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Trade-offs in long-term care for older people in an ageing society: A constrained portfolio choice experiment

Author

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  • Boxebeld, Sander
  • Mouter, Niek
  • Exel, Job van

Abstract

Many countries face rapidly ageing populations, resulting in a rising demand for long-term care (LTC) for older people and an increased pressure on LTC systems. In responding to this development, governments face challenging trade-offs between different policy measures and their effects. To inform allocation decisions, this study elicited citizens’ policy preferences for LTC for older people in the Netherlands in 2040. We conducted a constrained portfolio choice experiment, in which 997 respondents composed a portfolio of their preferred policies, subject to a budget constraint, while being presented with the expected effects of their choices. Choices were analysed using a Multiple Discrete Continuous Extreme Value (MDCEV) choice model and a Latent Class Cluster Analysis (LCCA). The results suggest a preference for distributing resources towards multiple policies, including both nursing and social care, over investing heavily in one or two particularly. Also, most respondents chose portfolios constituting a substantial public expenditure increase, suggesting a widespread willingness to accept a tax increase to allow for this. Preferences were particularly heterogeneous with respect to expenditure levels and the adoption of supportive care technologies and compulsory social service for young adults. Policymakers may use these results to support the selection of a portfolio of LTC policies that aligns with public preferences.

Suggested Citation

  • Boxebeld, Sander & Mouter, Niek & Exel, Job van, 2025. "Trade-offs in long-term care for older people in an ageing society: A constrained portfolio choice experiment," The Journal of the Economics of Ageing, Elsevier, vol. 32(C).
    • Handle: RePEc:eee:joecag:v:32:y:2025:i:c:s2212828x25000544
    DOI: 10.1016/j.jeoa.2025.100599
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    JEL classification:

    • D61 - Microeconomics - - Welfare Economics - - - Allocative Efficiency; Cost-Benefit Analysis
    • D71 - Microeconomics - - Analysis of Collective Decision-Making - - - Social Choice; Clubs; Committees; Associations
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • J14 - Labor and Demographic Economics - - Demographic Economics - - - Economics of the Elderly; Economics of the Handicapped; Non-Labor Market Discrimination
    • J18 - Labor and Demographic Economics - - Demographic Economics - - - Public Policy

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