A Macro Prediction of the Use of Care Provisions in the Netherlands Jedid-Jah Jonker, Ingrid Ooms, Isolde Woittiez, Social and Cultural Planning Office Discussant: Paul McNamee, HERU, University of Aberdeen, UK

Aims To examine the determinants of the use of different forms of long-term care (LTC) To determine the extent to which different forms of LTC are substitutes for one another To produce forecasts of different forms of LTC use for

Methods 2 different surveys of persons living at home and in institutions (n=9,455) LTC classified into 8 categories Health status (disease, limitations) Socio-demographic and economic

Modelling approach Nested logit Multinomial logit Macro modelling using population data to forecast LTC use at a national level

Results - I Most variables behave in the expected way (e.g. limitation in daily tasks predictive of any LTC use and more resource intensive forms of LTC) Few variables behave in an unexpected way Some variables have little or no effect (e.g. diseases / limitations does not increase probability of privately paid care vs. informal care)

Results - II Nested logit and multinomial logit produce comparable results People forecasted to use more LTC Use of privately paid care rises the most amongst the different forms of LTC

General comments Interesting and novel – macro modelling from micro data More information on LTC policy – to what extent is access to publicly funded care subject to income/asset tests? Representativeness of sample? (persons living at home conducted amongst independently living persons?) The modelling strategy – how robust for people with more than 1 form of LTC?

Specific comments The modelling strategy: - health assumed to be exogenous - tests for endogeneity? - test for the IIA assumption by dropping some variables? OV bias? – informal care likely to be a substitute for other forms of LTC – use of probit/logit models to check? “..surprising that disease/limitations do not affect choice between informal & private care” – but does it simply reveal they are substitutes?

Other issues When/where were the surveys conducted? (if recent, could you compare the forecast with the actual?) How is the supply side handled? Are different forms of LTC substitutes or not? Interpretation of the macro results – why large rise in privately paid care? – is model being driven by age changes rather than other variables?