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Equal long‐term care for equal needs with universal and comprehensive coverage? An assessment using Dutch administrative data

The Netherlands is one of the few countries that offer generous universal public coverage of long‐term care (LTC). Does this ensure that the Dutch elderly with similar care needs receive similar LTC, irrespective of their income? In contrast with previous studies of inequity in care use that relied...

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Autores principales: Tenand, Marianne, Bakx, Pieter, van Doorslaer, Eddy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7078855/
https://www.ncbi.nlm.nih.gov/pubmed/31958885
http://dx.doi.org/10.1002/hec.3994
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author Tenand, Marianne
Bakx, Pieter
van Doorslaer, Eddy
author_facet Tenand, Marianne
Bakx, Pieter
van Doorslaer, Eddy
author_sort Tenand, Marianne
collection PubMed
description The Netherlands is one of the few countries that offer generous universal public coverage of long‐term care (LTC). Does this ensure that the Dutch elderly with similar care needs receive similar LTC, irrespective of their income? In contrast with previous studies of inequity in care use that relied on a statistically derived variable of needs, our paper exploits a readily available, administrative measure of LTC needs stemming from the eligibility assessment organized by the Dutch LTC assessment agency. Using exhaustive administrative register data on 616,934 individuals aged 60 and older eligible for public LTC, we find a substantial pro‐poor concentration of LTC use that is only partially explained by poorer individuals' greater needs. Among those eligible for institutional care, higher‐income individuals are more likely to use—less costly—home care. This pattern may be explained by differences in preferences, but also by their higher copayments for nursing homes and by greater feasibility of home‐based LTC arrangements for richer elderly. At face value, our findings suggest that the Dutch LTC insurance “overshoots” its target to ensure that LTC is accessible to poorer elderly. Yet, the implications depend on the origins of the difference and one's normative stance.
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spelling pubmed-70788552020-03-19 Equal long‐term care for equal needs with universal and comprehensive coverage? An assessment using Dutch administrative data Tenand, Marianne Bakx, Pieter van Doorslaer, Eddy Health Econ Research Articles The Netherlands is one of the few countries that offer generous universal public coverage of long‐term care (LTC). Does this ensure that the Dutch elderly with similar care needs receive similar LTC, irrespective of their income? In contrast with previous studies of inequity in care use that relied on a statistically derived variable of needs, our paper exploits a readily available, administrative measure of LTC needs stemming from the eligibility assessment organized by the Dutch LTC assessment agency. Using exhaustive administrative register data on 616,934 individuals aged 60 and older eligible for public LTC, we find a substantial pro‐poor concentration of LTC use that is only partially explained by poorer individuals' greater needs. Among those eligible for institutional care, higher‐income individuals are more likely to use—less costly—home care. This pattern may be explained by differences in preferences, but also by their higher copayments for nursing homes and by greater feasibility of home‐based LTC arrangements for richer elderly. At face value, our findings suggest that the Dutch LTC insurance “overshoots” its target to ensure that LTC is accessible to poorer elderly. Yet, the implications depend on the origins of the difference and one's normative stance. John Wiley and Sons Inc. 2020-01-20 2020-04 /pmc/articles/PMC7078855/ /pubmed/31958885 http://dx.doi.org/10.1002/hec.3994 Text en © 2020 The Authors. Health Economics published by John Wiley & Sons Ltd This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Articles
Tenand, Marianne
Bakx, Pieter
van Doorslaer, Eddy
Equal long‐term care for equal needs with universal and comprehensive coverage? An assessment using Dutch administrative data
title Equal long‐term care for equal needs with universal and comprehensive coverage? An assessment using Dutch administrative data
title_full Equal long‐term care for equal needs with universal and comprehensive coverage? An assessment using Dutch administrative data
title_fullStr Equal long‐term care for equal needs with universal and comprehensive coverage? An assessment using Dutch administrative data
title_full_unstemmed Equal long‐term care for equal needs with universal and comprehensive coverage? An assessment using Dutch administrative data
title_short Equal long‐term care for equal needs with universal and comprehensive coverage? An assessment using Dutch administrative data
title_sort equal long‐term care for equal needs with universal and comprehensive coverage? an assessment using dutch administrative data
topic Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7078855/
https://www.ncbi.nlm.nih.gov/pubmed/31958885
http://dx.doi.org/10.1002/hec.3994
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