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

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

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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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
Contact details of provider: Postal: HEDG/HERC, Department of Economics and Related Studies, University of York, York, YO10 5DD, United Kingdom
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Web page: http://www.york.ac.uk/economics/postgrad/herc/hedg/
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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. Andrew M. Jones, 2012. "health econometrics," The New Palgrave Dictionary of Economics, Palgrave Macmillan.
  3. Willard G. Manning & John Mullahy, 1999. "Estimating Log Models: To Transform or Not to Transform?," NBER Technical Working Papers 0246, National Bureau of Economic Research, Inc.
  4. 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.
  5. 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.
  6. France Weaver & Sally C. Stearns & Edward C. Norton & William Spector, 2009. "Proximity to death and participation in the long-term care market," Health Economics, John Wiley & Sons, Ltd., vol. 18(8), pages 867-883.
  7. 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.
  8. 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.
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