Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America.
PLoS One. 2018 Jun 26;13(6):e0199522. doi: 10.1371/journal.pone.0199522. eCollection 2018.
Chile is experiencing a period of rapid aging, which increases the need of long-term care services in the country. Nursing homes have been the traditional alternative to deal with the increase of elderly population in the country, with services supplied by a mix of for-profit and nonprofit providers. Additionally, population exhibits a high degree of geographical concentration. The study aims to identify the determinants of the geographical location of nursing homes in Chile at municipality level. The analysis takes into account the different location criteria for different types of nursing homes as well as potential spatial effects. The paper uses spatial analysis tools to identify clusters of nursing homes and population characteristics and to estimate the determinants of nursing homes availability and coverage in the country. The analysis-based on spatial global and local tests, and spatial autoregressive models- show the existence of clusters of nursing homes as well as clusters of municipalities according to elderly population, income, poverty, population density, and public health insurance coverage. Residuals from ordinary least squares regressions were spatially autocorrelated, showing the need of using spatial models. Estimations show that availability and coverage of nursing homes are positively related with municipality income, and that for-profit and nonprofit facilities respond differently to different factors. A negative coefficient was found for poverty in nonprofit nursing homes, raising doubts about the effectiveness of giving public subsidies to incentive the installation of facilities in areas with high needs and low income.
智利正经历人口老龄化的快速发展阶段，这增加了该国对长期护理服务的需求。养老院一直是应对该国老年人口增长的传统选择，服务由营利性和非营利性提供者混合提供。此外，人口在地理上高度集中。本研究旨在确定智利市县级养老院地理位置的决定因素。该分析考虑了不同类型养老院的不同选址标准以及潜在的空间效应。本文使用空间分析工具来识别养老院和人口特征的集群，并估计该国养老院的供应和覆盖范围的决定因素。基于空间全局和局部检验以及空间自回归模型的分析表明，养老院存在集群，以及根据老年人口、收入、贫困、人口密度和公共医疗保险覆盖范围划分的市镇集群。普通最小二乘回归的残差具有空间自相关性，表明需要使用空间模型。估计结果表明，养老院的供应和覆盖范围与市镇收入呈正相关，营利性和非营利性设施对不同因素的反应不同。非营利性养老院的贫困因素呈负系数，这让人对给予公共补贴以激励在高需求和低收入地区安装设施的有效性产生了质疑。
