The Deinstitutionalisation of Old Age Care: Its Association With Other Long-Term Care Services and Outpatient Medical Expenses in 2000–2013
Abstract
The Finnish policy of deinstitutionalising old age care is aimed at reducing the coverage of traditional institutional care (i.e., long-term care in residential homes and health centres): the preference is that older people should rather be cared for in their homes. However, there has been only limited research into the consequences of deinstitutionalisation for other long-term care services. It is also unclear to what extent deinstitutionalisation has increased the expenses of outpatient drug purchases. We used panel regression models and macro-level data on Finnish municipalities in 2000–2013 to estimate the associations between the declining coverage of institutional care and changes in
other forms of long-term care for people aged 75 and over.
The results showed that a one percentage point decrease in the coverage of institutional care was associated with a 0.44 percentage point increase in the coverage of intensive service housing (with 24-hour care) and a 0.10 percentage point increase in the coverage of ordinary service housing (with only day-time care), after controlling for care needs in the older population. Changes in deinstitutionalisation were unrelated to changes in regular home care and informal care. Interaction analyses showed that municipalities with the highest care needs tended to increase the coverage
of intensive service housing more than municipalities with lower average care needs. A one percentage point decrease in the coverage of institutional care was found to increase the average expenses of outpatient prescription medicines for 75-year-olds by 0.9 per cent, independent
of changes in the medicine reimbursement system and in care needs. Along with deinstitutionalisation, it seems that municipalities have been able to shift the burden of medicine costs to the national health insurance system and to patients themselves. The results highlight the need to ensure that further deinstitutionalisation will be accompanied by ethically and economically sustainable alternatives.
Authors
Jenni Blomgren, Elina Einiö
Additional Information
- Peer-Reviewed: yes.
- Open Access: yes.
- Cite as: Blomgren, J., & Einiö, E. (2015). Laitoshoidon vähenemisen yhteys ikääntyneiden muihin pitkäaikaishoivan palveluihin ja sairausvakuutuksen korvaamien lääkkeiden kustannuksiin vuosina 2000–2013. Yhteiskuntapolitiikka, 80(4), 334–348. https://urn.fi/URN:NBN:fi-fe2015090211140
