School of Economics, University of Queensland, Australia; Centre for the Business and Economics of Health (CBEH), University of Queensland, Australia.
School of Economics, University of Queensland, Australia; Centre for the Business and Economics of Health (CBEH), University of Queensland, Australia.
Soc Sci Med. 2021 Jul;280:114017. doi: 10.1016/j.socscimed.2021.114017. Epub 2021 May 13.
Evaluation of Consumer Directed Care (CDC), an internationally recognized means to promote autonomy and choices in the delivery of health in community aged care, is growing, but little is known about the spatial implications of such policy. With differences in the utilisation of home care services across locations, the introduction of a national CDC program may affect different regions to different extents. This paper explores the regional effect of the CDC introduction on older Australians' mental health. We analyse data on 1780 individuals aged 65 years and over, from 11 waves (2007-2017) of the Household, Income and Labour Dynamics in Australia (HILDA) Survey. We find that older adults' mental health is worse after the introduction of the CDC in 2013. Moreover, older adults, who lived in the areas with higher utilisation of Home Care Packages, experienced worse mental stress than the same individuals who lived in the areas with lower utilisation of home care services. This pattern may reflect regional differences in Government funding, community aged care waiting time and provider service fees. Therefore, it is important for health policies that aim to promote choices to older consumers, such as CDC, to consider regional differences in its implementation, to minimise unwarranted variations in the population health and well-being.
评估消费者导向的护理 (CDC)，这是一种国际公认的促进社区老年人护理中自主性和选择的方法，其应用正在不断增加，但对于这种政策的空间影响却知之甚少。由于各地对家庭护理服务的利用程度存在差异，因此引入全国性的 CDC 计划可能会对不同地区产生不同程度的影响。本文探讨了 CDC 引入对澳大利亚老年人心理健康的区域影响。我们分析了来自澳大利亚家庭、收入和劳动力动态调查（HILDA）的 11 个波次（2007-2017 年）的 1780 名 65 岁及以上个体的数据。我们发现，2013 年 CDC 推出后，老年人的心理健康状况更差。此外，与居住在家庭护理服务利用率较低地区的相同个体相比，居住在家庭护理包利用率较高地区的老年人心理压力更大。这种模式可能反映了政府资金、社区老年人护理等待时间和提供者服务费用方面的地区差异。因此，对于旨在为老年消费者提供选择的健康政策（如 CDC）而言，在实施过程中考虑区域差异以最小化人口健康和福祉方面不必要的差异非常重要。
