The impact of long-term care on primary care doctor consultations for people over 75 years

Abstract

Many countries are adopting policies to create greater coordination and integration between acute and long-term care services. This policy is predicated on the assumption that these service areas have interdependent outcomes for patients. In this paper, we study the interdependencies between the long-term (home care) services and consultations with a primary care doctor, as used by people over 75 years. Starting with a model of individual's demand for doctor consultations, given supply, we formalize the hypothesis that exogenous increases to home care supply will reduce the number of consultations where these services are technical substitutes. Furthermore, greater coordination of public service planning and use of pooled budgets could lead to better outcomes because planners can account for these externalities. We test our main hypothesis using data from the British Household Panel Study for 1991-2009. To address potential concerns about endogeneity, we use a set of instrumental variables for home care motivated by institutional features of the social care system. We find that there is a statistically significant substitution effect between home care and doctor visits, which is robust across a range of specifications. This result has implications for policies that consider increased coordination between health care and social care systems.

Does formal home care reduce inpatient length of stay?

“…While we find that increasing home care supply may help to reduce inpatient LOS, especially for those with long LOS, the ability of home care to help reduce future hospital bed capacity requirements is more modest than assumed in these planning reports. Similarly, recent evidence from the NHS also shows only modest reductions in primary care use as a result of increased home care supply (Forder, Gousia, & Saloniki, 2018b).…”

Causal impact of social care, public health and healthcare expenditure on mortality in England: cross-sectional evidence for 2013/2014

“…They find a substitution effect between social care and healthcare services so that an increase in social care services may improve hospital outcomes, for example, by reducing delayed discharges. [12][13][14][15] However, we are not aware of any English studies of the joint impact of social care, healthcare and public health expenditure on mortality, and hence this study presents the first such estimates. We combine these estimates with information about the size of the post-2010 spending constraints to provide an alternative estimate of how many lives such constraints cost between 2011 and 2014.…”

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

“…The type of LA is argued to capture the eligibility policy across LAs which is assumed to have no direct impact on CRQoL. The follow-up study by Forder, Gousia, and Saloniki (2018) investigates the effect of formal community care services (e.g., home care, day care) on CRQoL, and also finds a beneficial effect. This study, however, does not distinguish between the effect of public and private LTC expenditure.…”

“…For example, Watkins et al (2017) suggest that lower public LTC expenditure is associated with higher mortality. Some studies find a substitution effect between social and health care services and that an increase in LTC services, such as nursing homes, may improve hospital outcomes, for example, by reducing delayed discharges (e.g., Fernandez & Forder, 2008;Forder, 2009;Forder, Gousia, & Saloniki, 2018;Gaughan et al, 2015).…”