Better Off at Home? Effects of a Nursing Home Admission on Costs, Hospitalizations and Survival

Tinbergen Institute Discussion Paper 2018-060/V

52 Pages Posted: 26 Jul 2018

See all articles by Pieter Bakx

Pieter Bakx

Erasmus University Rotterdam (EUR)

Bram Wouterse

CPB Netherlands Bureau of Economic Policy Analysis

Eddy van Doorslaer

Erasmus University Rotterdam (EUR) - Institute of Health Policy and Management

Albert Wong

National Institute for Public Health and the Environment (RIVM)

Date Written: July 6, 2018

Abstract

Aging-in-place policies substitute home care for nursing home admissions (NHA). They appear to be a win-win by keeping public spending in check and being in line with personal preferences, but have hitherto not been evaluated. We study the impact of NHA eligibility using Dutch administrative data and exploiting variation between randomly assigned assessors in their tendency to grant admission. The impact on mortality is zero, but with considerable effect heterogeneity. Moreover, aging-in-place policies come at the cost of increased curative care, especially hospital admissions, and do not reduce total healthcare spending, suggesting they may not be a win-win after all.

Keywords: long-term care, policy evaluation, instrumental variables

JEL Classification: C26, I10

Suggested Citation

Bakx, Pieter and Wouterse, Bram and van Doorslaer, Eddy and Wong, Albert, Better Off at Home? Effects of a Nursing Home Admission on Costs, Hospitalizations and Survival (July 6, 2018). Tinbergen Institute Discussion Paper 2018-060/V. Available at SSRN: https://ssrn.com/abstract=3209195 or http://dx.doi.org/10.2139/ssrn.3209195

Pieter Bakx (Contact Author)

Erasmus University Rotterdam (EUR) ( email )

Zuid-Holland
Netherlands

Bram Wouterse

CPB Netherlands Bureau of Economic Policy Analysis ( email )

P.O. Box 80510
2508 GM The Hague, 2585 JR
Netherlands

Eddy Van Doorslaer

Erasmus University Rotterdam (EUR) - Institute of Health Policy and Management

Netherlands

Albert Wong

National Institute for Public Health and the Environment (RIVM) ( email )

3720 BA Bilthoven
Netherlands

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