Eligibility or use? Disentangling the sources of horizontal inequity in home care receipt in the Netherlands

Abstract

We study horizontal inequity in home care use in the Netherlands, where a social insurance scheme aims to allocate long‐term care according to care needs. Whether the system reaches its goal depends not only on whether eligible individuals have equal access to care but also on whether entitlements for care reflect needs, irrespective of socioeconomic status and other characteristics. We assess and decompose total inequity into inequity in (i) entitlements for home care and (ii) the conversion of these entitlements into actual use. This distinction is original and important, because inequity calls for different policy responses depending on the stage at which it arises. Linking survey and administrative data on the 65 and older, we find higher income elderly to receive less home care than poorer elderly with similar needs. Although lower income elderly tend to make greater use of their entitlements, need‐standardized entitlements are similar across income, education, and wealth levels. However, both use and entitlements vary by origin and place of residence. The Dutch need assessment seems effective at restricting socioeconomic inequity in home care use but may not fully prevent inequity along other dimensions. Low financial barriers and universal eligibility rules may help achieve equity in access but are not sufficient conditions.

Well‐being right before and after a permanent nursing home admission

“…For instance, while waiting lists are virtually non‐existent at the regional level (e.g., CVZ, 2013 ), a place in the preferred NH may not be available right away. There is quite some variation in the time between the eligibility decision and the admission within groups with similar health, limitations, and other characteristics (Bakx, Wouterse, et al., 2020 ; Tenand et al., 2020 ). 17…”

“…Nursing home care is for people requiring intensive care and support, yet the extensive coverage of home care combined with few barriers to use, means there is an important subgroup of elderly for whom both types of arrangements are suited and available (Bakx, Wouterse, et al., 2020 ). The idea that many older people make a deliberate choice is reinforced by the observation that people generally do not move to a NH immediately after they become eligible, and some people who are eligible never move there at all (Bakx, Wouterse, et al., 2020 ; Tenand et al., 2020 ). Moreover, a sizable share of people recovers at home using home care after a hospitalization for a severe health problem such as a stroke or a hip fracture (Rellstab et al., 2020 ; Van den Burg et al., 2020 ).…”

From each according to means, to each according to needs? Distributional effects of abolishing asset-based payments for residential care in Austria

“… can then be averaged across income quintiles and compared. Alternatively, the horizontal inequity index (HI) can be used as a synthetic metric for how much OPPs paid deviate from needs [ 30 ]; an approach similar to other studies that used HI to assess the distribution of care costs [ 29 , 31 ]: …”

Socioeconomic Inequality in the Use of Long-Term Care among European Older Adults: An Empirical Approach Using the SHARE Survey

“…In other words, we can assess whether SES plays an important role although respondents have serious impairments and need LTC. We considered two set of variables: need (N) LTC determinants (age, gender, self-assessed health status, the number of limitations in activities of daily living, and the number of chronic diseases) and non-need (Z) LTC determinants (marital status, education level, household composition, number of descendants, and the region in which the respondent lives) [37][38][39][40]. We followed the indirect need-standardization process [35].…”