Incentives, Efficiency and Quality of Care in Long Term Care For The Elderly

The project examines how incentives in the organisation of long term care for the elderly affect their mortality, health and quality of life. We will do this by merging individual patient data from various registers, including information on institutional and home based services from Oslo Nursing Home Agency (ONHA), allowing care providers like ONHA to better understand the effect of economic incentives. The project consists of three parts: A study of selection mechanisms in the provision of long term care will examine how economic incentives interact with health and socio-economic variables. Key questions are whether and how (i) care services are provided solely on the basis of needs, (ii) municipal districts as care providers are affected by economic incentives, (iii) care service profiles affect longevity and health and (iv) user fees affect use of care across groups. A study of nursing home privatization will build on recent transfers of operation to private companies, using longitudinal data of care provision, patients' characteristics and workforce qualifications for Oslo. Identification of quality differences needs a credible research strategy. The assignment system in Oslo enables us to compare outcomes of patients with identical preferences, (in practice) randomly allocated across institutions. Qualitative studies complement the statistical studies to achieve verification and interpretation of results. We will also examine effects of privatization on the workforce as well as productivity. In addition, we will include a study of the privatization of kindergartens to see if the results differ from nursing homes. The role of the regular general practitioners in elderly care will be examined, focusing on the extent to which economic incentives affect care services allocation across space and socioeconomic variable. One last issue we will look at is how the introduction of care technology affects the use of nursing homes, the use of labor in the care sector as well as municipal costs. We will especially look at Lindås municipality and the Lister municipalities, which have been pioneer municipalities on this, but the results will probably be transferable to other municipalities. The project has been significantly delayed due to difficulties in accessing data. A lot of sensitive data is used from different registers, which have strict and to some extent different criteria for access, and there have been major shortcomings in data documentation and data quality. Most data was not available for the project until 2020. The project has therefore initially worked with theoretical models in addition to facilitating data. There are so far some divergent empirical results related to private and public operation of nursing homes. Some results are available in popular science channels and there are a number of draft articles being prepared for scientific journals. One article is accepted for publication in the American Journal of Health Economics and one has been published in the European Journal of Health Economics (partly funded from previous NFR project).

-

The project examines how incentives in the organisation of long term care for the elderly affect their mortality, health and quality of life. We will do this by merging individual patient data from various registers, including information on institutional and home based services from Oslo Nursing Home Agency (ONHA), allowing care providers like ONHA to better understand the effect of economic incentives. State of the art statistical methods will be used to identify causal mechanisms. Extraordinarily detailed data, combined with the expertise of care providers, pave the ground for high quality internationally publishable research. Qualitative studies of patient experience complement the statistics. A study of selection mechanisms in the provision of long term care will examine how economic incentives interact with health and socio-economic variables. Key questions are whether and how (i) care services are provided solely on the basis of needs, (ii) municipal districts as care providers are affected by economic incentives, (iii) care service profiles affect longevity and health and (iv) user fees affect use of care across groups. A study of nursing home privatization will build on recent transfers of operation to private companies, using longitudinal data of care provision, patients' characteristics and workforce qualifications for Oslo. Identification of quality differences needs a credible research strategy. The assignment system in Oslo enables us to compare outcomes of patients with identical preferences, (in practice) randomly allocated across institutions. Qualitative studies complement the statistical studies to achieve verification and interpretation of results. We will also examine effects of privatization on the workforce as well as productivity. The role of the regular general practitioners in elderly care will be examined, focusing on the extent to which economic incentives affect care services allocation across space and socioeconomic variable.