Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
Erasmus Centre for Health Economics Rotterdam, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Health Econ. 2022 Oct;31 Suppl 2(Suppl 2):115-133. doi: 10.1002/hec.4579. Epub 2022 Aug 19.
Societies face the challenge of providing appropriate arrangements for individuals who need living support due to their mental disorders. We estimate the effects of eligibility to the Dutch supported housing program (Beschermd Wonen), which offers a structured living environment in the community as an intermediate alternative to independent housing and inpatient care. For this, we use exogenous variation in eligibility based on conditionally random assignment of applications to assessors, and the universe of applications to supported housing in the Netherlands, linked to rich administrative data. Supported housing eligibility increases the probability of moving into supported housing and decreases the use of home care, resulting in higher total care expenditures. This increase is primarily due to the costs of supported housing, but potentially also higher consumption of curative mental health care. Supported housing eligibility reduces the total personal income and income from work. Findings do also suggest lower participation in the labor market by the individuals granted eligibility, but the labor participation of their parents increases in the long-run. Our study highlights the trade-offs of access to supported housing for those at the margin of eligibility, informing the design of long-term mental health care systems around the world.
社会面临着为那些因精神障碍而需要生活支持的人提供适当安排的挑战。我们评估了荷兰支持性住房计划（Beschermd Wonen）的资格的效果，该计划在社区中提供结构化的生活环境，作为独立住房和住院护理的中间选择。为此，我们根据对评估员的申请条件性随机分配利用资格的外生性变化，并利用荷兰支持性住房的申请总体情况，与丰富的行政数据相关联。支持性住房资格增加了入住支持性住房的可能性，并减少了家庭护理的使用，从而导致更高的总护理支出。这种增加主要是由于支持性住房的成本，但也可能是精神保健治疗的消费增加。支持性住房资格降低了总收入和工作收入。研究结果还表明，获得资格的个人参与劳动力市场的比例降低，但他们父母的劳动力参与率在长期内会增加。我们的研究强调了边缘资格人群获得支持性住房的权衡，为世界各地的长期精神卫生保健系统设计提供了信息。
