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Better off at home? Effects of nursing home eligibility on costs, hospitalizations and survival

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  • Bakx, Pieter
  • Wouterse, Bram
  • van Doorslaer, Eddy
  • Wong, Albert

Abstract

Encouraging and helping elderly to postpone a nursing home admission appears to be a win-win that keeps long-term care spending in check and is in line with the target population’s preferences, but there is little evidence about its effects. We study the causal impact of nursing home admission eligibility using Dutch administrative data and exploiting variation between randomly assigned assessors in their tendency to grant eligibility for a nursing home admission. We find a drop in medical care use when eligibility is granted, especially in hospital admissions, while total healthcare spending is unaffected. This suggests that postponing an admission may not always be a win-win after all.

Suggested Citation

  • Bakx, Pieter & Wouterse, Bram & van Doorslaer, Eddy & Wong, Albert, 2020. "Better off at home? Effects of nursing home eligibility on costs, hospitalizations and survival," Journal of Health Economics, Elsevier, vol. 73(C).
    • Handle: RePEc:eee:jhecon:v:73:y:2020:i:c:s0167629619307635
    DOI: 10.1016/j.jhealeco.2020.102354
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    as
    1. Alexandre Belloni & Victor Chernozhukov & Christian Hansen, 2014. "High-Dimensional Methods and Inference on Structural and Treatment Effects," Journal of Economic Perspectives, American Economic Association, vol. 28(2), pages 29-50, Spring.
    2. Joseph J. Doyle Jr., 2007. "Child Protection and Child Outcomes: Measuring the Effects of Foster Care," American Economic Review, American Economic Association, vol. 97(5), pages 1583-1610, December.
    3. James J. Heckman & Sergio Urzua & Edward Vytlacil, 2006. "Understanding Instrumental Variables in Models with Essential Heterogeneity," The Review of Economics and Statistics, MIT Press, vol. 88(3), pages 389-432, August.
    4. Eric French & Elaine Kelly & Pieter Bakx & Owen O'Donnell & Eddy Doorslaer, 2016. "Spending on Health Care in the Netherlands: Not Going So Dutch," Fiscal Studies, Institute for Fiscal Studies, vol. 37, pages 593-625, September.
    5. Brigham Frandsen & Lars Lefgren & Emily Leslie, 2023. "Judging Judge Fixed Effects," American Economic Review, American Economic Association, vol. 113(1), pages 253-277, January.
    6. Claudine de Meijer & Pieter Bakx & Eddy van Doorslaer & Marc Koopmanschap, 2015. "Explaining Declining Rates of Institutional LTC Use in the Netherlands: A Decomposition Approach," Health Economics, John Wiley & Sons, Ltd., vol. 24(S1), pages 18-31, March.
    7. Gordon B. Dahl & Andreas Ravndal Kostøl & Magne Mogstad, 2014. "Family Welfare Cultures," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 129(4), pages 1711-1752.
    8. Norton, E.C., 2016. "Health and Long-Term Care," Handbook of the Economics of Population Aging, in: Piggott, John & Woodland, Alan (ed.), Handbook of the Economics of Population Aging, edition 1, volume 1, chapter 0, pages 951-989, Elsevier.
    9. Will Dobbie & Jacob Goldin & Crystal S. Yang, 2018. "The Effects of Pretrial Detention on Conviction, Future Crime, and Employment: Evidence from Randomly Assigned Judges," American Economic Review, American Economic Association, vol. 108(2), pages 201-240, February.
    10. Alders, Peter & Costa-Font, Joan & de Klerk, Mirjam & Frank, Richard, 2015. "What is the impact of policy differences on nursing home utilization? The cases of Germany and the Netherlands," Health Policy, Elsevier, vol. 119(6), pages 814-820.
    11. Eric French & Jae Song, 2014. "The Effect of Disability Insurance Receipt on Labor Supply," American Economic Journal: Economic Policy, American Economic Association, vol. 6(2), pages 291-337, May.
    12. Jing Guo & R. Tamara Konetzka & Willard G. Manning, 2015. "The Causal Effects of Home Care Use on Institutional Long‐Term Care Utilization and Expenditures," Health Economics, John Wiley & Sons, Ltd., vol. 24(S1), pages 4-17, March.
    13. McKnight, Robin, 2006. "Home care reimbursement, long-term care utilization, and health outcomes," Journal of Public Economics, Elsevier, vol. 90(1-2), pages 293-323, January.
    14. David Autor & Nicole Maestas & Kathleen Mullen & Alexander Strand, 2011. "Does Delay Cause Decay? The Effect of Administrative Decision Time on the Labor Force Participation and Earnings of Disability Applicants," Working Papers wp258, University of Michigan, Michigan Retirement Research Center.
    15. Stephanie Riegg Cellini & Fernando Ferreira & Jesse Rothstein, 2010. "The Value of School Facility Investments: Evidence from a Dynamic Regression Discontinuity Design," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 125(1), pages 215-261.
    16. Jeffrey M Wooldridge, 2010. "Econometric Analysis of Cross Section and Panel Data," MIT Press Books, The MIT Press, edition 2, volume 1, number 0262232588, April.
    17. Costa-Font, Joan & Jimenez-Martin, Sergi & Vilaplana, Cristina, 2018. "Does long-term care subsidization reduce hospital admissions and utilization?," Journal of Health Economics, Elsevier, vol. 58(C), pages 43-66.
    18. Joshua D. Angrist & Jörn-Steffen Pischke, 2009. "Mostly Harmless Econometrics: An Empiricist's Companion," Economics Books, Princeton University Press, edition 1, number 8769.
    19. Claudine Meijer & Pieter Bakx & Eddy Doorslaer & Marc Koopmanschap, 2015. "Explaining Declining Rates of Institutional LTC Use in the Netherlands: A Decomposition Approach," Health Economics, John Wiley & Sons, Ltd., vol. 24, pages 18-31, March.
    20. Jing Guo & R. Tamara Konetzka & Willard G. Manning, 2015. "The Causal Effects of Home Care Use on Institutional Long‐Term Care Utilization and Expenditures," Health Economics, John Wiley & Sons, Ltd., vol. 24, pages 4-17, March.
    21. Abbring, Jaap H & van den Berg, Gerard J, 2005. "Social experiments and intrumental variables with duration outcomes," Working Paper Series 2005:11, IFAU - Institute for Evaluation of Labour Market and Education Policy.
    22. Nicole Maestas & Kathleen J. Mullen & Alexander Strand, 2013. "Does Disability Insurance Receipt Discourage Work? Using Examiner Assignment to Estimate Causal Effects of SSDI Receipt," American Economic Review, American Economic Association, vol. 103(5), pages 1797-1829, August.
    23. Stabile, Mark & Laporte, Audrey & Coyte, Peter C., 2006. "Household responses to public home care programs," Journal of Health Economics, Elsevier, vol. 25(4), pages 674-701, July.
    24. Lucy Kok & Caroline Berden & Klarita Sadiraj, 2015. "Costs and benefits of home care for the elderly versus residential care: a comparison using propensity scores," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(2), pages 119-131, March.
    25. Kim, Hyuncheol Bryant & Lim, Wilfredo, 2015. "Long-term care insurance, informal care, and medical expenditures," Journal of Public Economics, Elsevier, vol. 125(C), pages 128-142.
    26. Curtis Eberwein & John C. Ham & Robert J. Lalonde, 1997. "The Impact of Being Offered and Receiving Classroom Training on the Employment Histories of Disadvantaged Women: Evidence from Experimental Data," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 64(4), pages 655-682.
    27. Orsini, Chiara, 2010. "Changing the way the elderly live: Evidence from the home health care market in the United States," Journal of Public Economics, Elsevier, vol. 94(1-2), pages 142-152, February.
    28. David Autor & Nicole Maestas & Kathleen Mullen & Alexander Strand, 2011. "Does Delay Cause Decay? The Effect of Administrative Decision Time on the Labor Force Participation and Earnings of Disability Applicants," Working Papers wp258, University of Michigan, Michigan Retirement Research Center.
    29. Rudy Douven & Pieter Bakx & Frederik T. Schut, 2016. "Does independent needs assessment limit supply-side moral hazard in long-term care?," CPB Discussion Paper 327, CPB Netherlands Bureau for Economic Policy Analysis.
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    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 5th October 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-10-05 11:00:05

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    Cited by:

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    3. Stöckel, Jannis & Bom, Judith, 2022. "Revisiting longer-term health effects of informal caregiving: Evidence from the UK," The Journal of the Economics of Ageing, Elsevier, vol. 21(C).
    4. Bom, Judith & Stöckel, Jannis, 2021. "Is the grass greener on the other side? The health impact of providing informal care in the UK and the Netherlands," Social Science & Medicine, Elsevier, vol. 269(C).
    5. Xavier Flawinne & Mathieu Lefebvre & Sergio Perelman & Pierre Pestieau & Jérôme Schoenmaeckers, 2023. "Nursing homes and mortality in Europe: Uncertain causality," Health Economics, John Wiley & Sons, Ltd., vol. 32(1), pages 134-154, January.
    6. Moura, Ana, 2021. "Essays in health economics," Other publications TiSEM c93abd22-fa4a-42a5-b172-d, Tilburg University, School of Economics and Management.
    7. Bram Wouterse & Arjen Hussem & Albert Wong, 2022. "The risk protection and redistribution effects of long‐term care co‐payments," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 89(1), pages 161-186, March.
    8. Francisca Vargas Lopes & Pieter Bakx & Sam Harper & Bastian Ravesteijn & Tom Van Ourti, 2022. "The effects of supported housing for individuals with mental disorders," Health Economics, John Wiley & Sons, Ltd., vol. 31(S2), pages 115-133, October.
    9. Moura, Ana, 2022. "Do subsidized nursing homes and home care teams reduce hospital bed-blocking? Evidence from Portugal," Journal of Health Economics, Elsevier, vol. 84(C).
    10. Serrano-Alarcón, Manuel & Hernández-Pizarro, Helena & López-Casasnovas, Guillem & Nicodemo, Catia, 2022. "Effects of long-term care benefits on healthcare utilization in Catalonia," Journal of Health Economics, Elsevier, vol. 84(C).
    11. Crawford, Rowena & Stoye, George & Zaranko, Ben, 2021. "Long-term care spending and hospital use among the older population in England," Journal of Health Economics, Elsevier, vol. 78(C).
    12. Hollingsworth, Bruce & Ohinata, Asako & Picchio, Matteo & Walker, Ian, 2022. "Does It Matter Who Cares for You? The Effect of Substituting Informal with Formal Personal Care on the Care Recipients' Health," IZA Discussion Papers 15457, Institute of Labor Economics (IZA).
    13. Almuhaisen, Abdulmohsen & Amuedo-Dorantes, Catalina & Furtado, Delia, 2024. "Immigration enforcement and the institutionalization of elderly Americans," Journal of Health Economics, Elsevier, vol. 94(C).
    14. Bonekamp, Johan & Wouterse, Bram, 2023. "Do different shocks in health matter for wealth?," Journal of Health Economics, Elsevier, vol. 87(C).
    15. Manuel Serrano-Alarcón & Helena Hernández-Pizarro & Guillem López i Casasnovas & Catia Nicodemo, 2021. "The effect of Long-Term Care (LTC) benefits on healthcare use," Working Papers 2021-12, FEDEA.
    16. Walsh, Brendan & Lyons, Seán, 2021. "Demand for the Statutory Home Care Scheme," Research Series, Economic and Social Research Institute (ESRI), number RS122.
    17. Bergeot, Julien & Tenand, Marianne, 2023. "Does informal care delay nursing home entry? Evidence from Dutch linked survey and administrative data," Journal of Health Economics, Elsevier, vol. 92(C).

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    More about this item

    Keywords

    Long-term care; Policy evaluation; Instrumental variables;
    All these keywords.

    JEL classification:

    • C26 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Instrumental Variables (IV) Estimation
    • I10 - Health, Education, and Welfare - - Health - - - General

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