetary valuation of informal care: the well being valuation method. Health Econ. 16(11), 1227–1244 (2007)

    Article  PubMed  Google Scholar 

  19. Van den Berg, B., Al, M., Brouwer, W., Van Exel, J., Koopmanschap, M.: Economic valuation of informal care: the conjoint measurement method applied to informal caregiving. Soc. Sci. Med. 61(6), 1342–1355 (2005)

    Article  PubMed  Google Scholar 

  20. Klerk, M., Gilsing, R., Timmermans, J.: Op weg met de Wmo. Evaluatie van de Wet maatschappelijke ondersteuning 2007–2009 (The Social Support Act: the story so far. Evaluation of the Social Support Act 2007–2009). The Netherlands Institute for Social Research (SCP), The Hague (2010)

    Google Scholar 

  21. NIBUD (National institute for family finance information). Bestedingen van ouderen (Expenses of elderly people). Utrecht (2006)

  22. Kok, L., Stevens, J., Brouwer, N., van Gameren, E., Sadiraj, K., Woittiez, I.: Kosten en baten van extramuralisering (Costs and benefits of extramuralization). The Netherlands Institute for Social Research (SCP)/SEO Economic Research, The Hague (2004)

    Google Scholar 

  23. Hof, B., Koopmans, C.: Woningcorporaties in Amsterdam: Marktmacht en subsidies (Housing corporations in Amsterdam: Market power and subsidies). SEO Economic Research, Amsterdam (2006)

    Google Scholar 

  24. Van den Brakel, M., Moonen, L.: Huurtoeslag: wie krijgt hoeveel? (Rent subsidy, who gets how much?). Sociaaleconomische Trends pp. 9–19 (2012)

  25. Ho, K.W., Matsubayashi, K., Wada, T., Kimura, M., Yano, S., Otsuka, K., Fujisawa, M., Kita, T., Saijoh, K.: What determines the life satisfaction of the elderly? Comparative study of residential care home and community in Japan. Geriatr Gerontol Int 3(2), 79–85 (2003)

    Article  Google Scholar 

  26. Rodriguez-Blazquez, C., Forjaz, M.J., Prieto-Flores, M.-E., Rojo-Perez, F., Fernandez-Mayoralas, G., Martinez-Martin, P.: Health status and well-being of older adults living in the community and in residential care settings: are differences influenced by age? Aging Ment. Health 16(7), 884–891 (2012)

    Article  PubMed  Google Scholar 

  27. Asakawa, K., Feeny, D., Senthilselvan, A., Johnson, J.A., Rolfson, D.: Do the determinants of health differ between people living in the community and in institutions? Soc. Sci. Med. 69, 345–353 (2009)

    Article  PubMed  Google Scholar 

  28. Grenade, L., Boldy, D.: Social isolation and loneliness among older people: issues and future challenges in community and residential settings. Aust. Health Rev. 32, 468–478 (2008)

    Article  PubMed  Google Scholar 

  29. McCann, M., Grundy, E., O’Reilly, D.: Why is housing tenure associated with a lower risk of admission to a nursing or residential home? Wealth, health and the incentive to keep ‘my home’. J. Epidemiol. Community Health 66(2), 166–169 (2012)

    Article  PubMed  Google Scholar 

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Correspondence to Lucy Kok.

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Kok, L., Berden, C. & Sadiraj, K. Costs and benefits of home care for the elderly versus residential care: a comparison using propensity scores. Eur J Health Econ 16, 119–131 (2015). https://doi.org/10.1007/s10198-013-0557-1

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  • DOI: https://doi.org/10.1007/s10198-013-0557-1

Keywords

  • Home care
  • Residential care
  • Long-term care
  • Cost–benefit analysis
  • Propensity score matching

JEL Classification

  • J14
  • D61
  • C31