Time to Drop Time-to-Death? Unraveling the Determinants of LTC Spending in the Netherlands

46 Pages Posted: 24 Mar 2010

See all articles by Claudine de Meijer

Claudine de Meijer

Erasmus University Rotterdam (EUR) - Erasmus Medical Center (MC)

Marc A. Koopmanschap

Erasmus University Rotterdam (EUR) - Erasmus Medical Center (MC)

Teresa Bago d'Uva

Erasmus University Rotterdam (EUR) - Faculty of Economics; Tinbergen Institute

Eddy van Doorslaer

Erasmus School of Economics

Date Written: November 1, 2009

Abstract

A better understanding of what drives long term care (LTC) expenditures is important for all countries with aging populations. We employ unique new data sources to analyze the determinants of LTC spending in the Netherlands. First, we use two-part models, to analyze institutional LTC and homecare expenditures for the entire 55 population, conditioning not only on age, sex, time-to-death (TTD), but also on cause-of-death and co-residence status. These have profound effects. Those living alone, as well as those who deceased from diabetes, mental illness, stroke, diseases of the respiratory or digestive system have higher LTC, expenditures, while a neoplasm death resulted in lower expenditures.

Secondly, we examine homecare expenditures among a sample of noninstitutionalized individuals conditioning, additionally, on morbidity and disability. Finally, we reconsider the roles of age and TTD, when controlling for the most important determinants of LTC use - morbidity, disability and co-residence - and illustrate their relevance for forecasting LTC expenditures. Our analysis reveals that TTD is not a predictor of homecare expenditures when disability is controlled for, while age and co-residence are. We therefore conclude that it is time to drop time-todeath from LTC expenditure models as it merely acts as a proxy for disability status.

Keywords: aging, long-term care, expenditures, time-to-death, homecare, institutional care

Suggested Citation

de Meijer, Claudine and Koopmanschap, Marc A. and Bago d'Uva, Teresa and van Doorslaer, Eddy, Time to Drop Time-to-Death? Unraveling the Determinants of LTC Spending in the Netherlands (November 1, 2009). Netspar Discussion Paper No. 11/2009-045. Available at SSRN: https://ssrn.com/abstract=1572401 or http://dx.doi.org/10.2139/ssrn.1572401

Claudine De Meijer (Contact Author)

Erasmus University Rotterdam (EUR) - Erasmus Medical Center (MC) ( email )

Doctor Molewaterplein 40
Rotterdam, South Holland 3015 GD
Netherlands

Marc A. Koopmanschap

Erasmus University Rotterdam (EUR) - Erasmus Medical Center (MC) ( email )

Doctor Molewaterplein 40
Rotterdam, South Holland 3015 GD
Netherlands

Teresa Bago d'Uva

Erasmus University Rotterdam (EUR) - Faculty of Economics ( email )

Burgemeester Oudlaan 50
3000 DR Rotterdam, Zuid-Holland 3062PA
Netherlands

Tinbergen Institute ( email )

Burg. Oudlaan 50
Rotterdam, 3062 PA
Netherlands

Eddy Van Doorslaer

Erasmus School of Economics ( email )

Netherlands

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