Abstract
This paper examines the impact of changes in public long-term care spending on the use of public hospitals among the older population in England. Mean per-person long-term care spending fell by 31% between 2009/10 and 2017/18, but cuts varied considerably geographically. We instrument public long-term care spending with predicted spending based on historical national funding shares and national spending trends. We find that reductions in public long-term care spending led to substantial increases in the number of emergency department (ED) visits made by patients aged 65 and above, explaining between a quarter and a half of the growth in ED use among this population over this period, and to an increase in the share of patients revisiting the ED within seven days. However, there was no impact on wider use of inpatient or outpatient services (which are more expensive to provide), and consequently little impact on overall hospital costs.
Highlights
The funding of long-term care is becoming an increasingly important policy concern across the developed world due to demographic changes. 1.3% of US GDP was spent on long-term care in 2010, and this is expected to rise to 3.0% by 2050 (Congressional Budget Office, 2013)
10As a result, while we examine the impacts of changes to overall public long-term care spending, our analysis is more similar to past studies focusing on the relationship between home help and health care (McKnight, 2006; Polsky et al, 2014) as opposed to studies examining changes in nursing home provision (Bakx et al, 2020)
This paper examines the effects of reductions in funding for long-term care on public hospitals in England following a national austerity programme that reduced per-person spending on longterm care by 31% between 2009/10 and 2017/18
Summary
The funding of long-term care is becoming an increasingly important policy concern across the developed world due to demographic changes. 1.3% of US GDP was spent on long-term care in 2010, and this is expected to rise to 3.0% by 2050 (Congressional Budget Office, 2013). In this paper we examine the impacts of reductions in public long-term care spending on hospital utilisation, costs and care quality among the older population in England. While the spending cuts did not lead to large fiscal consequences for health expenditures in the short run, they did lead to significant disruptions in the provision of emergency care at public hospitals, with some evidence of deterioration in the quality of care provided to patients and their subsequent health outcomes. This suggests that the failure to maintain a well-financed system of long-term care will have broader consequences for public services and population health.
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