Proximity to death and participation in the long-term care market

France Weaver, Sally C. Stearns, Edward C. Norton and William Spector
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France Weaver: Swiss Health Observatory, Neuchâtel, Switzerland, Postal: Swiss Health Observatory, Neuchâtel, Switzerland
Sally C. Stearns: Department of Health Policy and Management, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, Postal: Department of Health Policy and Management, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
William Spector: Agency for Healthcare Research and Quality, Center for Delivery, Organization, and Markets, Rockville, MD, USA, Postal: Agency for Healthcare Research and Quality, Center for Delivery, Organization, and Markets, Rockville, MD, USA

Health Economics, 2009, vol. 18, issue 8, pages 867-883

Abstract: The extent to which increasing longevity increases per capita demand for long-term care depends on the degree to which utilization is concentrated at the end of life. We estimate the marginal effect of proximity to death, measured by being within 2 years of death, on the probabilities of nursing home and formal home care use, and we determine whether this effect differs by availability of informal care - i.e. marital status and co-residence with an adult child. The analysis uses a sample of elderly aged 70+from the 1993-2002 Health and Retirement Study. Simultaneous probit models address the joint decisions to use long-term care and co-reside with an adult child. Overall, proximity to death significantly increases the probability of nursing home use by 50.0% and of formal home care use by 12.4%. Availability of informal support significantly reduces the effect of proximity to death. Among married elderly, proximity to death has no effect on institutionalization. In conclusion, proximity to death is one of the main drivers of long-term care use, but changes in sources of informal support, such as an increase in the proportion of married elderly, may lessen its importance in shaping the demand for long-term care. Copyright © 2008 John Wiley & Sons, Ltd.

Date: 2009
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