IDEAS home Printed from https://ideas.repec.org/p/esj/esridp/024.html
   My bibliography  Save this paper

The Determinants of Nursing Home Exit and the Price Elasticity of Institutional Care: Evidence from Micro-level Data

Author

Listed:
  • SHIMIZUTANI Satoshi
  • NOGUCHI Haruko

Abstract

This paper uses a unique census data on Japanese nursing homes to evaluate the determinants of nursing home exit and the price elasticity of the institutional care. We take two approaches to address these by making use of micro-level data from Kaigo Service Shisetsu Zigyousho Chousa (Survey on Care Service Providers) conducted by the Ministry of Health, Labor and Welfare in September 2000. First, we use probit estimates to examine the choice decision to exit a nursing facility to home by making use of clients who left their facilities in September 2000. Our results show that one percentage point increase in self-burden to use institutional care will lead to an increase in probability to return to home by 0.04 percentage points for long-term care welfare facilities, 3.7 percentage points for long-term care health facilities, respectively. On the contrary, the price elasticity with respect to exit to re-hospitalization is minus 3.3 percentage points (health care facility) and minus 1.9 percentage points (medical care facility). These results suggest that at-home care is a substitute for institutional care but care services in medical institution are complement for services at nursing homes. Especially, the elderly with relatively lower care levels and thus higher self-burden to use long-term care tends to be re-hospitalized if they do not have any family members to live together. Therefore, policies to address deduction of the "socially hospitalized" elderly should focus on these types of the elderly. Then, we apply a duration model to the sample that consists of all clients who stayed in or left from a nursing home in September 2000 in order to evaluate the price effect on how long a client stays in a nursing home. Our results report that price elasticity with respect to duration staying in nursing homes is 1.7 percentage points (95% confidence interval: 0.4-3.0 percentage points) for long-term care welfare facilities; and 1.8 percentage points (95% confidence interval: 0.0-3.8 percentage points) for health facilities. Our findings demonstrate that price policy might be useful for allocating clients from institutional care to at-home care, though the effect is relatively small for long-term care welfare facilities compared to health facilities.

Suggested Citation

  • SHIMIZUTANI Satoshi & NOGUCHI Haruko, 2002. "The Determinants of Nursing Home Exit and the Price Elasticity of Institutional Care: Evidence from Micro-level Data," ESRI Discussion paper series 024, Economic and Social Research Institute (ESRI).
    • Handle: RePEc:esj:esridp:024
    as

    Download full text from publisher

    File URL: http://www.esri.go.jp/jp/archive/e_dis/e_dis024/e_dis024a.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Alvin E. Headen Jr., 1993. "Economic Disability and Health Determinants of the Hazard of Nursing Home Entry," Journal of Human Resources, University of Wisconsin Press, vol. 28(1), pages 80-110.
    2. Barry R. Chiswick, 1976. "The Demand for Nursing Home Care: An Analysis of the Substitution between Institutional and Noninstitutional Care," Journal of Human Resources, University of Wisconsin Press, vol. 11(3), pages 295-316.
    3. Alan M. Garber & Thomas E. MaCurdy, 1990. "Predicting Nursing Home Utilization among the High-Risk Elderly," NBER Chapters, in: Issues in the Economics of Aging, pages 173-204, National Bureau of Economic Research, Inc.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Mitchell Olivia S. & PIGGOTT John & SHIMIZUTANI Satoshi, 2004. "Aged-Care Support in Japan: Perspectives and Challenges," ESRI Discussion paper series 118, Economic and Social Research Institute (ESRI).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Noguchi, Haruko & Shimizutani, Satoshi, 2011. "The determinants of exit from institutions and the price elasticity of institutional care: Evidence from Japanese micro-level data," Journal of the Japanese and International Economies, Elsevier, vol. 25(2), pages 131-142, June.
    2. Sarma, Sisira & Simpson, Wayne, 2007. "A panel multinomial logit analysis of elderly living arrangements: Evidence from aging in Manitoba longitudinal data, Canada," Social Science & Medicine, Elsevier, vol. 65(12), pages 2539-2552, December.
    3. Darius Lakdawalla & Tomas Philipson, 1999. "Aging and the Growth of Long-Term Care," NBER Working Papers 6980, National Bureau of Economic Research, Inc.
    4. Adam Pilny & Magdalena A. Stroka, 2016. "Determinants of received long-term care – Individual responses to regional nursing home provisions," Health Care Management Science, Springer, vol. 19(4), pages 326-337, December.
    5. Adam Pilny & Magdalena A. Stroka, 2014. "Choice of Received Long-term Care – Individual Responses to Regional Nursing Home Provisions," Ruhr Economic Papers 0525, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
    6. Charles, Kerwin Kofi & Sevak, Purvi, 2005. "Can family caregiving substitute for nursing home care?," Journal of Health Economics, Elsevier, vol. 24(6), pages 1174-1190, November.
    7. Olivia S. Mitchell & John Piggott & Satoshi Shimizutani, 2004. "Aged-Care Support in Japan: Perspectives and Challenges," NBER Working Papers 10882, National Bureau of Economic Research, Inc.
    8. repec:zbw:rwirep:0525 is not listed on IDEAS
    9. Pilny, Adam & Stroka, Magdalena A., 2014. "Choice of Received Long-term Care – Individual Responses to Regional Nursing Home Provisions," Ruhr Economic Papers 525, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    10. Chou, Shin-Yi, 2002. "Asymmetric information, ownership and quality of care: an empirical analysis of nursing homes," Journal of Health Economics, Elsevier, vol. 21(2), pages 293-311, March.
    11. Axel Borsch-Supan & Daniel L. McFadden & Reinhold Schnabel, 1996. "Living Arrangements: Health and Wealth Effects," NBER Chapters, in: Advances in the Economics of Aging, pages 193-216, National Bureau of Economic Research, Inc.
    12. Benoit Dostie & Pierre Thomas Léger, 2005. "The Living Arrangement Dynamics of Sick, Elderly Individuals," Journal of Human Resources, University of Wisconsin Press, vol. 40(4), pages 989-1014.
    13. William F. Bassett, 2004. "Medicaid's nursing home coverage and asset transfers," Finance and Economics Discussion Series 2004-15, Board of Governors of the Federal Reserve System (U.S.).
    14. Alan L. Gustman & F. Thomas Juster, 1995. "Income and Wealth of Older American Households: Modeling Issues for Public Policy Analysis," NBER Working Papers 4996, National Bureau of Economic Research, Inc.
    15. Liliana E. Pezzin & Robert A. Pollak & Barbara S. Schone, 2007. "Efficiency in Family Bargaining: Living Arrangements and Caregiving Decisions of Adult Children and Disabled Elderly Parents," CESifo Economic Studies, CESifo Group, vol. 53(1), pages 69-96, March.
    16. Kenneth A. Couch & Alice Zawacki, 2001. "The Utilization of Different Modes of Residence and Health Services by the Elderly," Working Papers 01-14, Center for Economic Studies, U.S. Census Bureau.
    17. Alan M. Garber, 1994. "Financing Health Care for Elderly Americans in the 1990s," NBER Chapters, in: Aging in the United States and Japan: Economic Trends, pages 175-194, National Bureau of Economic Research, Inc.
    18. Axel Borsch-Supan & Vassilis Hajivassiliou & Laurence J. Kotlikoff, 1992. "Health, Children, and Elderly Living Arrangements: A Multiperiod-Multinomial Probit Model with Unobserved Heterogeneity and Autocorrelated Errors," NBER Chapters, in: Topics in the Economics of Aging, pages 79-108, National Bureau of Economic Research, Inc.
    19. Iegor Rudnytskyi & Joël Wagner, 2019. "Drivers of Old-Age Dependence and Long-Term Care Usage in Switzerland—A Structural Equation Model Approach," Risks, MDPI, vol. 7(3), pages 1-20, August.
    20. Bridget Hiedemann & Michelle Sovinsky & Steven Stern, 2018. "Will You Still Want Me Tomorrow?: The Dynamics of Families’ Long-Term Care Arrangements," Journal of Human Resources, University of Wisconsin Press, vol. 53(3), pages 663-716.
    21. Liangwen Zhang & Sijia Fu & Ya Fang, 2020. "Prediction of the Number of and Care Costs for Disabled Elderly from 2020 to 2050: A Comparison between Urban and Rural Areas in China," Sustainability, MDPI, vol. 12(7), pages 1-13, March.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:esj:esridp:024. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: HORI nobuko The email address of this maintainer does not seem to be valid anymore. Please ask HORI nobuko to update the entry or send us the correct address (email available below). General contact details of provider: https://edirc.repec.org/data/esrgvjp.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.