Practice variation in long-term care access and use: The role of the ability to pay

Daisy Duell*, Maarten Lindeboom, Xander Koolman, France Portrait

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


Practice variation in publicly financed long-term care (LTC) may be inefficient and inequitable, similarly to practice variation in the health care sector. Although most OECD countries spend an increasing share of their gross domestic product on LTC, it has received comparatively little attention to date compared with the health care sector. This paper contributes to the literature by assessing and comparing regional practice variation in both access to and use of institutional LTC and investigating its relation with income and out-of-pocket payment. For this, we have access to unique individual-level data covering the entire Dutch population. Even though we found practice variation in the use of LTC once access was granted, the variation between regions was still relatively small compared with international standards. In addition, we showed how a co-payment measure could be used to reduce practice variation across care office regions and income classes making the LTC system not only more efficient but also more equitable.

Original languageEnglish
Pages (from-to)1277-1292
Number of pages16
JournalHealth Economics
Issue number11
Early online date30 Aug 2019
Publication statusPublished - 1 Nov 2019


  • health care
  • health care financing
  • inequality
  • regional consumer behaviour


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