title: What is the impact of policy differences on nursing home utilization? The cases of Germany and the Netherlands.
abstract: Though need factors would predict a higher rate of institutional use in Germany, in 2004 the percentage of people over 65 in institutions in the Netherlands was almost double the percentage in Germany. The lower nursing home utilization in Germany coincided with lower out-of-pocket costs, de facto means-testing of social assistance for such care, a lower perceived quality of nursing home, and less acceptance of the nursing home as a main care modality for adults experiencing functional impairments. These factors have developed over time and are consistent with a--relatively--large government responsibility toward care for the elderly and a preference for institutional care over home care in the Netherlands. The policy to encourage older adults to move to elderly homes to decrease the housing shortage after WWII might have had long-lasting effects. This paper points out that a key in the success of a reform is a behavioral change in the system. As there seems to be no single factor to decrease the percentage of older adults in nursing homes, a sequence of policies might be a more promising route.
authors: Harvard Medical School, Department of Health Care Policy, 180 Longwood Avenue, Boston, MA 02115-5899, USA. Electronic address: pg.alders@minvws.nl.
authors: Peter
authors: P
authors: Alders
authors: London School of Economics & Political Science (LSE), Department of Social Policy, Houghton Street, WC2A 2AE London, England, UK. Electronic address: j.costa-font@lse.ac.uk.
authors: Joan
authors: J
authors: Costa-Font
authors: The Netherlands Institute for Social Research, Rijnstraat 50, 2515 XP The Hague, The Netherlands. Electronic address: m.de.klerk@scp.nl.
authors: Mirjam
authors: M
authors: de Klerk
authors: Harvard Medical School, Department of Health Care Policy, 180 Longwood Avenue, Boston, MA 02115-5899, USA. Electronic address: frank@hcp.med.harvard.edu.
authors: Richard
authors: R
authors: Frank
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005380:Financing, Government / Q000191:economics*; D005858:Germany; D005102:Health Expenditures; D006699:Home Care Services / Q000191:economics; D006801:Humans; D008134:Long-Term Care / Q000191:economics; D009426:Netherlands; D009735:Nursing Homes / Q000191:economics / Q000706:statistics & numerical data*; D011640:Public Policy / Q000191:economics*; D066262:Social Norms
keywords: Home care; Long-term care policy; Nursing homes; Out-of-pocket costs; Path-dependency; Social norms