The relationship of personal budgets with independence, participation and quality of life; a secondary analysis of survey data using propensity score matching.

OBJECTIVES: Personal budgets for social and health care have been introduced in many European countries over recent decades. The assumption is that people with a personal budget are able to purchase care that matches their needs more closely and therefore experience greater independence and improved well-being. The question is whether this assumption is true. Little research has been carried out on this and the research that has been carried out is inconclusive and hampered by methodological limitations. METHODS: We performed a secondary analysis of data collected in a survey among persons who had submitted an application for social support. Propensity score matching was used to investigate whether people with a personal budget experience better independence, participation in society and quality of life than comparable people using conventionally organised help. RESULTS: After matching, no significant effects of the personal budget were initially found. A sensitivity analysis that excluded the variable sense of mastery from the calculation of the propensity scores, showed a significantly greater independence for those using a personal budget. CONCLUSION: There may be several reasons for this lack of effect. First, perhaps there are no effects. It is also possible that effects can only be found in specific situations and/or specific groups.

Forecasting the use of elderly care: a static micro-simulation model.

This paper describes a model suitable for forecasting the use of publicly funded long-term elderly care, taking into account both ageing and changes in the health status of the population. In addition, the impact of socioeconomic factors on care use is included in the forecasts. The model is also suitable for the simulation of possible implications of some specific policy measures. The model is a static micro-simulation model, consisting of an explanatory model and a population model. The explanatory model statistically relates care use to individual characteristics. The population model mimics the composition of the population at future points in time. The forecasts of care use are driven by changes in the composition of the population in terms of relevant characteristics instead of dynamics at the individual level. The results show that a further 37 % increase in the use of elderly care (from 7 to 9 % of the Dutch 30-plus population) between 2008 and 2030 can be expected due to a further ageing of the population. However, the use of care is expected to increase less than if it were based on the increasing number of elderly only (+70 %), due to decreasing disability levels and increasing levels of education. As an application of the model, we simulated the effects of restricting access to residential care to elderly people with severe physical disabilities. The result was a lower growth of residential care use (32 % instead of 57 %), but a somewhat faster growth in the use of home care (35 % instead of 32 %).

More family responsibility, more informal care? The effect of motivation on the giving of informal care by people aged over 50 in the Netherlands compared to other European countries.

Against the backdrop of ongoing population ageing, informal care occupies an important place on European political agendas. This article discusses informal caregiving by middle aged and older persons in the Netherlands and other European countries, with particular emphasis on the role played by motives. The data are drawn from SHARE. Our results show that in the Netherlands, it is mainly feelings of being needed and obligation that increase the chance of informal care being given. Deriving pleasure from an activity, by contrast, reduces the likelihood. In Southern Europe, where the responsibility for providing care lies with the family, we found that, contrary to expectations, older carers do not more often feel obliged. They less often report that they feel needed or see being socially active as a way of contributing to society. Our simulations suggest that if the socially active Dutch had the same motives as their Southern European counterparts and behaved similarly in terms of informal caregiving, the number of informal carers would fall. This implies that a greater policy emphasis on family responsibility could actually bring about a decline in the amount of care given, as opposed to the envisaged increase.

Transitions between care provisions demanded by Dutch elderly.

UNLABELLED: We follow people who are considered eligible for an elderly care provision. Through the estimation of a duration model we determine when they can be expected to express demand for another care provision. Data are drawn from the registrations of needs assessment agencies in The Netherlands. MAIN FINDINGS: Age positively effects the probability of a reassessment if initially care at home was assessed. Living alone, access to informal care, and applications initiated by professionals increase transition probabilities. Also initial applications for care at home due to dementia are more likely to be followed by a quick reassessment. The results can aid assessment agencies to set validity terms of assessments, and in planning future supply of services.

Client demands and the allocation of home care in the Netherlands. A multinomial logit model of client types, care needs and referrals.

The purpose of this paper is to estimate the volume and composition of referrals to home care on the basis of applicant characteristics. The relationships between the background and care needs of applicant groups on the one hand and the referral of home care packages on the other, are studied by means of a multinomial logit model. The model is estimated on the basis of more than 7000 requests for home care in the northern part of the Netherlands. Home health care institutions have to deal with clients who arrive from many different branches of the health care system. As a result the services or products provided by home health care institutions are characterized by wide variation. In the modeling emphasis has, therefore, been placed on the differentiation of clients and products. We find for instance that elderly chronically ill applicants have a greater chance of being referred for domestic help only, while applicants with psychosocial disorders are more liable to be offered packages that include social support. Patients discharged from hospital have a greater chance of a referral to domestic help only when they are slightly disabled, and are more likely to be offered packages including physical care when they are more disabled. The model has a range of policy applications in assessing the impact of changes in the health care system on the volume and structure of the demand for home care services. Examples are presented of the consequences of the ageing population and earlier discharge from hospitals on demand for home care packages.