Practice variation in the Dutch long-term care and the role of supply-sensitive care: Is access to the Dutch long-term care equitable?

Daisy Duell*, Xander Koolman, France Portrait

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Universal access and generous coverage are important goals of the Dutch long-term care (LTC) system. It is a legal requirement that everyone eligible for LTC should be able to receive it. Institutional care (IC) made up for 90% of Dutch LTC spending. To investigate whether access to IC is as equitable as the Dutch government aspires, we explored practice variation in entitlements to IC across Dutch regions. We used a unique dataset that included all individual applications for Dutch LTC in January 2010–December 2013 (N = 3,373,358). This dataset enabled an accurate identification of the need for care. We examined the local variation in the probability of being granted long-term IC and in the intensity of the care granted given that individuals have applied for LTC. We also investigated whether the variation observed was related to differences in the local availability of care facilities. Although our analyses indicated the presence of some practice variation, its magnitude was very small by national and international standards (up to 3%). Only a minor part of the practice variation could be accounted for by local supply differences in care facilities. Overall, we conclude that, unlike many other developed countries, the Dutch system ensured equitable access to long-term IC.

Original languageEnglish
Pages (from-to)1728-1742
Number of pages15
JournalHealth Economics (United Kingdom)
Volume26
Issue number12
DOIs
Publication statusPublished - 1 Dec 2017

Keywords

  • equity in access
  • long-term care
  • needs assessment
  • practice variation
  • supply

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