Abstract
The Netherlands is one of the few countries that offer generous universal public coverage of long‐term care (LTC). Does this ensure that the Dutch elderly with similar care needs receive similar LTC, irrespective of their income? In contrast with previous studies of inequity in care use that relied on a statistically derived variable of needs, our paper exploits a readily available, administrative measure of LTC needs stemming from the eligibility assessment organized by the Dutch LTC assessment agency. Using exhaustive administrative register data on 616,934 individuals aged 60 and older eligible for public LTC, we find a substantial pro‐poor concentration of LTC use that is only partially explained by poorer individuals' greater needs. Among those eligible for institutional care, higher‐income individuals are more likely to use—less costly—home care. This pattern may be explained by differences in preferences, but also by their higher copayments for nursing homes and by greater feasibility of home‐based LTC arrangements for richer elderly. At face value, our findings suggest that the Dutch LTC insurance “overshoots” its target to ensure that LTC is accessible to poorer elderly. Yet, the implications depend on the origins of the difference and one's normative stance.
Highlights
In view of the current rate of population aging, Organisation for Economic Co-operation and Development (OECD) countries expect the number of elderly requiring assistance in activities of daily living to rise sharply in the coming decades
We first assess whether long-term care (LTC) is allocated according to care needs in the Netherlands, irrespective of income—that is to say, whether LTC use is distributed according to the traditional principle of socioeconomic horizontal equity
Our results show that looking at how actual care use varies across the 32 LTC purchasing regions, for given entitlements, reveals substantial disparities. 26This result complements the findings from a recent paper by Duell et al (2019) assessing practice variation in nursing home care in the Netherlands
Summary
In view of the current rate of population aging, Organisation for Economic Co-operation and Development (OECD) countries expect the number of elderly requiring assistance in activities of daily living to rise sharply in the coming decades. As all developed countries have introduced schemes for financing the use of long-term care (LTC hereafter) by the disabled elderly, public spending on LTC is projected to soar from 1.4% of gross domestic product (GDP) in 2014 to 4.3% by 2060 in Europe (Economic Policy Committee, 2015). 2017), empirical evidence on the ability of existing policies to ensure that all individuals have access to adequate LTC regardless of their socioeconomic resources is still scarce. Such evidence is essential to inform the public debate, as many countries are currently reforming their LTC systems, either to broaden coverage or to reign in increasing spending. We discuss the normative and policy implications of our results, in terms of the ability of the Dutch public insurance to ensure equitable LTC use
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