Determinants of first-time utilization of long-term care services in the Netherlands

An observational record linkage study

L.C.J. Slobbe, A. Wong, R.A. Verheij, J.A.M. Van Oers, J.J. Polder

Research output: Contribution to journalArticleScientificpeer-review

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Abstract

Background
Since in an ageing society more long-term care (LTC) facilities are needed, it is important to understand the main determinants of first-time utilization of (LTC) services.
Methods
The Andersen service model, which distinguishes predisposing, enabling and need factors, was used to develop a model for first-time utilization of LTC services among the general population of the Netherlands. We used data on 214,821 persons registered in a database of general practitioners (NIVEL Primary Care Database). For each person the medical history was known, as well as characteristics such as ethnicity, income, home-ownership, and marital status. Utilization data from the national register on long-term care was linked at a personal level. Generalized Linear Models were used to determine the relative importance of factors of incident LTC-service utilization.
Results
Top 5 determinants of LTC are need, measured as the presence of chronic diseases, age, household size, household income and homeownership. When controlling for all other determinants, the presence of an additional chronic disease increases the probability of utilizing any LTC service by 45% among the 20+ population (OR = 1.45, 95% CI: 1.41–1.49), and 31% among the 65+ population (OR = 1.31, 95% CI: 1.27–1.36). With respect to the 20+ population, living in social rent (OR = 2.45, 95% CI = 2.25–2.67, ref. = home-owner) had a large impact on utilizing any LTC service. In a lesser degree this was the case for living alone (OR = 1.63, 95% CI = 1.52–1.75, ref. = not living alone). A higher household income was linked with a lower utilization of any LTC service.
Conclusions
All three factors of the Anderson model, predisposing, enabling, and need determinants influence the likelihood of future LTC service utilization. This implies that none of these factors can be left out of the analysis of what determines this use. New in our analysis is the focus on incident utilization. This provides a better estimate of the effects of predictors than a prevalence based analysis, as there is less confounding by changes in determinants occurring after LTC initiation. Especially the need of care is a strong factor. A policy implication of this relative importance of health status is therefore that LTC reforms should take health aspects into account.
Keywords: Long-term care utilization, Chronic disease, Administrative data, Modelling
Original languageEnglish
Article number626
JournalBMC Health Services Research
Volume17
Issue number1
DOIs
Publication statusPublished - Sep 2017

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Long-Term Care
Netherlands
Databases
Ownership
Marital Status
General Practitioners
Linear Models

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@article{6ad881e7797b4c6b91582a55e3bda125,
title = "Determinants of first-time utilization of long-term care services in the Netherlands: An observational record linkage study",
abstract = "BackgroundSince in an ageing society more long-term care (LTC) facilities are needed, it is important to understand the main determinants of first-time utilization of (LTC) services.MethodsThe Andersen service model, which distinguishes predisposing, enabling and need factors, was used to develop a model for first-time utilization of LTC services among the general population of the Netherlands. We used data on 214,821 persons registered in a database of general practitioners (NIVEL Primary Care Database). For each person the medical history was known, as well as characteristics such as ethnicity, income, home-ownership, and marital status. Utilization data from the national register on long-term care was linked at a personal level. Generalized Linear Models were used to determine the relative importance of factors of incident LTC-service utilization.ResultsTop 5 determinants of LTC are need, measured as the presence of chronic diseases, age, household size, household income and homeownership. When controlling for all other determinants, the presence of an additional chronic disease increases the probability of utilizing any LTC service by 45{\%} among the 20+ population (OR = 1.45, 95{\%} CI: 1.41–1.49), and 31{\%} among the 65+ population (OR = 1.31, 95{\%} CI: 1.27–1.36). With respect to the 20+ population, living in social rent (OR = 2.45, 95{\%} CI = 2.25–2.67, ref. = home-owner) had a large impact on utilizing any LTC service. In a lesser degree this was the case for living alone (OR = 1.63, 95{\%} CI = 1.52–1.75, ref. = not living alone). A higher household income was linked with a lower utilization of any LTC service.ConclusionsAll three factors of the Anderson model, predisposing, enabling, and need determinants influence the likelihood of future LTC service utilization. This implies that none of these factors can be left out of the analysis of what determines this use. New in our analysis is the focus on incident utilization. This provides a better estimate of the effects of predictors than a prevalence based analysis, as there is less confounding by changes in determinants occurring after LTC initiation. Especially the need of care is a strong factor. A policy implication of this relative importance of health status is therefore that LTC reforms should take health aspects into account.Keywords: Long-term care utilization, Chronic disease, Administrative data, Modelling",
author = "L.C.J. Slobbe and A. Wong and R.A. Verheij and {Van Oers}, J.A.M. and J.J. Polder",
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Determinants of first-time utilization of long-term care services in the Netherlands : An observational record linkage study. / Slobbe, L.C.J.; Wong, A.; Verheij, R.A.; Van Oers, J.A.M.; Polder, J.J.

In: BMC Health Services Research, Vol. 17, No. 1, 626, 09.2017.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Determinants of first-time utilization of long-term care services in the Netherlands

T2 - An observational record linkage study

AU - Slobbe, L.C.J.

AU - Wong, A.

AU - Verheij, R.A.

AU - Van Oers, J.A.M.

AU - Polder, J.J.

PY - 2017/9

Y1 - 2017/9

N2 - BackgroundSince in an ageing society more long-term care (LTC) facilities are needed, it is important to understand the main determinants of first-time utilization of (LTC) services.MethodsThe Andersen service model, which distinguishes predisposing, enabling and need factors, was used to develop a model for first-time utilization of LTC services among the general population of the Netherlands. We used data on 214,821 persons registered in a database of general practitioners (NIVEL Primary Care Database). For each person the medical history was known, as well as characteristics such as ethnicity, income, home-ownership, and marital status. Utilization data from the national register on long-term care was linked at a personal level. Generalized Linear Models were used to determine the relative importance of factors of incident LTC-service utilization.ResultsTop 5 determinants of LTC are need, measured as the presence of chronic diseases, age, household size, household income and homeownership. When controlling for all other determinants, the presence of an additional chronic disease increases the probability of utilizing any LTC service by 45% among the 20+ population (OR = 1.45, 95% CI: 1.41–1.49), and 31% among the 65+ population (OR = 1.31, 95% CI: 1.27–1.36). With respect to the 20+ population, living in social rent (OR = 2.45, 95% CI = 2.25–2.67, ref. = home-owner) had a large impact on utilizing any LTC service. In a lesser degree this was the case for living alone (OR = 1.63, 95% CI = 1.52–1.75, ref. = not living alone). A higher household income was linked with a lower utilization of any LTC service.ConclusionsAll three factors of the Anderson model, predisposing, enabling, and need determinants influence the likelihood of future LTC service utilization. This implies that none of these factors can be left out of the analysis of what determines this use. New in our analysis is the focus on incident utilization. This provides a better estimate of the effects of predictors than a prevalence based analysis, as there is less confounding by changes in determinants occurring after LTC initiation. Especially the need of care is a strong factor. A policy implication of this relative importance of health status is therefore that LTC reforms should take health aspects into account.Keywords: Long-term care utilization, Chronic disease, Administrative data, Modelling

AB - BackgroundSince in an ageing society more long-term care (LTC) facilities are needed, it is important to understand the main determinants of first-time utilization of (LTC) services.MethodsThe Andersen service model, which distinguishes predisposing, enabling and need factors, was used to develop a model for first-time utilization of LTC services among the general population of the Netherlands. We used data on 214,821 persons registered in a database of general practitioners (NIVEL Primary Care Database). For each person the medical history was known, as well as characteristics such as ethnicity, income, home-ownership, and marital status. Utilization data from the national register on long-term care was linked at a personal level. Generalized Linear Models were used to determine the relative importance of factors of incident LTC-service utilization.ResultsTop 5 determinants of LTC are need, measured as the presence of chronic diseases, age, household size, household income and homeownership. When controlling for all other determinants, the presence of an additional chronic disease increases the probability of utilizing any LTC service by 45% among the 20+ population (OR = 1.45, 95% CI: 1.41–1.49), and 31% among the 65+ population (OR = 1.31, 95% CI: 1.27–1.36). With respect to the 20+ population, living in social rent (OR = 2.45, 95% CI = 2.25–2.67, ref. = home-owner) had a large impact on utilizing any LTC service. In a lesser degree this was the case for living alone (OR = 1.63, 95% CI = 1.52–1.75, ref. = not living alone). A higher household income was linked with a lower utilization of any LTC service.ConclusionsAll three factors of the Anderson model, predisposing, enabling, and need determinants influence the likelihood of future LTC service utilization. This implies that none of these factors can be left out of the analysis of what determines this use. New in our analysis is the focus on incident utilization. This provides a better estimate of the effects of predictors than a prevalence based analysis, as there is less confounding by changes in determinants occurring after LTC initiation. Especially the need of care is a strong factor. A policy implication of this relative importance of health status is therefore that LTC reforms should take health aspects into account.Keywords: Long-term care utilization, Chronic disease, Administrative data, Modelling

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DO - 10.1186/s12913-017-2570-z

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SN - 1472-6963

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