title: Determinants of long-term care spending: age, time to death or disability?
abstract: In view of population aging, better understanding of what drives long-term care expenditure (LTCE) is warranted. Time-to-death (TTD) has commonly been used to project LTCE because it was a better predictor than age. We reconsider the roles of age and TTD by controlling for disability and co-residence and illustrate their relevance for projecting LTCE. We analyze spending on institutional and homecare for the entire Dutch 55+ population, conditioning on age, sex, TTD, cause-of-death and co-residence. We further examined homecare expenditures for a sample of non-institutionalized conditioning additionally on disability. Those living alone or deceased from diabetes, mental illness, stroke, respiratory or digestive disease have higher LTCE, while a cancer death is associated with lower expenditures. TTD no longer determines homecare expenditures when disability is controlled for. This suggests that TTD largely approximates disability. Nonetheless, further standardization of disability measurement is required before disability could replace TTD in LTCE projections models.
authors.affiliation: Institute of Health Policy & Management, DR Rotterdam, The Netherlands. demeijer@bmg.eur.nl
authors.forename: Claudine
authors.initials: C
authors.lastname: de Meijer
authors.forename: Marc
authors.initials: M
authors.lastname: Koopmanschap
authors.forename: Teresa Bago
authors.initials: TB
authors.lastname: D' Uva
authors.forename: Eddy
authors.initials: E
authors.lastname: van Doorslaer
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities; D005260:Female; D005102:Health Expenditures; D006299:Health Services for the Aged / Q000191:economics*; D006306:Health Surveys; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D007326:Institutionalization / Q000191:economics*; D008134:Long-Term Care / Q000191:economics*; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009426:Netherlands; D013997:Time Factors