Does independent needs assessment limit use of publicly financed long-term care?

Highlights

• In publicly financed long-term care (LTC), eligibility assessments are often delegated to an independent assessor.

• This assessment aims to limit moral hazard and supplier-induced demand.

• The Dutch assessment hardly restricts use of people who are eligible.

• This is because of other constraints on use or lenient assessment.

• Independent needs assessment may still keep people out of the system.

Abstract

In health care the assessment of patients’ needs is typically entrusted to health care providers. By contrast, in publicly financed long-term care (LTC) needs assessment is often delegated to an independent assessor. One rationale offered for independent needs assessment in LTC is to limit the scope for moral hazard and supplier-induced demand, which may be particularly strong in case of public LTC insurance. We study whether independent needs assessment restricts use of publicly financed LTC at the intensive margin (i.e. after people are being assessed to be eligible for receiving care). Therefore, we link nationwide Dutch administrative datasets about individual LTC use and eligibility decisions by the independent assessment agency in 2012. We find for virtually all types of care, all population subgroups, and all regions that LTC use by patients was substantially less than the maximum amount of care allowed by the independent assessor. This suggests that in the Netherlands independent needs assessment in LTC does not impose a binding constraint on use once a person is considered eligible for care. Still, independent needs assessment may have reduced LTC use at the extensive margin. A significant proportion of the applications for care (16 %) was rejected. In addition, the independent assessment may deter some people from applying.