title: Costs and determinants of privately financed home-based health care in Ontario, Canada.
abstract: The Canadian context in which home-based healthcare services are delivered is characterised by limited resources and escalating healthcare costs. As a result, a financing shift has occurred, whereby care recipients receive a mixture of publicly and privately financed home-based services. Although ensuring that care recipients receive efficient and equitable care is crucial, a limited understanding of the economic outcomes and determinants of privately financed services exists. The purposes of this study were (i) to determine costs incurred by families and the healthcare system; (ii) to assess the determinants of privately financed home-based care; and (iii) to identify whether public and private expenditures are complements or substitutes. Two hundred and fifty-eight short-term clients (<90 days of service utilisation) and 256 continuing care clients (>90 days of utilisation) were recruited from six regions across the province of Ontario, Canada, from November 2003 to August 2004. Participants were interviewed by telephone once a week for 4 weeks and asked to provide information about time and monetary costs of care, activities of daily living (ADL), and chronic conditions. The mean total cost of care for a 4-week period was $7670.67 (in 2004 Canadian dollars), with the overwhelming majority of these costs (75%) associated with private expenditures. Higher age, ADL impairment, being female, and a having four or more chronic conditions predicted higher private expenditures. While private and public expenditures were complementary, private expenditures were somewhat inelastic to changes in public expenditures. A 10% increase in public expenditures was associated with a 6% increase in private expenditures. A greater appreciation of the financing of home-based care is necessary for practitioners, health managers and policy decision-makers to ensure that critical issues such as inequalities in access to care and financial burden on care recipients and families are addressed.
authors.affiliation: Department of Health Policy, Management and Evaluation, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada. denise.guerriere@utoronto.ca
authors.forename: Denise N
authors.initials: DN
authors.lastname: Guerriere
authors.forename: Ada Y M
authors.initials: AY
authors.lastname: Wong
authors.forename: Ruth
authors.initials: R
authors.lastname: Croxford
authors.forename: Vivian W
authors.initials: VW
authors.lastname: Leong
authors.forename: Patricia
authors.initials: P
authors.lastname: McKeever
authors.forename: Peter C
authors.initials: PC
authors.lastname: Coyte
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000191:economics*; D003695:Delivery of Health Care / Q000191:economics; D005260:Female; D017048:Health Care Costs; D019538:Health Care Surveys; D005102:Health Expenditures; D006297:Health Services Accessibility; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009864:Ontario; D017149:Private Sector; D017150:Public Sector