Forder Julien, Vadean Florin, Rand Stacey, Malley Juliette
Quality and Outcomes of Person-centred Care Policy Research Unit (QORU), PSSRU, University of Kent, UK.
Quality and Outcomes of Person-centred Care Policy Research Unit (QORU), PSSRU, London School of Economics, UK.
Health Econ. 2018 Mar;27(3):e43-e58. doi: 10.1002/hec.3612. Epub 2017 Nov 3.
Long-term care services are provided to help people manage the consequences of impairment, but their impact goes beyond the meeting of basic needs. Accordingly, the main aim was to explore the marginal effectiveness of care when measured in terms of people's overall care-related quality of life (CRQoL) and assess changes in marginal effect for increasing intensity. The associated aim was to refine and apply an observational method to estimate marginal effectiveness. A "production function" approach was used with survey data, including Adult Social Care Outcomes Toolkit-measured CRQoL, whereby we statistically modelled the expected relationship between service utilisation rates and CRQoL. This method seeks to limit endogeneity issues by controlling on observables and using instrumental variable. Using a survey of publicly funded long-term care service users in England, we found that community-based long-term care significantly improved people's CRQoL but with diminishing marginal effects and effects differentiated by baseline impairment levels. There are implications for how the care system should respond to changes in global public budgets. For example, where there is unmet need, a system aimed to maximise (unadjusted) CRQoL would put more emphasis on access (more recipients) than intensity of support compared to a system operating on a needs basis.
长期护理服务旨在帮助人们应对功能受损的后果，但其影响远不止于满足基本需求。因此，主要目的是探讨以人们的整体护理相关生活质量（CRQoL）衡量护理的边际效果，并评估随着护理强度增加边际效果的变化。相关目的是完善并应用一种观察方法来估计边际效果。我们使用“生产函数”方法和调查数据，包括用成人社会护理结果工具包测量的CRQoL，通过统计建模服务利用率与CRQoL之间的预期关系。该方法旨在通过控制可观测因素并使用工具变量来限制内生性问题。通过对英格兰公共资助的长期护理服务使用者的调查，我们发现基于社区的长期护理显著改善了人们的CRQoL，但边际效果递减，且效果因基线受损水平而异。这对护理系统应如何应对全球公共预算的变化具有启示意义。例如，在存在未满足需求的情况下，如果一个旨在使（未经调整的）CRQoL最大化的系统，与一个基于需求运作的系统相比，会更强调获得护理的机会（更多接受者）而非支持强度。
