Abstract
BackgroundSince in an ageing society more long-term care (LTC) facilities are needed, it is important to understand the main determinants of first-time utilization of (LTC) services.MethodsThe Andersen service model, which distinguishes predisposing, enabling and need factors, was used to develop a model for first-time utilization of LTC services among the general population of the Netherlands. We used data on 214,821 persons registered in a database of general practitioners (NIVEL Primary Care Database). For each person the medical history was known, as well as characteristics such as ethnicity, income, home-ownership, and marital status. Utilization data from the national register on long-term care was linked at a personal level. Generalized Linear Models were used to determine the relative importance of factors of incident LTC-service utilization.ResultsTop 5 determinants of LTC are need, measured as the presence of chronic diseases, age, household size, household income and homeownership. When controlling for all other determinants, the presence of an additional chronic disease increases the probability of utilizing any LTC service by 45% among the 20+ population (OR = 1.45, 95% CI: 1.41–1.49), and 31% among the 65+ population (OR = 1.31, 95% CI: 1.27–1.36). With respect to the 20+ population, living in social rent (OR = 2.45, 95% CI = 2.25–2.67, ref. = home-owner) had a large impact on utilizing any LTC service. In a lesser degree this was the case for living alone (OR = 1.63, 95% CI = 1.52–1.75, ref. = not living alone). A higher household income was linked with a lower utilization of any LTC service.ConclusionsAll three factors of the Anderson model, predisposing, enabling, and need determinants influence the likelihood of future LTC service utilization. This implies that none of these factors can be left out of the analysis of what determines this use. New in our analysis is the focus on incident utilization. This provides a better estimate of the effects of predictors than a prevalence based analysis, as there is less confounding by changes in determinants occurring after LTC initiation. Especially the need of care is a strong factor. A policy implication of this relative importance of health status is therefore that LTC reforms should take health aspects into account.
Highlights
Since in an ageing society more long-term care (LTC) facilities are needed, it is important to understand the main determinants of first-time utilization of (LTC) services
Wealth, homeownership and socio-economic status belong to this category, but these factors influence LTC use in a more complex manner depending on the way in which countries have organised the provision of long-term care [8]
In order to avoid the confounding that results from using current use of LTC we have explored a novel approach in which we looked at first-time use of LTC-services
Summary
Since in an ageing society more long-term care (LTC) facilities are needed, it is important to understand the main determinants of first-time utilization of (LTC) services. The cost of long-term care (LTC), defined as care for people needing daily living support over a prolonged period of time [1], is on the rise in many countries. The reported utilization of According to Andersen’s health care utilization model [3], determinants of LTC can be classified into three groups: predisposing, enabling and need determinants. Wealth, homeownership and socio-economic status belong to this category, but these factors influence LTC use in a more complex manner depending on the way in which countries have organised the provision of long-term care [8]. There are need determinants, which refer to the more or less ‘objective’ need for LTC based on someone’s physical or mental condition
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