Optimizing access to long-term care? Impact of long-term care policies on use, health and equity among the elderly

ended

OECD countries face the aging of their population, a demographic trend that will amplify in the next decades. This causes a substantial increase in the number of the disabled elderly, who require assistance with activities of daily living. Reconciling the societal concern for ensuring appropriate long-term care (LTC) to the disabled elderly and the pressure on public spending is a major challenge that all OECD countries struggle with. Governments aim at containing rising LTC costs by setting eligibility criteria and cost-sharing rules; such measures may however impact the efficiency and equity of LTC policies. How does the design of LTC policies affect LTC use at both the individual level and across population groups? And what are the downstream effects LTC use may have on health and health care use? This proposal aims at providing robust empirical evidence on these questions by making use of conceptual and measurement tools from applied economics. Identification of causal relationships will be achieved by exploiting quasi-experimental variation in LTC use and innovative individual-level data, which combine survey and administrative sources. My research will yield three main contributions to the economic literature and to our understanding of LTC policies. First, I will provide unprecedented insight on the impact of co-payments on nursing home entry in a European country, namely the Netherlands. Second, I will assess whether the under-use of LTC may deteriorate health and increase health care services. Finally, I will provide a comprehensive assessment of socio-economic inequalities in the use of LTC and its financing in France. This proposal tackles research questions that the international literature has left pending, in the context of two countries whose ongoing policy debates on LTC embody the trade-off faced by all European governments. It thus aims at contributing to evidence-based decisions in the field of LTC.