Explaining regional variation in home care use by demand and supply variables

Noort, Olivier van; Schotanus, Fredo; Klundert, Joris van der; Telgen, Jan

doi:10.1016/j.healthpol.2017.05.003

Cited by 6 publications

(9 citation statements)

References 43 publications

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“…Similar trends are observed in previous studies 35 and a possible explanation is that non-metropolitan individuals have less access to LTC services. 36 An alternative explanation is that fewer individuals in metropolitan areas live with extended family members, which may increase the probability of receiving LTC services 37 even after adjusting for single elderly households.…”

Section: Discussionmentioning

confidence: 99%

Individual and regional determinants of long-term care expenditure in Japan: evidence from national long-term care claims

Jin

Mori

Watanabe

et al. 2020

European Journal of Public Health

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Background Japan, with the oldest population in the world, faces a financial challenge caused by rising long-term care (LTC) expenditure. For policymakers to address this, it is important that we have a better understanding of how individual and regional characteristics affect LTC expenditure. Methods We linked national LTC insurance (LTCI) claim data, covering the entire population who used LTCI services in Japan, with municipality data on an individual level. Individuals 65 years and older (n=3 876 068) who had used LTCI benefits at least once in the fiscal year (FY) 2016 were included. We examined the associations of individual and municipality characteristics regarding supply and demand of healthcare with the LTC expenditures on facility care, home and community care, and total care (the sum of both types of care), after adjusting for regional differences in LTC extra charges. Results The following variables were associated with higher total expenditure; at the individual level: female, a higher care-need level, a lower income (0% co-payments) or a facility service user; at the municipality level: municipalities locating in metropolitan areas, with a higher proportion of single elderly households, more doctors per 1000 citizens, more nursing homes per 100 000 LTC benefit users or more outpatient medical spending per citizen ≥75 years old. Conclusions As we are able to identify several individual and municipality characteristics associated with higher LTC expenditure in Japan, the study offers insights into dealing with the rapidly growing LTC expenditure.

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Section: Discussionmentioning

confidence: 99%

Individual and regional determinants of long-term care expenditure in Japan: evidence from national long-term care claims

Jin

Mori

Watanabe

et al. 2020

European Journal of Public Health

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“…However, it is unfortunate that no data could be included regarding functioning and functional impairment, which are important predictors according to the literature. 17 19 The literature overview by van Noort et al 17 identified age, functional impairment, gender and income as important predictors of DNC severity. In our study, age was in both groups one of the most important predictors of DNC utilisation.…”

Section: Discussionmentioning

confidence: 99%

“…In the interpretation of the results, some limitations should be considered. First, because of the nature of claims data, it was not possible to include potentially relevant predictors based on the literature regarding health status, such as physical and daily functioning, 17 19 since this information was not readily available in the dataset. While the costs of healthcare utilisation other than DNC can be seen as an indicator for limitations in daily functioning, the dataset provides no insight into the details regarding the functional impairment on the patient level.…”

Section: Discussionmentioning

confidence: 99%

“…18 These characteristics are dependent on (1) predisposing factors (ie, characteristics that exist before a person's illness, such as age, gender and health beliefs), (2) enabling factors (ie, logistical aspects such as income, health insurance and travel time to available facilities), and (3) need factors (ie, the level of disability and illness as perceived by the individual). 18 Two recent studies conducted in the Dutch context focusing on predictors in home healthcare including DNC identified age and gender as predisposing factors, 17 income 17 or social environmental characteristics 19 as enabling factor, and impairment, 17 physical functioning and daily functioning 19 as need factors. Both studies focus on home healthcare, which includes social work, household care, and/or care delivered by municipals, rather than district nursing specifically.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…Two recent studies conducted in the Dutch context focusing on predictors in home healthcare including DNC identified age and gender as predisposing factors, 17 income 17 or social environmental characteristics 19 as enabling factor, and impairment, 17 physical functioning and daily functioning 19 as need factors. Both studies focus on home healthcare, which includes social work, household care, and/or care delivered by municipals, rather than district nursing specifically.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of district nursing care utilisation for community-living people in the Netherlands: an exploratory study using claims data

et al. 2021

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ObjectiveTo explore predictors of district nursing care utilisation for community-living (older) people in the Netherlands using claims data. To cope with growing demands in district nursing care, knowledge about the current utilisation of district nursing care is important.SettingDistrict nursing care as a part of primary care.ParticipantsIn this nationwide study, claims data were used from the Dutch risk adjustment system and national information system of health insurers. Samples were drawn of 5500 pairs of community-living people using district nursing care (cases) and people not using district nursing care (controls) for two groups: all ages and aged 75+ years (total N=22 000).Outcome measuresThe outcome was district nursing care utilisation and the 114 potential predictors included predisposing factors (eg, age), enabling factors (eg, socioeconomic status) and need factors (various healthcare costs). The random forest algorithm was used to predict district nursing care utilisation. The performance of the models and importance of predictors were calculated.ResultsFor the population of people aged 75+ years, most important predictors were older age, and high costs for general practitioner consultations, aid devices, pharmaceutical care, ambulance transportation and occupational therapy. For the total population, older age, and high costs for pharmaceutical care and aid devices were the most important predictors.ConclusionsPeople in need of district nursing care are older, visit the general practitioner more often, and use more and/or expensive medications and aid devices. Therefore, close collaboration between the district nurse, general practitioner and the community pharmacist is important. Additional analyses including data regarding health status are recommended. Further research is needed to provide an evidence base for district nursing care to optimise the care for those with high care needs, and guide practice and policymakers’ decision-making.

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Social factors influencing utilization of home care in community-dwelling older adults: a scoping review

et al. 2021

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Background Older adults want to live at home as long as possible, even in the face of circumstances that limit their autonomy. Home care services reflect this emergent preference, allowing older adults to ‘age in place’ in familiar settings rather than receiving care for chronic health conditions or ageing needs in an institutionalized setting. Numerous social factors, generally studied in isolation, have been associated with home care utilization. Even so, social circumstances are complex and how these factors collectively influence home care use patterns remains unclear. Objectives To provide a broad and comprehensive overview of the social factors influencing home care utilization; and to evaluate the influence of discrete social factors on patterns of home care utilization in community-dwelling older adults in high-income countries. Methods A scoping review was conducted of six electronic databases for records published between 2010 and 2020; additional records were obtained from hand searching review articles, reference lists of included studies and documents from international organisations. A narrative synthesis was presented, complemented by vote counting per social factor, harvest plots and an evaluation of aggregated findings to determine consistency across studies. Results A total of 2,365 records were identified, of which 66 met inclusion criteria. There were 35 discrete social factors grouped into four levels of influence using a socio-ecological model (individual, relationship, community and societal levels) and grouped according to outcome of interest (home care propensity and intensity). Across all studies, social factors consistently showing any association (positive, negative, or equivocal in pattern) with home care propensity were: age, ethnicity/race, self-assessed health, insurance, housing ownership, housing problems, marital status, household income, children, informal caregiving, social networks and urban/rural area. Age, education, personal finances, living arrangements and housing ownership were associated with home care intensity, also with variable patterns in utilization. Additional community and societal level factors were identified as relevant but lacking consistency across the literature; these included rurality, availability of community services, methods of financing home care systems, and cultural determinants. Conclusion This is the first literature review bringing together a wide range of reported social factors that influence home care utilization. It confirms social factors do influence home care utilization in complex interactions, distinguishes level of influences at which these factors affect patterns of use and discusses policy implications for home care reform.

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Explaining regional variation in home care use by demand and supply variables

Cited by 6 publications

References 43 publications

Individual and regional determinants of long-term care expenditure in Japan: evidence from national long-term care claims

Individual and regional determinants of long-term care expenditure in Japan: evidence from national long-term care claims

Predictors of district nursing care utilisation for community-living people in the Netherlands: an exploratory study using claims data

Social factors influencing utilization of home care in community-dwelling older adults: a scoping review

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