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Reforming Home Care Provision in Germany: Evidence from a Social Experiment

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  • Arntz, Melanie
  • Thomsen, Stephan L.

Abstract

In a long-run social experiment, personal budgets have been tested as an alternative to the home care programs of the German long-term care insurance (LTCI). Due to extending the coverage beyond LTCI approved services and agencies, personal budgets may improve care outcomes compared to the provision of agency care at a constant benefit level, a highly desirable result in light of the ongoing demographic challenge. However, personal budgets also compete with the less generous cash option of the LTCI. Any transition from cash recipients to personal budgets increases LTCI spending, while care outcomes may remain unchanged if informal caregivers are crowded out by formal care. This paper compares care outcomes of the different home care programs and provides a rough cost analysis from the perspective of the LTCI. While personal budgets improve care outcomes compared to agency services, the nationwide introduction of personal budgets increases LTCI spending for former cash recipients without any traceable effect on their care outcomes.

Suggested Citation

  • Arntz, Melanie & Thomsen, Stephan L., 2008. "Reforming Home Care Provision in Germany: Evidence from a Social Experiment," ZEW Discussion Papers 08-114, ZEW - Zentrum für Europäische Wirtschaftsforschung / Center for European Economic Research.
  • Handle: RePEc:zbw:zewdip:7504
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    References listed on IDEAS

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    1. Donges, Juergen B. & Eekhoff, Johann & Franz, Wolfgang & Fuest, Clemens & Möschel, Wernhard & Neumann, Manfred J. M., 2005. "Tragfähige Pflegeversicherung," Kronberger Kreis-Studien 42, Stiftung Marktwirtschaft / The Market Economy Foundation, Berlin.
    2. Liliana Pezzin & Barbara Schone, 1999. "Parental marital disruption and intergenerational transfers: An analysis of lone elderly parents and their children," Demography, Springer;Population Association of America (PAA), vol. 36(3), pages 287-297, August.
    3. Bijwaard, Govert E. & Ridder, Geert, 2005. "Correcting for selective compliance in a re-employment bonus experiment," Journal of Econometrics, Elsevier, vol. 125(1-2), pages 77-111.
    4. Liliana E. Pezzin & Peter Kemper & James Reschovsky, 1996. "Does Publicly Provided Home Care Substitute for Family Care? Experimental Evidence with Endogenous Living Arrangements," Journal of Human Resources, University of Wisconsin Press, vol. 31(3), pages 650-676.
    5. Schulz, Erika & Leidl, Reiner & Konig, Hans-Helmut, 2004. "The impact of ageing on hospital care and long-term care--the example of Germany," Health Policy, Elsevier, vol. 67(1), pages 57-74, January.
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    8. Jens Lundsgaard, 2005. "Consumer Direction and Choice in Long-Term Care for Older Persons, Including Payments for Informal Care: How Can it Help Improve Care Outcomes, Employment and Fiscal Sustainability?," OECD Health Working Papers 20, OECD Publishing.
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    10. Arntz, Melanie & Thomsen, Stephan L., 2008. "Crowding out Informal Care? Evidence from a Social Experiment in Germany," ZEW Discussion Papers 08-113, ZEW - Zentrum für Europäische Wirtschaftsforschung / Center for European Economic Research.
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    More about this item

    Keywords

    consumer directed long-term care; agency care; social experiment; Germany;

    JEL classification:

    • C93 - Mathematical and Quantitative Methods - - Design of Experiments - - - Field Experiments
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs

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