Long term care

Einleitung / Introduction

The utilization of dental services decreases with age despite the importance of regular dentist visits for oral health. Persons in need of home care, in particular, face difficulties in maintaining their oral health and organizing routine dental visits as their mobility decreases. In the current study, we aimed to analyze how utilization of oral healthcare changes after the onset of home care. Moreover, we investigated whether this interacts with the population density of a person’s place of residency.

Methode / Method

We designed a retrospective cohort study with health insurance claims data from 2015-2020 from the DAK-Gesundheit. We compared persons aged 60 or older with an incident and enduring need for home care in 2017 (study group) with a control group without need for home care in the entire study period. Both groups were observed for a 3-year follow-up and showed a regular utilization of routine dental visits (at least one visit for which treatment codes “BEMA” 01 or 04 were reimbursed) during the preceding 2-year baseline period. We applied entropy balancing to address baseline differences in patient characteristics between both groups. In all analyses, we used the weights obtained by the entropy balancing. We analyzed if persons utilized any dental service or routine dental service using weighted logistic regressions and the number of utilized services or routine services using weighted negative binomial regressions. We also tested for the interaction of home care and population density. We report odds ratios (OR) and incident rate ratios (IRR).

Ergebnisse / Results

We identified 13,616 persons with incident need for home care in 2017 and obtained a control group of 156,803 persons. The interaction term of home care and population density was non-significant for all outcomes. Thus, we recalculated all models with only the group indicator as a predictor and obtained lower odds for any dental service in the study than the control group, OR: 0.58 (0.52; 0.65). Moreover, persons in the study group utilized fewer dental visits than those in the control group, IRR 0.9 (0.89; 0.92). Results for routine dental visits were similar. Explorative analyses within the study group indicated that, among others, high age and a higher care level were associated with a lower utilization of dental services.

Zusammenfassung / Conclusion

Our analysis suggests that the onset of home care was associated with increased discontinuation of routine oral healthcare and fewer visits to a dentist, confirming findings from the literature. In line with this literature, this investigation shows a need to pay attention on the continuity of oral healthcare supervision in persons in need of home care and to develop strategies for interventions to improve oral healthcare provision for persons in home care.

AutorInnen

Espen Henken, Universitätsklinikum Hamburg-Eppendorf, Institut für Gesundheitsökonomie und Versorgungsforschung

Hans-Helmut König, Universitätsklinikum Hamburg-Eppendorf, Institut für Gesundheitsökonomie und Versorgungsforschung

Alexander Konnopka, Universitätsklinikum Hamburg-Eppendorf, Institut für Gesundheitsökonomie und Versorgungsforschung

Anja Behrens-Potratz, Hochschule für Angewandte Wissenschaften Hamburg, Forschungs- und Transferzentrum: Kooperatives Prozessmanagement

Stefanie Schellhammer, Deutsche Angestellten Krankenkasse-Gesundheit

Petra Schmage, Universitätsklinikum Hamburg-Eppendorf, Poliklinik für Parodontologie, präventive Zahnmedizin und Zahnerhaltung

Thomas Zimmermann, Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Allgemeinmedizin

Claudia Konnopka, Universitätsklinikum Hamburg-Eppendorf, Institut für Gesundheitsökonomie und Versorgungsforschung

Einleitung / Introduction

In nursing homes, single-room shares continuously have increased as a result of the person-centred care model in Germany in the last decade. We analyse whether this trend reduces nursing home access for individuals in severe need of care, e.g., when double rooms were transformed into single rooms. Moreover, in a second step, we investigate if limited access prompts people with significant care needs to prolong their stay at home within the formal versus the informal home care sector, where in particular the latter may be harmful when care needs cannot be satisfied at a high-quality level.

Methode / Method

We use the German Care Statistic from the Federal Statistical Offices covering a time period between 2007 and 2019. The data provide us with detailed information about the individuals in need of care and the nursing home facilities. To examine the single-room effect, we employ an instrumental variable approach inspired by the introduction of single-room quotas in approximately half of the German federal states.

Ergebnisse / Results

Our results show that higher single room shares have a substantial negative effect on nursing-home access with fewer empty places. Further, we find a clear reduction in the probability of finding a nursing home. We cannot show a negative effect on the share of individuals in severe need of care in informal home care, but see an increase in their share in professional home health care, which hints at a substitution effect towards more home health care also for people with high medical needs.

Zusammenfassung / Conclusion

It is crucial to consider the entire care market when the capacity of a specific sector is impacted. Initial evidence suggests a shift of higher care levels towards home health care. Consequently, we draw two conclusions. First, since informal home care remains unaffected, we conclude that there is no increased burden for caregivers. Second, if professional home health care accommodates the excess demand from nursing homes, care recipients may still receive professional care. Nevertheless, given the existing nursing shortage in home health care, the additional burden on nurses could lead to reductions in care provision quality.

AutorInnen

Annika Herr, Leibniz University Hannover, CHERH

Maximilian Lückemann, Leibniz University Hannover, CHERH

Einleitung / Introduction

This study examines how the anticipation of incurring substantial medical expenses in the future influences labor market participation decisions among near-elderly individuals (aged 45-64) in the United States. While existing research has acknowledged the impact of medical spending risk on employment choices, particularly through the channel of job-lock, the response of this demographic group to the risk of incurring large healthcare expenses remains insufficiently explored. Using quasi-experimental estimates from the staggered rollout of the Partnership Long-Term Care Insurance Program (PLTC) between 2000 and 2013, we highlight two key findings. First, the PLTC program significantly increased LTC insurance coverage among the near-elderly population, with the effect growing from 0.3 percentage points initially to 6.3 percentage points after six years. Second, the introduction of the PLTC program led to a decline in labor force participation of 10.9 percentage points, which was accompanied by an increase in the retirement rate. Consequently, there was a nine-percentage-point reduction in the uptake of employer-sponsored health insurance. Our findings underscore that older adults prioritize high-cost events, regardless of their temporal distance, and thus provide critical insights into the stability of risk preferences.

Methode / Method

To empirically investigate whether this is the case, we generate quasi-experimental estimates by leveraging the staggered implementation of the PLTC program across different states from 2000 to 2013. Employing detailed individual data sourced from the Health and Retirement Study (HRS) with a Difference-in-Differences (DID) empirical strategy, we find that the implementation of the PLTC program led to a surge in LTC insurance coverage among individuals aged 45-64. In addition, we show the introduction of the PLTC program increased the likelihood of these individuals exiting the labor market and claiming retirement status. Lastly, we illustrate that the decrease in labor force participation corresponded with a decline in employer-sponsored health insurance coverage. With the Deficit Reduction Act (DRA) signed into law in 2006, all states were granted permission to develop PLTC programs, marking their reintroduction after they were initially established in four states during the 1980s. The aim of the PLTC program is to finance the potential LTC costs of individuals who might require such services by integrating public Medicaid benefits with private LTC insurance. This enables policyholders to shield assets equivalent to the value of their PLTC insurance benefits from the Medicaid asset eligibility requirements (Stone-Axelrad 2005; GAO 2007; Lin and Prince 2013; Sun and Webb 2013; Bergquist et al. 2018; Costa-Font and Raut 2021). Due to this unique feature, policyholders enrolled in the PLTC program benefit from dual-layered protection, thus reducing the probability that they will exhaust their financial resources in their later years.

AutorInnen

Emma Zai, Max Planck Institute for Demographic Research