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Time To Drop Time-To-Death? –Unravelling The Determinants of LTC Spending In The Netherlands

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Author Info

  • de Meijer C
  • Koopmanschap M
  • Bago d
  • Uva T
  • van Doorslaer E

Abstract

A better understanding of what drives long term care (LTC) expenditures is important for all countries with aging populations. We employ unique new data sources to analyze the determinants of LTC spending in the Netherlands. First, we use two-part models, to analyze institutional LTC and homecare expenditures for the entire 55+ population, conditioning not only on age, sex, time-to-death (TTD), but also on cause-of-death and co-residence status. These have profound effects. Those living alone, as well as those who deceased from diabetes, mental illness, stroke, diseases of the respiratory or digestive system have higher LTC expenditures, while a neoplasm death resulted in lower expenditures. Secondly, we examine homecare expenditures among a sample of non-institutionalized individuals conditioning, additionally, on morbidity and disability. Finally, we reconsider the roles of age and TTD, when controlling for the most important determinants of LTC use - morbidity, disability and co-residence - andillustrate their relevance for forecasting LTC expenditures. Our analysis reveals that TTD is not a predictor of homecare expenditures when disability is controlled for, while age and co-residence are. We therefore conclude that it is time to drop time-to-death from LTC expenditure models as it merely acts as a proxy for disability status.

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Bibliographic Info

Paper provided by HEDG, c/o Department of Economics, University of York in its series Health, Econometrics and Data Group (HEDG) Working Papers with number 09/33.

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Date of creation: Dec 2009
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Handle: RePEc:yor:hectdg:09/33

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Postal: HEDG/HERC, Department of Economics and Related Studies, University of York, York, YO10 5DD, United Kingdom
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Fax: (0)1904 323759
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Web page: http://www.york.ac.uk/economics/postgrad/herc/hedg/
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Related research

Keywords: aging; long-term care; expenditures; time-to-death; homecare; institutional care;

References

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  1. Van Houtven, Courtney Harold & Norton, Edward C., 2004. "Informal care and health care use of older adults," Journal of Health Economics, Elsevier, vol. 23(6), pages 1159-1180, November.
  2. Andreas Werblow & Stefan Felder & Peter Zweifel, 2007. "Population ageing and health care expenditure: a school of 'red herrings'?," Health Economics, John Wiley & Sons, Ltd., vol. 16(10), pages 1109-1126.
  3. Thomas E. Getzen, 2001. "Aging and health care expenditures: A comment on Zweifel, Felder and Meiers," Health Economics, John Wiley & Sons, Ltd., vol. 10(2), pages 175-177.
  4. Manning, Willard G. & Mullahy, John, 2001. "Estimating log models: to transform or not to transform?," Journal of Health Economics, Elsevier, vol. 20(4), pages 461-494, July.
  5. Jones, Andrew M., 2000. "Health econometrics," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 6, pages 265-344 Elsevier.
  6. Eric Bonsang, 2008. "Does Informal Care from Children to their Elderly Parents Substitute for Formal Care in Europe?," CREPP Working Papers 0801, Centre de Recherche en Economie Publique et de la Population (CREPP) (Research Center on Public and Population Economics) HEC-Management School, University of Liège.
  7. Manning, Willard G., 1998. "The logged dependent variable, heteroscedasticity, and the retransformation problem," Journal of Health Economics, Elsevier, vol. 17(3), pages 283-295, June.
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Cited by:
  1. Karlsson, Martin & Klohn, Florian, 2011. "Some notes on how to catch a red herring Ageing, time-to-death & care costs for older people in Sweden," Darmstadt Discussion Papers in Economics 57663, Darmstadt Technical University, Department of Business Administration, Economics and Law, Institute of Economics (VWL).
  2. Karlsson, Martin & Klohn, Florian, 2011. "Some notes on how to catch a red herring - Ageing, time-to-death and care costs for older people in Sweden," HERO On line Working Paper Series 2011:6, Oslo University, Health Economics Research Programme.

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