Care for the needy - demand and allotment of services

An examination of factors that have an impact on the level of individuals' functionality has been carried out. The results show that high-income municipalities, which allocate high per capita expenditures to care-services, end up with a larger share of its inhabitants at a low level of functionality, compared to low-income municipalities. We explain this result by the argument that persons with only moderate functionality-problems who receive a substantial volume of care-services may lose their ability to carry out tasks themselves. Thereby their functionality degrades. Within the theoretical framework of an "Almost Ideal Demand System" we have carried out an analysis of municipalities' allocation of resources to long-term care in institutions versus home care. The analysis gave the following main results: (1) Municipalities with high per capita revenues provide substantially more home care, but only marginally more institutional care, than municipalities with low revenues. (2) High unit costs in institutional care induces municipalities to provide relatively more home care. (3) Municipalities with a population of less than 4000 provide many nursing-home beds, even if the cost per bed is high. (4)The volume of home care is negatively related to the rate of work-participation for females in the age class 40-67 years. (5) Whether there is a hospital in the municipality or not has no impact on the structure of the care services. (6) Political factors like representation of different parties, consentration of political power, and the age of the median voter, has some impact on the balance between home care and nursing home care. By means of a statistical model we have examined which factors that have an impact on whether an individual resides permanently in a nursing home or not. The reusults show that individual-specific characteristics like age, functionality and Access to informal care have a strong impact. Equally important is it, however, how high the capacity of the nursing homes in the municipality is. This implies that municipalities with high nursing home capacity provide nursing home beds to individuals with substantially higher functionality than what is the case in municipalities with a low nursing home capacity. On the other hand, in municipalities with many sheltered dwellings the probability of nursin ghome residence is lower. We have carried out an analysis of municipalities alotment of home care (Home help and home nursing). The analyses show that age, functionality, and Access to informal care are important determinents. Moreover, the size of the home care budget in the municipality is important for how much home care an individual enjoys. Municipalities with ample supply of beds in nursing homes and old Peoples homes provide home care services to a much larger group of people, than municipalities where the supply of beds in institutions is scares; this holds even if there is no difference in the home care Budget. hjemmetjenestebudsjett, hjemmetjenester til en langt større gruppe individer enn det kommuner med få institusjonsplasser gjør. We have in the project developed compact indicators for differences between municipalities in age structure and death rates. These indicators build on the idea that proximity to death may be more important for individuals need for care-services than is a person's age. These indicators perform well, and may replace age (age-classes) as explanatory variables in analyses of the kind referred to above.

The project aims at studying the entire long-term care sector in Norway, with an emphasis on home help, home nursing and nursing home care. There will be a focus on the interaction between these services, on the choice of living arrangements, and on acces s to informal care. The project will for the most part be based on existing theory, but will contribute some to the theory on demand for long-term care. The project is largely empirical, and will be based on the IPLOS database merged with other types of d ata on individuals and municipalities. In estimating economertic relationships emphasis will be on structural relationships. This distinguishes the project from many of the previous contributions, which were based on reduced form relationships or had no b asis in explicit theoretical models of optimizing agents. The project will provide information about how individual users enter the care-system, how some are filtered out, and how others are provided substantial amonts of services, and on the distributio n on publicly provided services between users.