Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON, M5T3M6, Canada.
Canadian Centre for Health Economics/Centre canadien en économie de la santé, 155 College Street, Toronto, ON, M5T3M6, Canada.
Health Econ Rev. 2016 Dec;6(1):8. doi: 10.1186/s13561-016-0086-6. Epub 2016 Feb 25.
The role of Home Care (HC) services for the elderly will be increasingly important in meeting populations' future needs for care. HC services include Home Health Care (HHC) and Homemaking/Personal Support (HMPS), distinction rarely seen in the literature. This paper argues that it is important to distinguish between these types of HC, since the factors that drive the likelihood of the receipt of each type of care may differ, and also to investigate the interrelationship between them. We explored the interrelationship between receipt of publicly funded HMPS and HHC, and the determinants of the receipt of each type of services. A Panel Two-Stage Residual Inclusion approach was applied to estimate the likelihood of the receipt of HC services using data for those aged 65 and over from 9 biannual waves of the Canadian National Population Health Survey (1994-95 to 2010-11). We found that there are in fact differences in the determinants of the likelihood of HHC and HMPS receipt. Moreover, receipt of publicly funded HMPS was found to be complementary with receipt of publicly funded HHC services after adjusting for functional and health status. Dependence on help with activities of daily living, health status, household arrangement, and income were found to be determinants of the propensity to receive both publicly funded HHC and HMPS services. This study aims to contribute to the existent literature by taking a step toward explicitly modelling the potential interaction between the determinants of the receipt of different types of HC services simultaneously, as a system. Our methodological approach, a Panel Two-Stage Residual Inclusion method, seems to effectively address problems that are known to be a source of bias in the literature.
家庭护理（HC）服务在满足未来人口护理需求方面的作用将变得越来越重要。HC 服务包括家庭保健护理（HHC）和家政/个人支持（HMPS），但在文献中很少有区分。本文认为，区分这两种类型的 HC 很重要，因为驱动每种类型护理服务的可能性的因素可能不同，并且还需要研究它们之间的相互关系。我们探讨了公共资助的 HMPS 和 HHC 之间的相互关系，以及每种服务的接受的决定因素。使用来自加拿大国家人口健康调查（1994-95 年至 2010-11 年）的 9 次双年度波中年龄在 65 岁及以上的人群数据，采用 Panel Two-Stage Residual Inclusion 方法来估计 HC 服务的接受可能性。我们发现，HHC 和 HMPS 接受的决定因素实际上存在差异。此外，在调整了功能和健康状况后，发现公共资助的 HMPS 的接受与公共资助的 HHC 服务的接受具有互补性。发现日常生活活动的帮助依赖、健康状况、家庭安排和收入是接受公共资助的 HHC 和 HMPS 服务的倾向的决定因素。本研究旨在通过明确模拟不同类型 HC 服务的接受决定因素之间的潜在相互作用，为现有文献做出贡献，作为一个系统。我们的方法，Panel Two-Stage Residual Inclusion 方法，似乎有效地解决了文献中已知是偏差来源的问题。
