A new public insurance for long-termcare was introduced in July 2008 to provide for the rising demand for long-termcare as the population is aging rapidly. The demand for long-termcare is expected to rise further because more and more elderly are living alone or in households with only other elderly, such as his/her spouse, without informal care of their adult children. Even when the elderly are living together with their adult children, daughters and daughters in law, once the main informal care-givers, are not available because they choose to become economically active and work more over time.
A variety of modular base packages was supplied by the cases. As such, the cases were beginning to exploit ana- logies among elderly clients. Pre-grouping of compo- nents into base packages enables organizations to reduce variability [21,25] with respect to needs and requirements that are similar for all clients. At the same time, it allows organizations to take into account diver- sity in client demand [21,25] since the packages provide the ability to address directly different types of long- termcare clients with services that meet their particular needs. Our data showed that distinctions among base packages can easily be achieved by making different component combinations while drawing from the same set of care service supply. This allows for a more effec- tive and efficient way of working and helps care profes- sionals to directly tune organizational practices to a particular segment of elderly clients . In addition, room is left for activities required by particular client cases since components can be added to or withdrawn from the base package based on individual client needs . Thus, based on our insights, pre-grouping of com- ponents based on similarities among all clients and within client segments (e.g., based on health status, con- straints faced by clients or the development of con- straints and diseases over time) seems to form a largely client-centered starting point for care package specifica- tion on the level of individual clients since it explicitly recognizes that clients differ in their needs and prefer- ences .
The presence of people other than the spouse in the household may also influence admission rates. One study showed that living with a spouse, a spouse plus other people, or as a lone parent with children led to lower admission risk than living alone, whereas living with other combinations of relatives or non-relatives, did not show a lower risk (Grundy 1997). Breeze et al (1999) found different impacts of living arrangements for the younger-old and older-old. Younger-old divorced or separated men had around a threefold excess risk and widowed men who were not living alone a relative risk of 2.3. In the older-old, among single and widowed men, only those who were not living alone were at increased risk while being divorced or separated had no influence. McCann et al (2011) found that living with children reduced the risk of admission to a care home. Amongst people living with a partner, those also living with children had the lowest overall risk of admission, 33% lower than those living as a couple. Informal care and formal home care were found to be substitutes in a cross-sectional study for 11 EU countries (Bolin et al. 2008) while informal care was found to be an effective substitute for formal, home care only when the need was for low, unskilled care (Bonsang 2009). Availability of informal care is commonly proxied in models of long-termcaredemand by female labour force participation (Schulz et al. 2004; OECD 2006b). However, there is mixed evidence on the effects of female labour force participation on long-termcare expenditure and on the association between parental need for care and women's labour market behaviour. Yoo et al (2004) found an unexpected negative association between the proportion of women in the labour force and LTC expenditures, which could reflect a shift to part-time work by women providing care for older relatives so that a rise in numbers of part-time working women would be negatively associated with formal LTC. This study concluded that projections of future long-termcaredemand should distinguish between female part-time and full-time work, with the former associated with decreases and the latter associated with increases in LTC expenditures.
This study examines the factors that associated with the decision of consulting medical treatment and the choice between health care service providers using primary data collected from Mekelle city. While household level factors expected to affect the decision to consult medical treatment, patient and provider specific factors included as potential determinants of choice among different health care service providers. The nested multinomial logit NMNL) estimated using full information maximum likelihood (FIML) technique that estimates both levels of decisions simultaneously. In the upper level of the model, education of household head and number of days the patient individual suffered positively and significantly affect the decision to consult modern medical care. However, number of children in the household negatively and significantly affects the decision to consult modern care. In the lower level of the model, the probability of consulting both public and private health care increase with log of consumption and quality of treatment, but decline with patients age. While patients’ primary education increases the probability of consulting public provider, secondary and above education increases the likelihood of consulting private care relative to the no-care. Computation of the arc price elasticities shows that elasticities are negative over all prices and income groups. In addition to that, demand is more price elastic at lower incomes and at higher level of prices. Therefore, the result indicates user fees would be regressive in that they would reduce health care services utilization of the poor segment of population than the rich. The low magnitude of price elasticities indicates government has the potential to generate more revenue by increasing user fee, but this measure should be supported by mechanisms that ensure enough utilization among the poor.
One limitation of this study concerns the respondents selected for the interviews. This study focused on clients who were able to speak about their care relationship ex- periences. This means that some groups in long-termcare were not interviewed and excluded from the target group on beforehand, i.e. people with a severe disability or severe forms of dementia. The consequence is limited generalizability of the determinants found to the least ar- ticulate client groups who also receive long-termcare. Furthermore, the respondents received or provided care within three care organisations. The results from the present study do not attempt to portray a general opin- ion on satisfaction on care relationships within the care organisations but instead were an exploration of deter- minants related to the quality of care relationships from a client perspective and a professional perspective. Al- though organisation cultures may differ, it is likely that the determinants of care relationships are transferable
On the demand side, problems of limited consumer rationality may limit demand for private long- termcare insurance. For example, individuals may have difficulty understanding low-probability, high- loss events (see e.g. Kunreuther, 1978), or may simply avoid having to think about the unpleasant possibility of ending up in a nursing home. Another major factor that may limit demand for private long- termcare insurance is the availability of imperfect but cheaper substitutes. These may come in the form of government assistance (e.g., the Medicaid program), financial transfers from children, or unpaid care provided directly by family members in lieu of formal paid care (Pauly, 1990). These are all likely to be imperfect substitutes for comprehensive private insurance. For example, Medicaid’s income and asset eligibility requirements place substantial restrictions on individuals’ abilities to smooth consumption over time and across states of care, as well as to bequeath upon death, and thus provides only limited
Studies focusing on people with physical and/or intellectual disabilities were scarce, resulting in fewer find- ings for the determinants of the quality of care relation- ships for this client group. Perhaps for this specific client group, more information is covered by ‘grey’ literature in- cluding practice-oriented journals for client group-specific professions. A grey literature study could provide a clearer picture of whether this is the case. Furthermore, this re- view shows that determinants at the client level are stud- ied less often than determinants at the care professional level. One possible explanation for this might be that care professionals are seen as having more responsibility to make efforts for a good care relationship, given their edu- cational background, their choice of a caring profession and their expected expertise. The responsibility of clients in long-termcare relationships might be emphasized less often due to expected shortcomings in the abilities of cli- ents regarding their need for care or assistance. Nonethe- less, given the importance of equal care relationships and empowerment of clients, it is important to focus on deter- minants at the client level as well.
in subsidized home care keeping input prices fixed (i.e., without changing market price for professional care, the unitary subsidy nor market wages) allows to substitute formal care paid out ‐of‐pocket with the subsidized one, therefore reduc- ing the average formal care price. More precisely, formal care can be bought from private providers (M2, at a price P), or from public sources (M1, at a unitary cost P − S, where S is subsidy). Publicly provided formal care is rationed: Each individual can consume up to a maximum amount m. The household maximizes utility under a budget constraint (labour earnings can be allocated between expenditures in formal care and other consumption goods) and a time allo- cation constraint (time is divided between leisure, work, and caregiving activities). Private and public formal care are assumed to be equally productive in care provision and normal inputs in the care receiver health production function. The model delivers clear empirical implications for policy changes affecting the quantity of publicly provided care m holding prices constant (i.e., holding P, S, and the market wage constant). If the household exhausts all the publicly provided care (M1 = m) and additionally buys private care (M2 > 0, M = m + M2), then increasing m will increase the household nonwage income (the fraction of subsidized formal care increases), leading to an increase of informal caregiving. If, conversely, the household consumes public care at its limit (M1 = m), but does not purchase private care (M2 = 0), increasing the generosity of the public home care programme will lead to a reduction of informal care provision. They validate the model on Canadian data and use three province ‐level variables (share of 65+ population, provincial spending on education, and province tax rate) as instruments for generosity of the public home care.
This brief provides an overview of long-termcare (LTC), a term that refers to a broad range of health and supportive services delivered in a variety of service settings, including people’s own homes and nursing homes. People of all ages and with many different health conditions may need LTC. Although the demand for these services is increasing, funding sources for LTC remain unstable. Moreover, lack of societal agreement about the goals of LTC makes it difficult to establish an effective LTC policy for the future. This brief discusses these issues and reviews the key challenges that must be confronted in order to build a strong infrastructure for LTC. AUTHOR’S NOTE – This brief is a summary of the material in Feldman, P.H., Nadash, P., & Gursen, M.D. (2005). Long-termcare. In A.R. Kovner & S. Jonas (Eds.), Jonas and Kovner’s
The AWBZ scheme is open-ended in nature: since it is public insurance, everyone who is eligible for long-termcare is— in principle— entitled to receive care. In practice, the central government tries to keep the AWBZ expenditures within a budget. Every time a new government is formed, a projection is made of the necessary AWBZ expenditures in the next four years, based on the expected development of the demand for LTC and on the intended policy of the new government. The ministry of Health, Welfare and Sports (VWS) has to make sure that expenditures stay within this budget. Possible instruments to ensure this are an increase in co-payments, a decrease in coverage and tariff cuts for the providers. The ministry can ask permission in the council of ministers to spend more than the budget, if it maintains that cost-containment measures have too many disadvantages. This request has a relatively good chance of succeeding when other government expenditures are lower than projected (as can happen with social security expenses when the macroeconomic development is favourable). The Wmo is not an insurance scheme; the Wmo concerns provision of social services. Entitlement to these social services is affected by the available funds. For domestic help, in particular, local councils receive a (non-earmarked) budget. This gives them financial
Seasonal influenza infection outbreaks are a significant problem in LTCFs both in terms of morbidity and mortality for individuals as well as putting additional strain on already overburdened health services. With an increasingly elderly population, demand for LTCF services will likely increase over the coming years. Many basic and clinical questions remain unanswered about the transmission, prevention and treatment of influenza in these institutions and further evidence is needed to determine which interventions, or combination of interventions and hygiene practices are most efficacious in these settings. Although vaccination for residents and staff forms the cornerstone of preventive influenza policy in LTCFs, and vaccine coverage is high among residents in some countries, currently available vaccines are less effective in older people and those with co-
Indeed, married persons may feel the need to protect their partner from the financial burden of impover- ishment due to long-termcare expenses and could then demand more insurance. The role of children is more complex, as explained previously, because they are subject to intra-family moral hazard. Risk per- ception or awareness is represented through two types of variables: providing or having provided in- formal care to a family member, and having person- ally experienced hospitalisation or serious illness in the past. So as to test for the influence of intra-fami- ly moral hazard, we need to know how the presence of informal care influences the demand for LTC insurance. Informal care occurs when the household receives help for personal care, domestic and admin- istrative help from a descendant. Since we do not have any indication of the level of insurance premi- ums, age could be regarded as a proxy for the price of insurance. One might expect that age is negative- ly correlated with the probability of purchasing in- surance since insurance premiums found on the mar- ket usually increase importantly with age. We also control for the level of education of individuals as well as their health status (chronic diseases, level of activities, symptoms).
In most OECD countries, the era of long-termcare (LTC) has arrived. More than two out of five people aged 65 or older report having some type of functional limitation (sensory, physical, mental, self-care disability, or difficulty leaving home), and, as such, are not autonomous, and require adequate care. 4 A few years from now, the aging trend will accelerate, fueled by the large “baby boomer” generation, and the relative importance of people aged 65 or older will more than double by 2050, according to the forecasts of the European Union (2009). On the other hand, with the drastic change in family values, the increasing number of childless households and the mobility of children, the number of dependent elderly who cannot rely on the assistance of anyone is increasing. 5 Those two parallel evolutions – demographic and societal – explain why there is a mounting demand on governments and the market to provide alternatives to the family, which has been, across epochs, the largest provider of LTC services (even though those services, by being informal, remain hard to measure). One may hope that both private and social LTC insurance will grow substantially in coming decades. But there are a number of problems that both the State and the market have to solve before they can replace family solidarity. The problems of private LTC can be coined by the concept of LTC insurance puzzle.
The level of education is the second supply-side determinant of the non-profit sustainability. The primary assumption was that the higher the education level of the population, the greater the altruistic behavior of the society as well as a dimension of non-profit organizations in the country. A positive relationship between the size of non- profits serving households and the share of tertiary-educated people in the country was established in Slovakia, Hungary and Poland. So, this factor can be established as supply-side determinant of the non-profit sector in three of four Visegrad countries. Alternatively, there is a negative relationship in the Czech Republic. Explanation would require more in-depth sociological survey. However, according to a hypothesis that draws on demographic- structural theory, the acceleration in international NGO numbers during the last 50 years was caused by the post-war baby boom and a crisis in the credential system (Turner, 2010). After testing the hypothesis according to which it was the growing supply of credentialed professionals, rather than the greater demand for their services, that has been the proximate mechanism for the surge in those organisations, Turner concludes that the growth of NGOs was due to the “cyclical demographic-structural processes which have increased intraelite competition over the last half-century. Having in mind that the share of graduates of tertiary education has increased manifold in these countries after the transitions (in Poland, this increase was more than 5-fold), it is highly possible that it was not the over-supply of qualified individuals (unable to find job in the other sectors) which triggered the growth of NGOs, rather than these individuals’ alleged altruistic inclinations.
In 1998, the Government of Ontario announced a new capital program to support the building of approximately 20,000 new long-termcare beds and the redevelopment of approximately 16,000 existing “D” classification long-termcare beds. This initiative included a new capital funding program and a new set of long-termcare home design standards. The Ministry of Health and Long-TermCare (the Ministry) consulted with many stakeholders in the development of these standards. The objective of the new standards was to create less institutional, more residential long-termcare homes that would provide a higher quality of life to the people who lived there. The Ministry published the new design standards in the Long-TermCare Facility Design Manual, May 1999.
The number of persons receiving informal care according to Mikrozensus 2002 is 464,800; this is roughly 100,000 persons more than the number of receivers of care allowance in the same year, because two additional groups of persons in need of care are included here: Persons who did not apply for care allowance, and persons who do not qualify for care allowance, e.g. because their need for care is estimated to be lower than the required 50 hours per month. 9 Note, though, that Mikrozensus covers only the non-institutionalized population, while numbers of recipients of care allowance include both settings of care, institutional and home based. According to Mikrozensus, 281,900 women and 144,000 men over 18 years care for one or more persons due to their longer lasting health problems without being fully compensated for this care. 38,900 persons or one of ten persons out of this group care for more than one person, the age group 50-54 is the age group with the highest share of multiple carers. It has to be kept in mind, however, that Mikrozensus 2002 does not ask for the age of the care recipient. The numbers for both, care recipients as well as care providers, are therefore overestimating informal care for the elderly. (Hörl 2008, p. 351)
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On the other hand, the life-cycle literature, consider, for instance, the contributions by Cocco, Gomes, and Maenhout (2005), Gomes and Michaelides (2005), Bodie, Merton, and Samuelson (1992), Heaton and Lucas (1997), Viceira (2001), Campbell and Cocco (2003), and Munk and Sorensen (2005), has shown the importance of accounting for both income received by the investor over the investment period and portfolio constraints. Especially when labor income cannot be capitalized via …nancial markets due to omnipresent borrowing constraints, labor income forms a non-traded asset that in‡uences portfolio choice. The e¤ects can be separated into two parts. First, Gollier and Pratt (1996) and Elmendorf and Kimball (2000) have shown that increasing idiosyncratic risk triggers a reduction in the …nancial risk an investor is willing to bear. As a consequence, the presence of idiosyncratic labor income risk induces an e¤ective increase in the risk aversion of the individual. Secondly, the correlation between labor income risk and …nancial risks is important for two reasons. On the one hand, traded assets can be used to hedge part of labor income risk. As a consequence, the optimal portfolio contains a hedging demand to o¤set unfavorable changes in labor income. On the other hand, as shown by, for instance, Munk and Sorensen (2005), the value of human capital becomes investor speci…c, if labor income is non- tradable. This implicit value is, among other factors, determined as well by the correlations between labor income risk and …nancial risks that are priced. Hence, di¤erent correlations between labor income risk and …nancial risks induce di¤erent hedging demands and implicit values of human capital. This can have serious implications for the composition of the optimal portfolio.