Abstract
ABSTRACTPractice variation in publicly financed long‐term care (LTC) may be inefficient and inequitable, similarly to practice variation in the health care sector. Although most OECD countries spend an increasing share of their gross domestic product on LTC, it has received comparatively little attention to date compared with the health care sector. This paper contributes to the literature by assessing and comparing regional practice variation in both access to and use of institutional LTC and investigating its relation with income and out‐of‐pocket payment. For this, we have access to unique individual‐level data covering the entire Dutch population. Even though we found practice variation in the use of LTC once access was granted, the variation between regions was still relatively small compared with international standards. In addition, we showed how a co‐payment measure could be used to reduce practice variation across care office regions and income classes making the LTC system not only more efficient but also more equitable.
Highlights
Practice variation in health care refers to variation across geographic areas, or between doctors, that cannot be explained by differences in need (Skinner, 2011)
The first main contribution of our paper is to assess and compare practice variation in both access to and use of institutional long‐term care (LTC) across Dutch care office regions, given that the client has applied for LTC
We (a) provide separate insight into practice variation for granted and for used institutional LTC entitlements across Dutch care office regions, given that the client has applied for LTC and (b) investigate whether differences in income and in out‐of‐pocket payments can explain practice variation
Summary
Practice variation in health care refers to variation across geographic areas, or between doctors, that cannot be explained by differences in need (Skinner, 2011). We (a) provide separate insight into practice variation for granted and for used institutional LTC entitlements across Dutch care office regions, given that the client has applied for LTC and (b) investigate whether differences in income and in out‐of‐pocket payments can explain practice variation. The second analysis (Equation 2) regarding the costs per IC entitlement used by client j (y2j ) was performed on a dataset stratified by income classes This was first done without correcting for out‐of‐pocket payments by client j (Pj) and correcting for Pj. We calculated inequality indexes to investigate the effect of income and out‐ of‐pocket payments on individual differences in practice variation. This, to take into account the possible additional effect of income and out‐of‐pocket payments as a mediator between case‐mix factors and LTC use
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