Does public long‐term care expenditure improve care‐related quality of life of service users in England?

Abstract

Long-term care (LTC) consists of medical and social services for individuals with chronic conditions or disability that have difficulties with their activities of daily living (e.g., Lipszyc et al., 2012; National Institute on Aging, 2017). Public LTC systems are common across countries within the Organisation for Economic Co-operation and Development (OECD) to address the failure of unregulated LTC markets (Finkelstein & McGarry, 2006;Forder et al., 1996), and public spend on LTC in most of these countries is considerable. In 2017, for example, the Netherlands, the Nordic countries and Switzerland were among those spending the most on public LTC, that is, between 2.5% and 4% of GDP. The provision of public LTC has the primary goal of improving the quality of life of the service user (Fernandez et al., 2011). In addition, LTC aims to support the health care sector in achieving a better allocation of resources by providing less costly alterna-

Cuts to local government spending, multimorbidity and health-related quality of life: A longitudinal ecological study in England

“…Our results also agree with previous findings that increased local government spending is associated with other measures of population health, including lower prevalence of individual long-term conditions, 12 higher levels of general health, 15 fewer preventable hospital visits, 13 and higher quality of life for specific sub-populations. 14 We build on these findings by showing cuts are not only associated with decreased quantity of life, but also decreased health-related quality of life for the general population who survive.…”

“…In the US, for example, States with a higher ratio of social to healthcare spending had better outcomes for prevalence rates of single long-term conditions, such as obesity and asthma, as well as mortality rates. 12 Lower spending has also been linked with an increase in hospital visits for potentially preventable acute and chronic conditions, 13 reductions in care-related quality of life for social care users, 14 and lower population general health status. 15 …”

More long‐term care for better healthcare and vice versa: investigating the mortality effects of interactions between these public sectors

“…In this study, following Andrews et al (2017) and Martin et al (2021a), we use three candidate instruments for HC expenditure per capita: the DFT index, the age-cost index and the MFF index. Following Longo et al (2021), we use the council tax base per user as our primary instrument for LTC expenditure per user. 27 We use these four instruments in all the models presented below, and Section 2.4 includes a full discussion about their validity.…”

“…In addition, endogeneity may arise from simultaneity between expenditure and mortality since, for example, higher mortality may determine more investments in HC and LTC. 14 To address endogeneity in HC and LTC expenditure, we follow the approach introduced by Andrews et al (2017) and Longo et al (2021), respectively. Both approaches suggest the selection of instruments among variables that determine the level of HC and LTC funding and that can be argued to be exogenous conditional on need and socio-economic variables.…”

Program Evaluation of Population- and System-Level Policies: Evidence for Decision Making

“…For multiple budgets or nonfinancial constraints, estimates of the opportunity costs can be captured through marginal productivities for the outcome(s) of interest for each budget or constraint. 13,33,84,85 An evaluation of air pollution strategies considered budgets in the National Health Service (NHS), public health, and social care, whereas nonfinancial constraints have been considered in evaluations of eye care services in Zambia and viral load testing in sub-Saharan Africa. 34,35,54 When there are nonmarginal impacts, evidence is required on the scale of the impact and the change in the opportunity costs per unit of expenditure.…”