Population aging, family structure and the demand for long-term care

According to projections from Statistics Norway (SSB), the number of persons aged 67 and above will be doubled in Norway during the next 50 years. At the same time, we observe significant changes in family structures that affect the supply of informal care. The purpose of this research project was to improve the knowledge concerning the economics of aging population. The following issues were investigated: a) socioeconomic differences in health and long-term care utilization for the elderly, and b) the family as provider of long term care. Lifestyle and future need for social care Early-age lifestyle may be an important predictor of demand for social care later in life. Using a longitudinal dataset, in this paper we analyze the effects of previous lifestyle on the need for social care. Physical exercise, smoking, alcohol consumption, and body mass index are measured in 1986, and a proxy for the need for social care, the ADL score, is measured in 2006 for individuals aged 70 or above. Findings suggest that smoking and obesity are significantly and positively associated with future need for social care, whereas doing exercise has a negative influence. The relationship between socioeconomic status and waiting time among elderly people in Norway We investigate whether educational attainment affects waiting time of elderly patients in somatic hospitals. We find evidence of an educational gradient in waiting time for male patients, but not for female patients. Conditional on age, male patients with tertiary education wait 45% shorter than male patients with secondary or primary education. Relative to patients with primary education, variation in waiting time and education level across local hospitals contributes to higher waiting time for male patients with secondary education and female patients with secondary or tertiary education and lower waiting time for male patients with tertiary education. These effects are in the order of 15-20%. The educational gradients within catchment areas disappear when we control for travel distance and supply of private specialists. Socioeconomic Status and Physicians? Treatment Decision This paper aims at shedding light on the social gradient by studying the relationship between socioeconomic status (SES) and provision of health care. Our data allow us to control for a wide set of patient and GP characteristics. To account for (unobserved) heterogeneity, we limit the sample to patients with a specific disease, diabetes type 2, and estimate a model with GP fixed effects. Our results show that patients with low SES visit the GPs more often, but the value of services provided per visit is lower. The composition of services varies with SES, where patients with low education and African or Asian ethnicity receive more medical tests but shorter consultations, whereas patients with low income receive both shorter consultations and fewer tests. Thus, our results show that GPs differentiate services according to SES, but give no clear evidence for a social gradient in health care provision. Do Treatment Decisions Depend on Physician? Financial Incentives We study whether and how physicians respond to financial incentives, making use of detailed register data on the health-care services provided to patients by general practitioners (GPs) in Norway. To identify GPs treatment responses, we exploit that specialisation in general medicine entitles the GPs to a higher consultation fee, implying a change in total and relative fee payments. To control for demand and supply factors related to becoming a specialist, we estimate a GP fixed effect model focusing on a narrow time window around the date of specialist certification. Our results show a sharp response by the GPs immediately after obtaining specialist certification and thus a higher consultation fee: the number of visits increases, while the treatment intensity (prolonged consultations, lab tests, medical procedures) decline. Nursing and care services? an analysis of elders with and without close relatives The article is based on data from the IPLOS registry merged with data from SSB in order to analyze whether elder individuals without close relatives (spouse or adult children) less often receive nursing and care services from the municipality. We find that access to informal care reduces formal care, regarding both home-based services and long term care. It appears that spouses are far more important caregivers than adult children. The distribution of home care is particularly strongly (negatively) associated with having a spouse. For lone elderly, adult children are substitutes to municipal care services. Lone elderly parents have a lower probability of receiving home care if they have daughters than if they have sons. For lone mothers, this gender difference also applies for home health care.

The proposal is based on empirical analyses where we will use data from the IPLOS register matched with extensive demographic and socio-economic information (from SSB) about the cohorts of elderly people as well as some of the younger cohorts. The follow ing two themes will be considered: a) socioeconomic differences in health and long-term care utilization for the elderly, and b) the family as provider of long term care. In theme one, we will focus on socioeconomic differences in health and long-term c are utilization for elderly. We will distinguish between two alternative explanations for socio-economic differences in health and utilization: First, differences in health and long-term care utilization can be related to individual socioeconomic status ( education, wealth, employment, etc.). Second, socioeconomic factors at the community level can have an independent effect. We will also include studies of how the family influence on formal and informal long-term care utilization. We will conduct separa te analyses for males and females where we characterize individuals after family status (whether or not the elderly live alone, have a spouse, have children, the number of children, the sex of the children, whether or not the children live nearby, the so cioeconomic status of the children and the spouse, etc.)