Effects of formal home care on hospitalizations and doctor visits

Abstract

This study estimates the effects of formal home care, provided by paid professionals, on hospitalizations and doctor visits. We look at different lengths-of-stay (LOS) and types of doctor visits—general practitioners (GP) and specialists—and investigate heterogeneous effects by age groups and informal care availability. Two-part generalized linear models are estimated, using data from Switzerland. In this federal country, home care policy is decentralized into 26 cantons. Home care is measured at the canton level and its endogeneity is addressed by using an instrumental variable strategy combined with canton and time fixed-effects. We instrument home care use with the introduction of patient cost sharing for home care in some cantons in 2011. Overall, home care significantly increases the likelihoods of having a hospitalization, any doctor visit, or a GP visit. In addition, home care significantly reduces LOS up to 30 days, but has no effect on the number of doctor visits. These results are driven by the effects on persons 65 years and older. The effects are small, suggesting that the potential of formal home care to limit the growth in inpatient care and doctor visits may be limited.

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Acknowledgments

This study was funded by the Swiss National Science Foundation (grant PDFMP1_134899) and the Swiss School of Public Health+. Work was conducted while both authors were at the Geneva School of Economics and Management, University of Geneva. We are particularly grateful to Tamara Konetzka and Peter Kemper for their suggestions and support. We appreciate the comments of Courtney Van Houtven, Will Manning, Peter Zweifel, Eva Cantoni, Jaya Krishnakumar, two anonymous reviewers, and the participants at the 5th American Society of Health Economists Conference, the Health Economics Workshop at the University of Chicago, and the Swiss School of Public Health+ PhD Seminar. We thank Flavia Lazzeri, from the Swiss Federal Statistical Office, for data support, Silvia Marti Lavanchy and Walter Zecca, from the Swiss and Geneva’s Home Care Associations, for answering questions about home care policy in Switzerland.

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Correspondence to Judite Gonçalves.

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Appendix

Appendix

See Figs. 2, 3, 4 and 5 and Tables 5, 6, 7 and 8.

Fig. 2
figure2

Home care hours per capita by canton. Black: cantons without cost sharing; gray: cantons with cost sharing since 2011. Only German-speaking cantons included

Fig. 3
figure3

Hospital beds, doctors, and nursing home beds per capita in cantons with and without cost sharing. Black: cantons without cost sharing; gray: cantons with cost sharing since 2011. Only German-speaking cantons included. Only data since 2005 due to some missing values in prior years

Fig. 4
figure4

Hospital beds, doctors, and nursing home beds per capita by canton. Only German-speaking cantons included

Fig. 5
figure5

Unemployment rate by canton. Only German-speaking cantons included

Table 5 First-stage regressions
Table 6 Full regressions for the German-speaking cantons
Table 7 Full regressions for the national sample
Table 8 Sensitivity checks

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Gonçalves, J., Weaver, F. Effects of formal home care on hospitalizations and doctor visits. Int J Health Econ Manag. 17, 203–233 (2017). https://doi.org/10.1007/s10754-016-9200-x

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Keywords

  • Home care
  • Hospitalizations
  • Doctor visits
  • Instrumental variable

JEL Classification

  • C26
  • H75
  • I11
  • I18