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Determinants of received long-term care – Individual responses to regional nursing home provisions

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Abstract

Existing literature analyzing the choice of received long-term care by frail elderly (65+ years) predominantly focuses on physical and psychological conditions of elderly people as factors that influence the decision for a particular type of care. Until now, however, the regional in-patient long-term care supply has been neglected as influential factor in this decision-making process. In this study, we analyze the determinants of received long-term care in Germany by explicitly taking the regional supply of nursing homes into account. We estimate a multinomial probit model to illustrate this decision-making process. Therefore, within this discrete choice setting we distinguish between all available types of long-term care in Germany, i.e. four different types of formal and informal care provision. We find that the decision for long-term in-patient care is significantly correlated with the regional supply of nursing home beds, while controlling for physical and psychological conditions of the individual.

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Notes

  1. For price adjustments, price indices for out-patient as well as in-patient health care services are considered using 2012 as base year [30].

  2. A general overview on care provision and its taxonomy is provided by [22].

  3. Detailed definitions of the variables are provided in Table 3 in the Appendix.

  4. For the long list of variables we performed a collinearity check. This check revealed correlations on a moderate level for all variable combinations.

  5. A theoretical illustration of this model is provided in [8, 14] and [43].

  6. Other authors also assume that individuals choose that alternatives providing them the highest utility level (see e.g. [27, 41]).

  7. Intuitively, an interaction term of both dummy variables for women und living alone may be of interest. However, due to the non-linearity of the model an interaction term does not allow for correct inference about sign, magnitude or statistical significance of the estimated interaction effect as shown by [1]. Therefore, we forgo including this interaction term in the model.

  8. The average marginal effects for this model specification are provided in Table 4 in the Appendix.

References

  1. Ai C, Norton EC (2003) Interaction terms in logit and probit models. Econ Lett 80(1):123–129

    Article  Google Scholar 

  2. Arling G, Harkins EB, Romaniuk M (1984) Adult day care and the nursing home: the appropriateness of care in alternative settings. Res. Aging 6(2):225–242

    Article  Google Scholar 

  3. Balia S, Brau R (2011) A country for old men? An analysis of the determinants of long-term home care in Europe. Working paper, Centre for North South Economic Research. University of Cagliari and Sassari, Sardinia

    Google Scholar 

  4. Bauer EJ (1996) Transitions from home to nursing home in a capitated long-term care program: the role of individual support systems. Health Serv Res 31(3):309–326

    Google Scholar 

  5. Bolin K, Lindgren B, Lundborg P (2008) Informal and formal care among single-living elderly in Europe. Health Econ 17(3):393–409

    Article  Google Scholar 

  6. Bonsang E (2009) Does informal care from children to their elderly parents substitute for formal care in Europe? J Health Econ 28(1):143–154

    Article  Google Scholar 

  7. Cameron AC, Trivedi PK (2005) Microeconomerics - methods and applications. Cambridge University Press, Cambridge

    Book  Google Scholar 

  8. Cameron AC, Trivedi PK (2005) Microeconometrics: methods and applications. Cambridge university press

  9. Charles KK, Sevak P (2005) Can family caregiving substitute for nursing home care? J Health Econ 24 (6):1174–1190

    Article  Google Scholar 

  10. Chiswick BR (1976) The demand for nursing home care: an analysis of the substitution between institutional and noninstitutional care. J Human Res 11(3):295–316

    Article  Google Scholar 

  11. Coughlin TA, McBride TD, Perozek M, Liu K (1992) Home care for the disabled elderly: predictors and expected costs. Health Serv Res 27(4):453–479

    Google Scholar 

  12. Du J (2012) Formal and informal care: an empirical Bayesian analysis using the two-part model. Forum Health Econ Policy 15(2)

  13. Freedman VA (1996) Family structure and the risk of nursing home admission. J Gerontol Ser B Psychol Sci Soc Sci 51B(2):S61–S69

    Article  Google Scholar 

  14. Greene WH (2008) Econometric analysis. Granite Hill Publishers

  15. Harwood RH, Sayer AA, Hirschfeld M (2004) Current and future worldwide prevalence of dependency, its relationship to total population, and dependency ratios. Bull World Health Organ 82(4):251–258

    Google Scholar 

  16. Headen AE Jr (1993) Economic disability and health determinants of the hazard of nursing home entry. J Human Res 28 (1):80–110

  17. Houtven CHV, Norton EC (2004) Informal care and health care use of older adults. J Health Econ 23 (6):1159–1180

    Article  Google Scholar 

  18. Jette AM, Branch LG, Sleeper LA, Feldman H, Sullivan LM (1992) High-risk profiles for nursing home admission. Gerontologist 32(5):634–640

    Article  Google Scholar 

  19. Lyons KS, Zarit SH (1999) Formal and informal support: the great divide. Int J Geriatr Psychiatry 14 (3):183–192

    Article  Google Scholar 

  20. McAuley W, Arling G (1984) Use of in-home care by very old people. J Health Soc Behav 25:54–64

    Article  Google Scholar 

  21. Miller EA, Weissert WG (2000) Predicting elderly people?s risk for nursing home placement, hospitalization, functional impairment, and mortality: a synthesis. Med Care Res Rev 57(3):259–297

    Article  Google Scholar 

  22. Norton EC (2000) Long-term care. In: Culyer AJ, Newhouse JP (eds) Handbook of health economics, handbook of health economics, vol. 1. Elsevier, pp 955–994

  23. Pezzin LE, Kemper P, Reschovsky J (1996) Does publicly provided home care substitute for family care? Experimental evidence with endogenous living arrangements. J Human Res 31(3):650–676

    Article  Google Scholar 

  24. Reschovsky JD (1996) Demand for and access to institutional long-term care: the role of Medicaid in nursing markets. Inquiry 33(1):15–29

    Google Scholar 

  25. Sasso ATL, Johnson RW (2002) Does informal care from adult children reduce nursing home admissions for the elderly? Inquiry 39(3):279–297

    Google Scholar 

  26. Schmitz H, Stroka MA (2013) Health and the double burden of full-time work and informal care provision – Evidence from administrative data. Labour Econ 24(0):305–322

    Article  Google Scholar 

  27. Schmitz H, Stroka MA (2014) Do elderly choose nursing homes by quality, price or location? Ruhr Economic Papers:495

  28. Statistisches Bundesamt (2012) Gesundheit – Ausgaben 1995 bis 2010. Fachserie 12 – Reihe 7.1.2. Wiesbaden

  29. Statistisches Bundesamt (2014) Gesundheit – Ausgaben 2012. Fachserie 12 – Reihe 7.1.1. Wiesbaden

  30. Statistisches Bundesamt (2014) Preise – Verbraucherpreisindizes für Deutschland – Jahresbericht 2013. Wiesbaden

  31. Tennstedt SL, Sullivan LM, McKinlay JB, D’Agostino RB (1990) How important is functional status as a predictor of service use by older people? J Aging Health 2(4):439–461

    Article  Google Scholar 

  32. Thorslund M, Norström T, Wernberg K (1991) The utilization of home help in Sweden: a multivariate analysis. Gerontologist 31(1):116–119

    Article  Google Scholar 

  33. Tomiak M, Berthelot JM, Guimond E, Mustard CA (2000) Factors associated with nursing-home entry for elders in Manitoba, Canada. J Gerontol Ser A Biol Sci Med Sci 55(5):M279–M287

    Article  Google Scholar 

  34. Trydegard GB (1998) Public long term care in Sweden. J Gerontol Soc Work 29(4):13–34

    Article  Google Scholar 

  35. Wan TT, Weissert WG (1981) Social support networks, patient status, and institutionalization. Res Aging 3(2):240–256

    Article  Google Scholar 

  36. Weaver F, Stearns SC, Norton EC, Spector W (2009) Proximity to death and participation in the long-term care market. Health Econ 18(8):867–883

    Article  Google Scholar 

  37. Weissert WG, CREADY C, Pawelak JE (2005) The past and future of home-and community-based long-term care. Milbank Quarterly 83(4):1–71

    Article  Google Scholar 

  38. Weissert WG, Cready CM (1989) Toward a model for improved targeting of aged at risk of institutionalization. Health Serv Res 24(4):485–510

    Google Scholar 

  39. Weissert WG, Scanlon WJ (1985) Determinants of nursing home discharge status. Med Care 23(4):333–343

    Article  Google Scholar 

  40. Weissert WG, Wan TT, Livieratos BB, Pellegrino J (1980) Cost-effectiveness of homemaker services for the chronically ill. Inquiry:230–243

  41. Werner RM, Norton EC, Konetzka RT, Polsky D (2012) Do consumers respond to publicly reported quality information? evidence from nursing homes. J Haematol Suppl 31(1):50–61

    Google Scholar 

  42. Wingard DL, Williams-Jones D, McPhillips J, Kaplan RM, Barret-Connor E (1990) Nursing home utilization in adults: a prospective population-based study. J Aging Health 2(2):179–193

    Article  Google Scholar 

  43. Wooldridge JM (2010) Econometric analysis of cross section and panel data. MIT press

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Acknowledgments

We thank Thomas K. Bauer, Dörte Heger, Ingo Kolodziej, Sandra Schaffner, Ansgar Wübker and three anonymous referees for helpful comments and suggestions. We are grateful to our colleagues from the WINEG for the access to the data of the Techniker Krankenkasse. Financial support by the German Research Foundation (DFG) and the Ruhr Graduate School in Economics is gratefully acknowledged.

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Authors and Affiliations

  1. Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Hohenzollernstr. 1-3, 45128, Essen, Germany

    Adam Pilny & Magdalena A. Stroka

  2. Ruhr Graduate School in Economics, Ruhr-University Bochum, Bochum, Germany

    Adam Pilny

  3. Ruhr-University Bochum, Bochum, Germany

    Magdalena A. Stroka

  4. WINEG - Scientific Institute of TK for Benefit and Efficiency in Health Care, Bramfelder Str. 140, 22305, Hamburg, Germany

    Magdalena A. Stroka

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  1. Adam Pilny
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  2. Magdalena A. Stroka
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Correspondence to Adam Pilny.

Appendix

Appendix

Table 3 Definition of variables
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Table 4 Robustness check – average marginal effects
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Pilny, A., Stroka, M.A. Determinants of received long-term care – Individual responses to regional nursing home provisions. Health Care Manag Sci 19, 326–337 (2016). https://doi.org/10.1007/s10729-015-9333-3

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