IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v126y2022i1p43-48.html
   My bibliography  Save this article

Strategic cost-shifting in long-term care. Evidence from the Netherlands

Author

Listed:
  • Alders, Peter
  • Schut, Frederik T.

Abstract

With the reform in 2015 of the system of long-term care (LTC) in the Netherlands, responsibilities for the provision of social support and assistance were delegated from the central government to the municipalities. Unintentionally, the way municipalities are financed created incentives to shift cost from the local level back to central level. In this paper we examine whether municipalities respond to the prevailing financial incentives by shifting costs to the public LTC insurance scheme. Using data on almost all Dutch municipalities over the period 2015–2019, we estimate that municipalities with a solvency rate below 20% have a 2.5% higher admission rate to the public LTC scheme. Furthermore, we show that the tightening municipal budgets for social care since 2017 were accompanied with about 14% higher admission rates in 2018 and 2019 compared to 2015. The results point to strategic cost shifting by municipalities that can be counteracted by changing the financial incentives for municipalities and by reducing the existing overlap between the local and central care domains.

Suggested Citation

  • Alders, Peter & Schut, Frederik T., 2022. "Strategic cost-shifting in long-term care. Evidence from the Netherlands," Health Policy, Elsevier, vol. 126(1), pages 43-48.
    • Handle: RePEc:eee:hepoli:v:126:y:2022:i:1:p:43-48
    DOI: 10.1016/j.healthpol.2021.11.008
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S016885102100289X
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.healthpol.2021.11.008?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Bakx, Pieter & Douven, Rudy & Schut, Frederik T., 2021. "Does independent needs assessment limit use of publicly financed long-term care?," Health Policy, Elsevier, vol. 125(1), pages 41-46.
    2. Alders, Peter & Schut, Frederik T., 2019. "The 2015 long-term care reform in the Netherlands: Getting the financial incentives right?," Health Policy, Elsevier, vol. 123(3), pages 312-316.
    3. Alders, Peter & Schut, Frederik T., 2019. "Trends in ageing and ageing-in-place and the future market for institutional care: scenarios and policy implications," Health Economics, Policy and Law, Cambridge University Press, vol. 14(1), pages 82-100, January.
    4. Maarse, J.A.M. (Hans) & Jeurissen, P.P. (Patrick), 2016. "The policy and politics of the 2015 long-term care reform in the Netherlands," Health Policy, Elsevier, vol. 120(3), pages 241-245.
    5. Giuliano Bonoli & Philipp Trein, 2016. "Cost-Shifting in Multitiered Welfare States: Responding to Rising Welfare Caseloads in Germany and Switzerland," Publius: The Journal of Federalism, CSF Associates Inc., vol. 46(4), pages 596-622.
    6. 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.
    Full references (including those not matched with items on IDEAS)

    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. Rainer Kotschy & David E. Bloom, 2022. "A Comparative Perspective on Long-Term Care Systems," NBER Working Papers 29951, National Bureau of Economic Research, Inc.
    2. Grol, Sietske & Molleman, Gerard & van Heumen, Nanne & Muijsenbergh, Maria van den & Scherpbier-de Haan, Nynke & Schers, Henk, 2021. "General practitioners’ views on the influence of long-term care reforms on integrated elderly care in the Netherlands: a qualitative interview study," Health Policy, Elsevier, vol. 125(7), pages 930-940.
    3. de Bresser, Jochem & Knoef, Marike & van Ooijen, Raun, 2022. "Preferences for in-kind and in-cash home care insurance," Journal of Health Economics, Elsevier, vol. 84(C).
    4. Maud H. Korte & Gertjan S. Verhoeven & Arianne M. J. Elissen & Silke F. Metzelthin & Dirk Ruwaard & Misja C. Mikkers, 2020. "Using machine learning to assess the predictive potential of standardized nursing data for home healthcare case-mix classification," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(8), pages 1121-1129, November.
    5. 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.
    6. Marianne Tenand & Pieter Bakx & Bram Wouterse, 2021. "The impact of co-payments for nursing home care on use, health, and welfare," CPB Discussion Paper 430, CPB Netherlands Bureau for Economic Policy Analysis.
    7. Alders, Peter & Schut, Frederik T., 2019. "The 2015 long-term care reform in the Netherlands: Getting the financial incentives right?," Health Policy, Elsevier, vol. 123(3), pages 312-316.
    8. Matus-López, Mauricio, 2021. "Diferencia entre cuidados a la dependencia y cuidados de larga duración o long-term care. Una aclaración necesaria [Difference between dependency care and long-term care. A necessary clarification]," MPRA Paper 107959, University Library of Munich, Germany.
    9. Mikkers, Misja, 2016. "The Dutch Healthcare System in International Perspective," Other publications TiSEM 800704a0-24ee-4830-8659-2, Tilburg University, School of Economics and Management.
    10. Costa-Font, Joan & Zigante, Valentina, 2020. "Building ‘implicit partnerships’? Financial long-term care entitlements in Europe," LSE Research Online Documents on Economics 106099, London School of Economics and Political Science, LSE Library.
    11. Quitterie Roquebert & Remi Kabore & Jerome Wittwer, 2018. "Decentralized policies and formal care use by the disabled elderly," PSE Working Papers halshs-01877829, HAL.
    12. Noort, Bart A.C. & Ahaus, Kees & van der Vaart, Taco & Chambers, Naomi & Sheaff, Rod, 2020. "How healthcare systems shape a purchaser’s strategies and actions when managing chronic care," Health Policy, Elsevier, vol. 124(6), pages 628-638.
    13. 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).
    14. Amitabh Chandra & Courtney Coile & Corina Mommaerts, 2023. "What Can Economics Say about Alzheimer's Disease?," Journal of Economic Literature, American Economic Association, vol. 61(2), pages 428-470, June.
    15. Van der Aa, Maartje J. & Paulus, Aggie T.G. & Klosse, Saskia & Evers, Silvia M.A.A. & Maarse, Johannes A. M., 2019. "The impact of reforms of national health insurance on solidarity in the Netherlands: comparing health care insurance and long-term care insurance," LSE Research Online Documents on Economics 106225, London School of Economics and Political Science, LSE Library.
    16. van de Bovenkamp, Hester M. & Stoopendaal, Annemiek & Bochove, Marianne van & Bal, Roland, 2020. "Tackling the problem of regulatory pressure in Dutch elderly care: The need for recoupling to establish functional rules," Health Policy, Elsevier, vol. 124(3), pages 275-281.
    17. Marie Blaise & Laetitia Dillenseger, 2020. "Informal caregivers and life satisfaction: Empirical Evidence from the Netherlands," Working Papers of BETA 2020-55, Bureau d'Economie Théorique et Appliquée, UDS, Strasbourg.
    18. 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.
    19. Schichel, Mignon C.P. & Veenstra, Marja Y. & Kempen, Gertrudis I.J.M. & de Vugt, Marjolein E. & van der Zanden, Brigitte A.M. & Verhey, Frans R.J., 2020. "Senior Friendly Communities: Designing an approach for cross-border exchange of public health policy," Health Policy, Elsevier, vol. 124(10), pages 1129-1136.
    20. de Vries, Hein & Vahl, Jos & Muris, Jean & Evers, Silvia & van der Horst, Henriëtte & Cheung, Kei Long, 2021. "Effects of the reform of the Dutch healthcare into managed competition: Results of a Delphi study among experts," Health Policy, Elsevier, vol. 125(1), pages 27-33.

    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:eee:hepoli:v:126:y:2022:i:1:p:43-48. 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: Catherine Liu or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    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.