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Health and Cognition in Old Age pp 179–199Cite as

Understanding Long-Term Care Outcomes: The Contribution of Conventional and Behavioral Economics

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Part of the book series: International Perspectives on Aging ((Int. Perspect. Aging,volume 10))

Abstract

Aging societies are confronted by a growing need for adequate and reliable long-term care (LTC). Against the background of limited financial resources, measurement of LTC outcomes has attracted increasing interest. This chapter discusses how conventional and behavioral economic approaches contribute to our understanding of LTC outcomes and how LTC outcomes can be measured. A production-centered approach is used to identify final LTC outcomes that indicate the impact of LTC on care recipients’ and carers’ quality of life (QoL). Conventional economic approaches assume rational, utility-maximizing individuals as well as perfect markets and suggest that it is possible to measure LTC outcomes indirectly, using revealed-preference approaches, with preferences inferred from care recipients’ choices. However, behavioral economics holds that revealed preferences are not a reliable starting point for measuring QoL gains from LTC services. At the same time, behavioral economists also caution against taking self-assessments of QoL outcomes and stated-preference approaches in economic evaluation at face value. Whichever approach is being followed to measure LTC outcomes, at least three issues need to be addressed: specifying LTC outcome domains, eliciting preferences for these domains, and measuring the impact of LTC on QoL.

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References

  • Albrecht GL, Devlieger PJ (1999) The disability paradox: high quality of life against all odds. Soc Sci Med 48(8):977–988. doi:10.1016/S0277-9536(98)00411-0

    Article  Google Scholar 

  • Amundson R (2010) Quality of life, disability, and hedonic psychology. J Theory Soc Behav 40(4):374–392

    Article  Google Scholar 

  • Ariely D (2009) Predictably irrational. The hidden forces that shape our decisions. HarperCollins, London

    Google Scholar 

  • Ariely D, Wertenbroch K (2002) Procrastination, deadlines, and performance: self-control by precommitment. Psychol Sci 13(3):219–224. doi:10.1111/1467-9280.00441

    Article  Google Scholar 

  • Baldock J (1997) Social care in old age: more than a funding problem. Soc Policy Admin 31(1): 73–89

    Article  Google Scholar 

  • Brandtstädter J, Renner G (1990) Tenacious goal pursuit and flexible goal adjustment: explication and age-related analysis of assimilative and accommodative strategies of coping. Psychol Aging 5(1):58–67

    Article  Google Scholar 

  • Brouwer W, Rutten F, Koopmanschap M (2001) Costing in economic evaluations. In: Drummond MF, McGuire A (eds) Economic evaluations in health care: merging theory with practice. Oxford University Press, New York, pp 68–93

    Google Scholar 

  • Byford S, Sefton T (2003) Economic evaluation of complex health and social care interventions. Natl Inst Econ Rev 186(1):98–108. doi:10.1177/002795010300100114

    Article  Google Scholar 

  • Coons S, Rao S, Keininger D, Hays R (2000) A comparative review of generic quality-of-life instruments. Pharmacoeconomics 17(1):13–35. doi:10.2165/00019053-200017010-00002

    Article  Google Scholar 

  • Diener E, Suh EM, Lucas RE, Smith HL (1999) Subjective well-being: three decades of progress. Psychol Bull 125(2):276–302

    Article  Google Scholar 

  • Dimitrov DM, Rumrill JPD (2003) Pretest-posttest designs and measurement of change. Work 20(2):159–165

    Google Scholar 

  • Flynn TN, Peters TJ, Coast J (2013) Quantifying response shift or adaptation effects in quality of life by synthesising best-worst scaling and discrete choice data. J Choice Model 6:34–43. doi:10.1016/j.jocm.2013.04.004

    Article  Google Scholar 

  • Forder J, Netten A, Caiels J, Smith J, Malley J (2007) Measuring outcomes in social care: conceptual development and empirical design. PSSRU discussion paper 2422. University of Kent, Canterbury

    Google Scholar 

  • Forder J, Malley J, Towers A-M, Netten A (2013) Using cost-effectiveness estimates from survey data to guide commissioning: an application to home care. Health Econ. doi:10.1002/hec.2973

    Google Scholar 

  • Gertler PJ, Martinez S, Premand P, Rawlings LB, Vermeersch CMJ (2011) Impact evaluation in practice. The World Bank, Washington

    Google Scholar 

  • Gilbert DT, Pinel EC, Wilson TD, Blumberg SJ, Wheatley TP (1998) Immune neglect: a source of durability bias in affective forecasting. J Pers Soc Psychol 75(3):617–638. doi:10.1037/0022-3514.75.3.617

    Article  Google Scholar 

  • Johnson M, Maas M, Moorhead S (2005) Pflegeergebnisklassifikation NOC, deutschsprachige Ausgabe übersetzt, bearbeitet und herausgegeben von Andreas Büscher und Peter Tackenberg. Hans Huber, Bern

    Google Scholar 

  • Kahneman D, Krueger AB (2006) Developments in the measurement of subjective well-being. J Econ Perspect 20(1):3–24. doi:10.1257/089533006776526030

    Article  Google Scholar 

  • Kahneman D, Thaler RH (2006) Anomalies: utility maximization and experienced utility. J Econ Perspect 20(1):221–234

    Article  Google Scholar 

  • Kahneman D, Tversky A (1979) Prospect theory: an analysis of decision under risk. Econometrica 47(2):263–292

    Article  Google Scholar 

  • Kahneman D, Tversky A (1996) On the reality of cognitive illusion. Psychol Rev 103(3):582–593

    Article  Google Scholar 

  • Kahneman D, Wakker PP, Sarin R (1997) Back to Bentham? Explorations of experienced utility. Q J Econ 112:375–405

    Article  Google Scholar 

  • Knapp M (1984) The economics of social care. Macmillan, London

    Google Scholar 

  • Le Grand J, Barlett W (1993) Quasi-markets and social policy. Macmillan, London

    Google Scholar 

  • Leibenstein H (1950) Bandwagon, snob, and Veblen effects in the theory of consumers’ demand. Q J Econ 64(2):183–207

    Article  Google Scholar 

  • Loewenstein G (2000) Emotions in economic theory and economic behavior. Am Econ Rev 90(2):426–432

    Article  Google Scholar 

  • Malley J, Fernández J-L (2010) Measuring quality in social care services: theory and practice. Ann Public Coop Econ 81(4):559–582. doi:10.1111/j.1467-8292.2010.00422.x

    Article  Google Scholar 

  • Malley J, Trukeschitz B, Trigg L (forthcoming) Policy instruments to promote good quality long-term care services. In: Fernández J-L, Gori C (eds) Long-term care reforms in OECD countries: successes and failures. Policy Press, Bristol.

    Google Scholar 

  • Mullainathan S, Thaler RH (2000) Behavioral economics. Working paper 7948. National Bureau of Economic Research, Cambridge

    Google Scholar 

  • Netten A (1993a) Costing informal care. In: Netten A, Beecham J (eds) Costing community care. Theory and practice. Ashgate, Aldershot

    Google Scholar 

  • Netten A (1993b) Ökonomische Aspekte sozialer Dienste. In: Braun H, Johne G (eds) Die Rolle sozialer Dienste in der Sozialpolitik. Campus, Frankfurt/Main, pp 27–47

    Google Scholar 

  • Netten A (2011) Overview of outcome measurement for adults using social care services and support. Methods review 6. National Institute for Health Research, School for Social Care Research, London

    Google Scholar 

  • Netten A, Davis B (1990) The social production of welfare and consumption of social services. J Public Policy 10(3):331–347

    Article  Google Scholar 

  • Netten A, Beadle-Brown J, Trukeschitz B, Towers A-M, Welch E, Forder J, Smith J, Alden E (2010) Measuring the outcomes of care homes: final report. PSSRU discussion paper 2696/2. University of Kent, Canterbury

    Google Scholar 

  • Netten A, Burge P, Malley J, Potoglou D, Towers AM, Brazier J, Flynn T, Forder J, Wall B (2012a) Outcomes of social care for adults: developing a preference-weighted measure. Health Technol Assess 16(16):1–166

    Google Scholar 

  • Netten A, Trukeschitz B, Beadle-Brown J, Forder J, Towers A-M, Welch E (2012b) Quality of life outcomes for residents and quality ratings of care homes: is there a relationship? Age Ageing 41:512–517. doi:10.1093/ageing/afs050

    Article  Google Scholar 

  • Nicholas E, Qureshi H (2004) Developing outcome-focused practice: examining the process. Res Policy Plann 22(3):1–13

    Google Scholar 

  • Pindyck RS, Rubinfeld DL (2013) Microeconomics, 8th edn. Pearson, Boston

    Google Scholar 

  • Potoglou D, Burge P, Flynn T, Netten A, Malley J, Forder J, Brazier JE (2011) Best–worst scaling vs. discrete choice experiments: an empirical comparison using social care data. Soc Sci Med 72(10):1717–1727. doi:10.1016/j.socscimed.2011.03.027

    Article  Google Scholar 

  • Qureshi H, Nicholas E (2001) A new conception of social care outcomes and its practical use in assessment with older people. Res Policy Plann 19(2):11–25

    Google Scholar 

  • Qureshi H, Patmore C, Nicholas E, Bamford C (1998) Overview: outcomes of social care for older people and carers. Outcomes in community care practice series. Social Policy Research Unit, University of York, York

    Google Scholar 

  • Raftery J (2000) Costing in economic evaluation. Br Med J 320(10):1597

    Article  Google Scholar 

  • Rand SE, Malley J, Netten A (2012) Measuring the social care outcomes of informal carers. An interim technical report for the identifying the impact of social care (IIASC) study. PSSRU discussion paper 2833. University of Kent, Canterbury

    Google Scholar 

  • Rapley M (2003) Quality of life research. A critical introduction. Sage, London

    Google Scholar 

  • Rossi PH, Lipsey MW, Freeman HE (2004) Evaluation: a systematic approach, 7th edn. Sage, Newbury Park

    Google Scholar 

  • Samuelson PA (1948) Consumption theory in terms of revealed preference. Economica 15(60):243–253. doi:10.2307/2549561

    Article  Google Scholar 

  • Schneider U, Trukeschitz B, Mühlmann R, Ponocny I (2013) “Do I stay or do I go?”—Job change and labor market exit intentions of informal caregivers to the elderly. Health Econ 22(10):1230–1249

    Article  Google Scholar 

  • Schneider U, Sundström G, Johannson L, Tortosa MÁ (forthcoming) Policies to support informal care. In: Fernández J-L, Gori C (eds) Long-term care reforms in OECD countries: successes and failures. Policy Press, Bristol

    Google Scholar 

  • Schooler JW, Ariely D, Loewenstein G (2001) The pursuit and assessment of happiness can be self-defeating. In: Brocas I, Carillo JD (eds) The psychology of economic decisions. Oxford University Press, New York, pp 41–70

    Google Scholar 

  • Schwartz C, Rapkin B (2004) Reconsidering the psychometrics of quality of life assessment in light of response shift and appraisal. Health Qual Life Outcomes 2(1):1–11. doi:10.1186/1477-7525-2-16

    Article  Google Scholar 

  • Schwartz CE, Sajobi TT, Lix LM, Quaranto BR, Finkelstein JA (2013) Changing values, changing outcomes: the influence of reprioritization response shift on outcome assessment after spine surgery. Qual Life Res 22:2255–2264. doi:10.1007/s11136-013-0377-x

    Article  Google Scholar 

  • Sen AK (1985) Commodities and capabilities. North-Holland, Amsterdam

    Google Scholar 

  • Sharp C (1981) The economics of time. Martin Robertson, Oxford

    Google Scholar 

  • Simon HA (1956) Rational choice and the structure of the environment. Psychol Rev 63(2): 129–138

    Article  Google Scholar 

  • Thaler RH (1980) Toward a positive theory of consumer choice. J Econ Behav Organ 1:39–60

    Article  Google Scholar 

  • Trukeschitz B (2006) Im Dienst Sozialer Dienste. Ökonomische Analyse der Beschäftigung in sozialen Dienstleistungseinrichtungen des Nonprofit Sektors, Forschungsergebnisse der Wirtschaftsuniversität Wien, Band 11. Peter Lang, Frankfurt am Main

    Google Scholar 

  • Trukeschitz B (2010) Safeguarding good quality in long-term care: the Austrian approach. Eurohealth 16(2):17–20

    Google Scholar 

  • Trukeschitz B (2011) Worauf es letztlich ankommt. Ergebnisqualität in der Langzeitpflege und Betreuung Kurswechsel 26(4):22–35

    Google Scholar 

  • Trukeschitz B, Fliegenschnee K (2012) Ergebnisqualität in Wiener Tageszentren—eine qualitative Analyse, Forschungsbericht 4/2012. WU Wirtschaftsuniversität Wien, Forschungsinstitut für Altersökonomie,

    Google Scholar 

  • Trukeschitz B, Michalitsch V (2011) “Wo der Schuh drückt”—Stellungnahmen und Verbesserungsvorschläge pflegender Angehöriger zu Betreuungs- und Pflegedienstleistungen in Wien. Forschungsbericht 2/2011, WU Wirtschaftsuniversität Wien, Forschungsinstituts für Altersökonomie,

    Google Scholar 

  • Trukeschitz B, Schneider U, Mühlmann R, Ponocny I (2013) Informal eldercare and work-related strain. J Gerontol B Psychol Sci Soc Sci 68(2):257–267. doi:10.1093/geronb/gbs101

    Article  Google Scholar 

  • Tversky A, Kahneman D (1974) Judgment under uncertainty: heuristics and biases. Science 185(4157):1124–1131

    Article  Google Scholar 

  • Vaarama M (2009) Care-related quality of life in old age. Eur J Ageing 6(2):113–125

    Article  Google Scholar 

  • Wilkinson N, Klaes M (2012) An introduction to behavioural economics, 2nd edn. Palgrave macmillan, Basingstoke

    Google Scholar 

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Acknowledgments

I would like to acknowledge the valuable contributions of Juliette Malley (PSSRU at LSE and the University of Kent), Susanne Mayer and Ulrike Schneider (Institute for Social Policy, WU Vienna University of Economics and Business), Julia Kleindienst (Research Institute for Economics of Aging, WU Vienna), and Ivo Ponocny (MODUL University Vienna). Any errors remain my responsibility. This work has been funded by WU and the Wiener Gesundheitsfoerderung (Vienna Health Promotion).

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Authors and Affiliations

  1. WU-Vienna University of Economics and Business, Research Institute for Economics of Aging, Welthandelsplatz 1, 1020, Vienna, Austria

    Birgit Trukeschitz

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  1. Birgit Trukeschitz
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Correspondence to Birgit Trukeschitz .

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Editors and Affiliations

  1. Faculty of Language and Literature, Humanities, Arts and Education, University of Luxembourg, Walferdange, Luxembourg

    Anja K. Leist

  2. Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland

    Jenni Kulmala

  3. Mental Health Promotion Unit, National Institute for Health and Welfare, THL, Vaasa, Finland

    Fredrica Nyqvist

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Trukeschitz, B. (2014). Understanding Long-Term Care Outcomes: The Contribution of Conventional and Behavioral Economics. In: Leist, A., Kulmala, J., Nyqvist, F. (eds) Health and Cognition in Old Age. International Perspectives on Aging, vol 10. Springer, Cham. https://doi.org/10.1007/978-3-319-06650-9_12

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