Search Results (14)

Objectives: This study investigates the presence of crowding-in or crowding-out effects of long-term care insurance (LTCI) on older adults’ care in Korea. Additionally, it examines the influence of old-age income security and private systems, including private transfer income and private health insurance, on these effects. The analysis focuses on three aspects: family-provided care, private non-family care, and total care expenses. Methods: This study conducted logistic and linear regression. Logistic regression was used to examine the likelihood of receiving family-provided and private non-family care, while linear regression analyzed factors associated with total care expenditures. Results: The results reveal a crowding-in effect for family care, as greater utilization of public LTCI is positively associated with family-provided care. However, the relationship between public LTCI and private non-family care was not statistically significant, suggesting that the crowding-in effect on private care systems remains limited. Lastly, LTCI utilization was significantly associated with higher care expenditures. It is noteworthy that the current public LTCI in Korea has low coverage, resulting in insufficient care provision. Consequently, there is growing activity in the private care sector. Conclusions: These findings highlight the need for a more integrated approach to long-term care in Korea, balancing public, private, and family care resources. To achieve quality integrated long-term care for older people, policymakers should focus on expanding public LTCI coverage while fostering coordination between family caregivers and professional care services, ensuring a comprehensive and high-quality care system that meets the diverse needs of Korea’s aging population. Full article

Demographic aging results in a growing number of older people in need of care in many regions all over the world. Germany has witnessed steady population aging for decades, prompting policymakers and other stakeholders to discuss how to fulfill the rapidly growing demand for care workers and finance the rising costs of long-term care. Informed decisions on this matter to ensure the sustainability of the statutory long-term care insurance system require reliable knowledge of the associated future costs. These need to be simulated based on well-designed forecast models that holistically include the complexity of the forecast problem, namely the demographic transition, epidemiological trends, concrete demand for and supply of specific care services, and the respective costs. Care risks heavily depend on demographics, both in absolute terms and according to severity. The number of persons in need of care, disaggregated by severity of disability, in turn, is the main driver of the remuneration that is paid by long-term care insurance. Therefore, detailed forecasts of the population and care rates are important ingredients for forecasts of long-term care insurance expenditures. We present a novel approach based on a stochastic demographic cohort-component approach that includes trends in age- and sex-specific care rates and the demand for specific care services, given changing preferences over the life course. The model is executed for Germany until the year 2050 as a case study. Full article

Road infrastructure serves as a foundational driver of a nation’s economic and cultural growth. Incorporating life cycle cost analysis (LCCA), as well as considerations of availability and environmental impact, enables policymakers to make strategic decisions that not only enhance fiscal efficiency but also support sustainable progress. This paper centers on an in-depth examination of two prevalent pavement technologies: continuously reinforced concrete pavements (CRCP) and jointed plain concrete pavements (JPCP). It specifically delineates the application of these methods to a hypothetical one-kilometer motorway construction in Germany. Employing LCCA for concrete pavements, the paper evaluates long-term fiscal prudence among alternative investment opportunities, factoring in resource utilization—both materials and machinery—and long-term care and upkeep obligations over the pavements’ operational lifespans. The analysis extends to appraise agency expenditures associated with the pair of pavement strategies and estimates the concomitant delay durations and costs relevant to the exemplar project. Central to this research is the investigation of road availability and its quantifiable influence on traffic efficacy, parsing through metrics such as the tally of days roads are out of service and the subsequent repercussions on vehicular flow. The investigation also proposes strategies for the reduction of embodied carbon in CRCP and JPCP systems. While accounting for variances in functional performance and vehicular comfort levels, this study contributes scientifically by tackling pragmatic engineering dilemmas involved in pavement selection, with a spotlight on minimizing costs, curtailing traffic interruptions, and mitigating ecological impacts for the duration of the pavement’s life cycle. Full article

There is evidence of benefits from the national health insurance systems in the EU Member States in the case of better-adjustment of housing units to the functional capacities of older adults. Still, the systematic approach to evaluating the social value (SV) of investments in specialised housing and other types of built environment is not yet developed. This paper aims to show how these benefits can be quantified if we evaluate the actuarial present value (APV) of reducing public expenditures in Long-term care (LTC), including Health care (HC) in these systems, after the development of specialised housing units which can accommodate the declined functional capacities of seniors. The paper presents steps to measure the SV as the impact of investments in the properly built age-friendly public housing stock, creating positive externalities for HC expenditures and LTC systems achieved for the Health Insurance Institute of Slovenia, thereby decreasing expenditures for this body. We developed a new model to forecast the SV of investments in specialised social housing as savings for national health and care systems, particularly the Central-European health and care insurance systems. We were forecasting the different demands for different specialised housing as part of the social infrastructure for insured older adults, which mitigates public expenditure on HC and LTC services. The multistate transitions are described based on projections and probability-weighted cashflows (actuarial present value, APV) are calculated. Unfortunately, there are no documents by the European Commission yet, although the Commission stresses the need to develop such a model. Full article

This study aims to examine the characteristics of long-term care (LTC) financing in Organization for Economic Cooperation Development (OECD) countries. To this end, the 26 OECD countries that have introduced LTC systems were classified into three types of models: tax-based, health insurance, and LTC insurance (LTCI) systems. Thereafter, these systems were analyzed using Gilbert and Terrell’s policy analysis framework. The results indicated differences in the characteristics of each type of financing in terms of allocation, benefit provision, service delivery, and finance. It is likely that while the LTC insurance model was mainly based on universalism and showed the highest level of coverage, the tax-based and health insurance models adopted selectivism with lower level of benefits per capita. In terms of service delivery, local authorities tended to have the responsibility to decide LTC service users and provide services in many countries, regardless of the type of model. In terms of finance, LTC insurance-based countries had the highest LTC expenditure as a percentage of GDP, followed by countries with tax-based and health insurance systems. Full article

The purpose of this study was to evaluate the impact of long-term care insurance (LTCI) on medical utilization and expenditures in Jingmen, a pilot city of China. The propensity score matching-difference in difference (PSM-DID) approach was employed to examine the expenses and frequency of inpatient and outpatient services before and after the implementation of the LTCI based on the 2015–2018 panel data from the China Health and Retirement Longitudinal Study (CHARLS). The results showed that the annual expenditure and frequency of the inpatient services of Jingmen residents were reduced by 1923 Yuan (287.0 USD) and 0.24 times, respectively. The impact of the LTCI varied between urban and rural areas. The annual expenditure and frequency of inpatient services in rural areas were reduced by 1600 Yuan (238.8 USD) and 0.30 times, which were lower than those (3400 Yuan (507.5 USD) and 0.20 times) in urban areas. The monthly outpatient expenses and frequency in rural areas were reduced by 300 Yuan (44.8 USD) and 0.14 times, but increased by 555 Yuan (82.8 USD) and 0.07 times in urban area. The findings indicated that the implementation of the LTCI can reduce the medical utilization and expenses, and it had a greater effect in rural areas than in urban areas. It is suggested to promote the LTCI nationwide, and more policy preference should be given to the development of the LTCI in rural areas. Full article

Background: Multiple Long Term conditions (MLTC) are a major health care challenge associated with high service utilisation and expenditure. Once established, the trajectory to an increased number and severity of conditions, hospital admission, increased social care need and mortality is multifactorial. The role of wider environmental determinants in the MLTC sequelae is unclear. Aim: the aim of this review was to summarise and collate existing evidence on environmental determinants on established MLTC. Methods: comprehensive search of Medline, Embase, Cochrane, CINAHL and Bielefeld Academic Search Engine (BASE), from inception to 4th June 2022 in addition to grey literature. Two authors independently screened and extracted papers. Disagreements were resolved with a third author. Results: searches yielded 9079 articles, 12 of which met the review’s inclusion criteria. Evidence of correlations between some environmental determinants and increased or decreased risks of MLTC were found, including the quality of internal housing/living environments, exposure to airborne environmental hazards and a beneficial association with socially cohesive, accessible and greener neighbourhood environments. Conclusions: The majority of the 12 included papers focused on the built and social environments. The review uncovered very limited evidence, indicating a need for further research to understand the role of environmental determinants in MLTC. Full article

Background: The globally increasing healthcare expenditures related to the need to treat the consequences of adverse events, as well as the number of claims filed by patients (or their families) and remuneration paid as their result mean that the interest in the subject of adverse event cost management is increasing. An increase in the number of cases concerning medical errors has also occurred in Poland in recent years. The newest statistics from the Ministry of Justice demonstrate that the courts are awarding increasingly higher amounts. The goal of this work was an attempt to approximate, based on our own experiences, the impact of adverse events on the expenditures of the healthcare system in Poland, including the costs of treatment of the consequences of such events, described by the authors as “secondary harm”. Methods: Based on the analysis of 100 cases for compensation for the occurrence of a medical event, an initial estimate of the costs of primary (initial) treatment, which resulted in the occurrence of the adverse event, and the costs of subsequent hospitalisations/stays, which were its consequences. The study was conducted in the period from October 2020 to November of 2021. Results: The statistical analysis of the examined cases enabled establishing that in 62% they concerned women. Only 38% were events which applied to men. The highest number of cases concerned events which occurred in the last years, that is 2018 (35%), 2019 (23%), and 2017 (17%). The most frequent events included those related to incorrect diagnosis (the lack of correct diagnosis), which resulted in appropriate activities not being undertaken and a lack of appropriate treatment, e.g., lack of diagnosis of cancer, myocardial infarction, appendicitis, or fracture (26%). The next one was incorrect surgical treatment (17%)—the consequence of which was most frequently a need for repeated surgery and an incorrect conservative treatment of injuries. The obtained results demonstrate that significantly higher funds are spent by medical entities for “restorative” actions (on average EUR 1433, which attempt to mitigate against the negative consequences of incorrect decisions or actions in the original treatment (average cost of EUR 814)). Conclusions: The consequences of adverse events include not only health-related harm for the patient, but also long-term social, familial, or professional results. The authors of the article are of an opinion that all the conducted analyses and conclusions drawn from them should serve the improvement of patient safety. They also form an initial point for establishing recommendations and advice for the improvement of safety and quality of medical services and the reduction of healthcare-related costs. The authors propose covering the parties injured by an adverse event (subjected to “secondary harm”) with a unique, innovative programme of post-accident health care, “Health Reconstruction”. Full article

The current paper uses comparable data to present an overview of home-based long-term care (LTC) for persons over 65 years of age in Europe. It aims to provide new insights to aid discussions on LTC policy convergence in three areas: the need for services, the extent to which these needs are met and the means employed to do so. It uses data from wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE). Four summary indicators are charted: (i) the care need: how many people need care; (ii) the care gap: the extent to which stated needs remain unmet; (iii) the care mix: how overall provision is divided into formal, informal or a mix of both; and (iv) care satisfaction based on stated preferences by recipients. Heterogeneity at individual level is explained by probit analyses, examining how individual factors (age, severity of need, gender, social networks, prosperity and others) combine with country group and country effects. Scatter plots are used to relate differences among countries to systemic variables, such as public expenditures. The key conclusions are that: (i) Once needs are defined in comparable terms, there remains a surprisingly large number of people across Europe whose needs are not addressed at all, what we call the care gap, especially among the younger group aged 65–80; this is evident everywhere and is not limited to any one type of system or group of countries; (ii) formal and informal care are both significant for the stability of an LTC provision system and for the well-being of care recipients; and (iii) recipients of care are especially sceptical about formal care, as they reward principally informal carers with whom they have personal relationships. The overwhelming finding is that the heterogeneity defies easy generalisations, whether these relate to individual characteristics or systemic effects. This (unexplained) heterogeneity is a challenge for researchers to explain, but it could also represent an untapped resource for policymakers to exploit. Full article

Background: Cognitive frailty (CF) as a potential risk factor for dementia, functional disability, poor quality of life, and mortality. The aim of this study was to explore the health care-related utilization and out-of-pocket (OOP) expenditures, sociodemographic characteristics, and comorbidities among elderly Malaysians with CF. Methods: A cross-sectional study targeting elderly Malaysian aged ≥65 years was conducted. The study included all participants of the fourth phase of the Malaysian representative Long-Term-Research-Grant-Scheme Towards-Useful-Aging (LRGS-TUA) community-based study. A structured and validated interview questionnaire was used. Results: In total, 1006 elderly were interviewed, with a 66.18% response rate. Only 730 respondents met the inclusion criteria. Of the eligible respondents, the CF prevalence was 4.5%. Around 60.6% of the participants with CF had utilized outpatient care at government clinics within the past 6 months. The estimated mean total OOP payments for CF during the past 6 months was 84 Malaysian Ringgit (RM) (SD 96.0). Conclusions: CF among elderly Malaysians is within the internationally recognized range of prevalence. The OOP payments for seeking health care among CF elderly are not different from that of other elderly categories. There is a high possibility of underutilization of the health care services of CF cases while they are still needy. Full article

This study aimed to determine the impact of physical activity on the cumulative cost of long-term care insurance (LTCI) services in a cohort of community-dwelling people (65 years and older) in Japan. Using cohort data from the Japan Gerontological Evaluation Study (JAGES) on those who were functionally independent as of 2010/11, we examined differences in the cumulative cost of LTCI services by physical activity. We followed 38,875 participants with LTCI service costs for 59 months. Physical activity was assessed by the frequency of going out and time spent walking. We adopted a generalized linear model with gamma distribution and log-link function, and a classical linear regression with multiple imputation. The cumulative LTCI costs significantly decreased with the frequency of going out and the time spent walking after adjustment for baseline covariates. LTCI’s cumulative cost for those who went out once a week or less was USD 600 higher than those who went out almost daily. Furthermore, costs for those who walked for less than 30 min were USD 900 higher than those who walked for more than 60 min. Physical activity among older individuals can reduce LTCI costs, which could provide a rationale for expenditure intervention programs that promote physical activity. Full article

The use of preventive health services is a long-term health investment due to its potential to help individuals to take care of their health. This study aimed to explore the availability and performance of health services in primary health care (PHC) in the domain of general practice (GP), pediatrics, and gynecology, as well as to analyze the influence of sociodemographic and health determinants on the utilization of preventive health services. This descriptive study used data from the National Health Insurance Fund and the Statistical Office of the Republic of Serbia for 2015 and included 149 independent PHC units. The relationship between the utilization of preventive services and sociodemographic and health characteristics of the population was analyzed by bivariate and multivariate linear regression models. The higher health expenditure per capita and noncommunicable diseases mortality rate were, the more preventive health services were provided by a chosen GP. Children with a higher completion rate of primary school (p = 0.024), higher health expenditure (p = 0.017), and higher life expectancy at birth (p = 0.041) had more preventive health services. The fertility rate was positively associated with the number of preventive health services per 1000 women (p = 0.033). Our findings should serve as a starting point for where efforts should be made to achieve better health outcomes. Full article

On 11 March 2011, the great earthquake hit Japan, resulting in 15,895 deaths, 6156 serious injuries, and 2539 missing persons. This event affected the health and lives of older residents, and reports showed an increase in the number of people eligible for long-term care afterward. In this study, among the places affected by the 2011 Great East Japan Earthquake and tsunami, we focused on 15 municipalities, including designated municipalities based on the Special Act on Nuclear Evacuation in Fukushima Prefecture, and aimed to clarify the medium-term effects (six years post-disaster) on the long-term care certification rate and expenditure for provision of services. We used the Ministry of Health, Labour, and Welfare Monthly Status Report on Long-Term Care Insurance and the Ministry of Internal Affairs and Communications Population Register for 2011, 2014, and 2017. In 2011, we found no intergroup differences among the 15 Fukushima municipalities and other municipalities in either the long-term care certification rate or the per-person expenditure for use of services. In 2014, after the earthquake, the long-term care certification rate was 5.4% higher in the 15 Fukushima municipalities than in other municipalities for those aged 75 years or older. The rate of 2014–2017 has not increased significantly, partly because of stability after the disaster and change in the population structure. Nevertheless, the long-term care certification rate in the 15 Fukushima municipalities is higher than that of the other two groups even after six years since the earthquake. Similarly, the per-person expenditure for use of services for one month was 11,800 yen higher in the 15 Fukushima municipalities than in other municipalities in 2014, and this trend continued into 2017. Strong, ongoing governmental support is needed, especially for those aged 75 or older, following a disaster. Full article

Background: Out-of-pocket (OOP) payments are configured as an important source of financing long-term care (LTC). However, very few studies have analyzed the risk of impoverishment and catastrophic effects of OOP in LTC. To estimate the contribution of users to the financing of LTC and to analyze the economic consequences for households in terms of impoverishment and catastrophism after financial crisis in Spain. Methods: The database that was used is the 2008 Spanish Disability and Dependency Survey, projected to 2012. We analyze the OOP payments effect associated to the impoverishment of households comparing volume and financial situation before and after OOP payment. At the same time, the extent to which OOP payment had led to catastrophism was analyzed using different thresholds. Results: The results show that contribution of dependent people to the financing of the services they receive exceeds by 50% the costs of these services. This expenditure entails an increase in the number of households that live below the poverty. In terms of catastrophism, more than 80% of households dedicate more than 10% of their income to dependency OOP payments. In annual terms, the catastrophe gap generated by devoting more than 10% of the household income to dependent care OOP payment reached €3955, 1 million (0.38% of GDP). Conclusion: This article informs about consequences of OOP in LCT and supplements previous research that focus on health. Our results should serve to develop strategic for protection against the financial risk resulting from facing the costs of a situation of dependence. Full article