[The upper-limits of deinstitutionalization not yet reached]. / De grens van extramuralisering is nog niet bereikt.

The government aims at decreasing the number of elderly with disabilities in institutional care, and supplying them with homecare instead. This article provides starting points to identify the elderly for whom homecare is a realistic alternative to institutionalized care. Data from two Dutch surveys are used: the Amenities and Services Utilization Survey (AVO'07) and Elderly in Institutions (OII'08). We use a regression model that explains the use of care from several characteristics, and predict the probability to use a certain type of care for each individual. One ninth to a fifth of the elderly receiving institutional care have similar characteristics to homecare users. They are generally younger than other users of institutional care, attained higher educational levels, have higher incomes and have fewer disabilities. The prevalence of dementia is noticeably lower in this group. Domestic help, often in combination with personal care and nursing, is the most likely alternative for institutional care. Personal assistance may also prove to be an alternative, but could not be included in this research. However, there will always be a group of elderly that are more suitably and more efficiently cared for in an institutional setting. It is important that institutionalized care remains an option for this group.

A quality-adjusted cost function in a regulated industry: the case of Dutch nursing homes.

The primary objective of this paper is to examine the cost structure of the Dutch nursing home industry, using econometric techniques. In this paper we present a model that combines economic behaviour and quality of services measured by a latent variable. We propose a simple method for identifying and estimating cost functions in the presence of endogenous, unobserved quality. Estimating this quality-adjusted cost function and the corresponding cost share equations indicates that quality is negatively related to the input prices of nurses and other personnel, indicating that nursing homes have a preference for labour. We also show that the quality-adjusted model is superior to a model with exogenous quality.