Personal Social Services Research Unit, University of Kent, Canterbury, Kent, CT2 7NX, UK.
Centre for Health Services Studies, University of Kent, Canterbury, Kent, CT2 7NX, UK.
Eur J Health Econ. 2019 Apr;20(3):375-387. doi: 10.1007/s10198-018-0999-6. Epub 2018 Sep 5.
Many countries are adopting policies to create greater coordination and integration between acute and long-term care services. This policy is predicated on the assumption that these service areas have interdependent outcomes for patients. In this paper, we study the interdependencies between the long-term (home care) services and consultations with a primary care doctor, as used by people over 75 years. Starting with a model of individual's demand for doctor consultations, given supply, we formalize the hypothesis that exogenous increases to home care supply will reduce the number of consultations where these services are technical substitutes. Furthermore, greater coordination of public service planning and use of pooled budgets could lead to better outcomes because planners can account for these externalities. We test our main hypothesis using data from the British Household Panel Study for 1991-2009. To address potential concerns about endogeneity, we use a set of instrumental variables for home care motivated by institutional features of the social care system. We find that there is a statistically significant substitution effect between home care and doctor visits, which is robust across a range of specifications. This result has implications for policies that consider increased coordination between health care and social care systems.
许多国家正在采取政策，以实现急性和长期护理服务之间更大的协调和整合。这一政策的前提是，这些服务领域对患者的结果具有相互依存关系。本文研究了 75 岁以上人群使用的长期（家庭护理）服务和初级保健医生咨询之间的相互依存关系。从给定供应的个体对医生咨询的需求模型出发，我们正式提出假设，即家庭护理供应的外生增加将减少这些服务互为技术替代品的咨询次数。此外，公共服务规划和使用统筹预算的更大协调可以带来更好的结果，因为规划者可以考虑到这些外部性。我们使用 1991-2009 年英国家庭面板研究的数据来检验我们的主要假设。为了解决内生性的潜在问题，我们使用了一套由社会关怀制度的制度特征所激发的家庭护理工具变量。我们发现，家庭护理和医生就诊之间存在显著的替代效应，这在一系列规范中是稳健的。这一结果对考虑增加医疗保健和社会保健系统之间协调的政策具有重要意义。
