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

Author

Listed:
  • Pieter Bakx

    (Erasmus University Rotterdam)

  • Bram Wouterse

    (CPB)

  • Eddy (E.K.A.) van Doorslaer

    (Erasmus School of Economics Rotterdam)

  • Albert Wong

    (RIVM)

Abstract

Aging-in-place policies substitute home care for nursing home admissions (NHA). They appear to be a win-win by keeping public spending in check and being in line with personal preferences, but have hitherto not been evaluated. We study the impact of NHA eligibility using Dutch administrative data and exploiting variation between randomly assigned assessors in their tendency to grant admission. The impact on mortality is zero, but with considerable effect heterogeneity. Moreover, aging-in-place policies come at the cost of increased curative care, especially hospital admissions, and do not reduce total healthcare spending, suggesting they may not be a win-win after all.

Suggested Citation

  • Pieter Bakx & Bram Wouterse & Eddy (E.K.A.) van Doorslaer & Albert Wong, 2018. "Better off at home? Effects of a nursing home admission on costs, hospitalizations and survival," Tinbergen Institute Discussion Papers 18-060/V, Tinbergen Institute.
    • Handle: RePEc:tin:wpaper:20180060
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    Cited by:

    1. Krabbe-Alkemade, Yvonne & Makai, Peter & Shestalova, Victoria & Voesenek, Tessa, 2020. "Containing or shifting? Health expenditure decomposition for the aging Dutch population after a major reform," Health Policy, Elsevier, vol. 124(3), pages 268-274.
    2. Maaike Diepstraten & Rudy Douven & Bram Wouterse, 2019. "Can your house keep you out of a nursing home?," CPB Discussion Paper 397, CPB Netherlands Bureau for Economic Policy Analysis.
    3. Marianne Tenand & Arjen Hussem & Pieter Bakx, 2020. "Promoting aging in place through flexible care options: recent developments from the Netherlands [Encourager le maintien à domicile des personnes âgées dépendantes par des modalités alternatives de," Working Papers hal-02985777, HAL.
    4. Marianne Tenand & Pieter Bakx & Eddy van Doorslaer, 2020. "Equal long‐term care for equal needs with universal and comprehensive coverage? An assessment using Dutch administrative data," Health Economics, John Wiley & Sons, Ltd., vol. 29(4), pages 435-451, April.
    5. Marianne Tenand & Pieter Bakx & Eddy van Doorslaer, 2020. "Eligibility or use? Disentangling the sources of horizontal inequity in home care receipt in the Netherlands," Health Economics, John Wiley & Sons, Ltd., vol. 29(10), pages 1161-1179, October.
    6. Maaike Diepstraten & Rudy Douven & Bram Wouterse, 2019. "Can your house keep you out of a nursing home?," CPB Discussion Paper 397.rdf, CPB Netherlands Bureau for Economic Policy Analysis.

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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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