Embed Size (px)
DESCRIPTION
Introduction Determinants of the use of care provisions? Are care provisions substitutes? Predictions of the use of care? Research questions
Citation preview
A prediction of the use of care provisions in the Netherlands
(2005-2020)
Jedid-Jah JonkerIngrid Ooms
Isolde WoittiezSocial and Cultural Planning Office (SCP)
The Hague, Netherlands
Outline
1. Introduction2. Conceptual model3. Determinants4. Predictions5. Conclusions
Introduction
Determinants of the use of care provisions?
Are care provisions substitutes? Predictions of the use of care?
Research questions
Process to modelUse of health care provisions No Care Informal care Privately paid care at home Publicly paid household care Publicly paid personal care Publicly paid nursing care Publicly paid residential care Publicly paid nursing homes
Conceptual model: nested
‘Choice’ dimensions Care versus No Care Care at home versus Care in an institution Public paid care at home versus Non-public Choice of the provision
Nested logit Models probabilities of using provision
Nested logit model
Data
Sample Dutch population in 2000 9,457 individuals 30 years or older Demographic variables (age, gender,
education, household composition, degree of urbanization)
Health variables (diseases, limitations, reason for need of care, use of special aid or resources)
Income
Use of care provisions
Decisions No care: 7,475 (79.0%) Informal care: 729 (8.0%) Privately paid care at home: 659 (7.0%) Public household care at home: 255 (3.0%) Public personal care at home: 67 (0.7%) Public nursing care at home: 116 (1.2%) Residential care: 106 (1.1%) Care in a nursing home: 49 (0.5%) Total: 9,457 (100%)
Determinants of the use of care1 2 3 4 5a 5b 6
Diseases 0 + 0 +/- + 0 0Limitations + +/- + 0 0 0 0Reason for need of care ++ + + --Use of special aid + +/- + + 0 0 +/-Age ++ ++ -- + 0 0 ++Female 0 - -- ++ 0 0 ++Widow or single ++ + + 0 0 0 ++Urbanisation ++ +/- -- 0 0 0 0Education ++ 0 0 0 0 0 ++Income + -- +/- - 0 0 ++
1 = Care (vs. no care) 5a = Nursing care at home (vs. household)2 = Care in institution (vs. care at home) 5b = Personal care at home (vs. household)3 = Nursing home (vs. residential care) 6 = Private care at home (vs. informal care)4 = Public care at home (vs. non-public)
Conclusion determinants
Determinants Demographic, health and incomes variables
are important Demographic especially for care / no care and
private / informal care at home decision Determinants not important for choice of
public care provision at home
Macro-use of care provisions
Prediction based on: Estimated probabilities of use of care
provisions Forecasts of the determinants, based on
population simulation model (not only demography)
For instance: income based on projections by CPB, diseases on projections by RIVM
Prediction of determinants Ageing: more people of 60 years and older (from
30% to 38%) Not much evidence for double-ageing Impairments with movement (14% to 16%) Diabetes (from 5% to 7%) Asthma (from 9% to 12%) Education: only lower education decreases from 11%
to 7% Real income grows with 0.75% per year
Care and no care (indices)
90
100
110
120
130
2005 2010 2015 2020
CareTotal populationNo care
Care at home vs. in an institution
90
100
110
120
130
2005 2010 2015 2020
Care at homeCare in institutionTotal population
Residential care vs. nursing home
90
100
110
120
130
2005 2010 2015 2020
Nursing homesResidential careTotal population
Public vs. non-public care at home
90
100
110
120
130
2005 2010 2015 2020
Non-publicPublicTotal population
Privately paid vs. informal care
90
100
110
120
130
140
150
2005 2010 2015 2020
Privately paidInformalTotal population
Public paid care at home
90
100
110
120
130
2005 2010 2015 2020
Personal careNursing careTotal populationHousehold care
Summary of predictions
Demand for care increases Care at home and in an institution
both increase equally fast Care at home: Privately paid care
grows fast. Public care and informal care grow slightly
Institutional care: Nursing homes grows slightly faster than residential care
Public care at home: Growth in personal care (and nursing care). Household care decreases
Conclusions (1)Privately paid care increases People rely less on public care at
home Quality too low? Supply too limited
(waiting times, too few hours)? Too high own payments?
Informal care does not increase Informal care is not a substitute for
public care Supply too limited? Difficult to ask?
Privately paid more flexible?
Conclusions (2)
Household care decreases People prefer privately paid care for
‘light’ care
Personal care increases People stay at home longer, needing
more specialized care
Nursing care slightly increases ‘Heavy’ care: care at home no
alternative for care in institution
Summary
Use of care Demographic, health and income variables Demographic important for care / no care and
private / informal care
Prediction Rely less on public care Do not rely more on informal care Stay at home longer, needing more care Nursing care at home no alternative for
institutional care
