Substitution of Formal and Informal Home Care Service Use and Nursing Home Service Use: Health Outcomes, Decision-Making Preferences, and Implications for a Public Health Policy.

Chia-Ching Chen,I-Ming Chiu,Taeko Nakashima,Tetsuji Yamada

doi:10.3389/fpubh.2017.00297

Abstract

The purposes of this study are: (1) to empirically identify decision-making preferences of long-term health-care use, especially informal and formal home care (FHC) service use; (2) to evaluate outcomes vs. costs based on substitutability of informal and FHC service use; and (3) to investigate health outcome disparity based on substitutability. The methods of ordinary least squares, a logit model, and a bivariate probit model are used by controlling for socioeconomic, demographic, and physical/mental health factors to investigate outcomes and costs based substitutability of informal and formal health-care use. The data come from the 2013 Japanese Study of Aging and Retirement (JSTAR), which is designed by Keizai-Sangyo Kenkyu-jo, Hitotsubashi University, and the University of Tokyo. The JSTAR is a globally comparable data survey of the elderly. There exists a complement relationship between the informal home care (IHC) and community-based FHC services, and the elasticity's ranges from 0.18 to 0.22. These are reasonable results, which show that unobservable factors are positively related to IHC and community-based FHC, but negatively related to nursing home (NH) services based on our bivariate probit model. Regarding health-care outcome efficiency issue, the IHC is the best one among three types of elderly care: IHC, community-based FHC, and NH services. Health improvement/outcome of elderly with the IHC is heavier concentrated on IHC services than the elderly care services by community-based FHC and NH care services. Policy makers need to address a diversity of health outcomes and efficiency of services based on providing services to elderly through resource allocation to the different types of long-term care. A provision of partial or full compensation for elderly care at home is recommendable and a viable option to improve their quality of lives.

Highlights

The rapid increase in an aging population through a prolonged life expectancy combined with an increase in dependent elderly in Japan [1, 2] has caused a shortage of labor supply, a deterioration of the pension system, an upsurge in health-care costs, and a change in elderly nursing care programs/policies [3]
The primary parameter of interest in this study is the influence of behavioral preferences or choices of home care or nursing home care
Using “bivariate probit model,” we examined the relationship and substitution between IHC and community-based FHC, and NH, our results indicate that unobservable factors are positively related to IHC and community-based FHC, but negatively related to nursing home care

Summary

Introduction

The rapid increase in an aging population through a prolonged life expectancy combined with an increase in dependent elderly in Japan [1, 2] has caused a shortage of labor supply (a decrease in the labor force participation rate from 60% in 2010 to 54% in 2030), a deterioration of the pension system (from one elderly vs. 2.4 working age persons in 2012 to 1.2 persons in 2060), an upsurge in health-care costs (an increase in health spending in % of GDP from 9% in 2010 to 14% in 2020, and to 19% in 2030), and a change in elderly nursing care programs/policies [3]. This is imperative because of the tightening health-care economy in addition to a lack of human resources, long-term care facilities, and financial resources. Is a change in policy/program from institutional formal care to a community-based formal/ informal care efficient and sufficient?

Objectives

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Results

Conclusion