Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-27T10:23:32.953Z Has data issue: false hasContentIssue false
  • English
  • Français

A Comparative Analysis of Costs to Government for Home Care and Long-term Residential Care Services, Standardized for Client Care Needs*

Published online by Cambridge University Press:  31 March 2010

Marcus J. Hollander  and
Neena L. Chappell
Marcus J. Hollander*
Affiliation:
Hollander Analytical Services Ltd.
Neena L. Chappell
Affiliation:
University of Victoria
*
Requests for offprints should be sent to:/Les demandes de tirés-à-part doivent être adressées à : Marcus J. Hollander, Ph.D., Hollander Analytical Services Ltd., 300 – 895 Fort Street, Victoria, BC V8W 1H7. ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

This paper reports on the results of analyses using administrative data from British Columbia for 10 years from fiscal 1987/1988 to 1996/1997, inclusive, to examine the comparative costs to government of long-term home care and residential care services. The analyses used administrative data for hospital care, physician care, drugs, and home care and residential long-term care. Direct comparisons for cost and utilization data were possible, as the same care-level classification system is used in BC for home care and residential care clients. Given significant changes in the type and/or level of care of clients over time, a full-time equivalent client strategy was used to maximize the accuracy of comparisons. The findings suggest that, in general, home care can be a lower-cost alternative to residential care for clients with similar care needs. The difference in costs between home care and residential care services narrows considerably for those who change their type and/or level of care, and home care was found to be more costly than long-term institutional care for home care clients who died. The findings from this study indicate that with the appropriate substitution for residential care services, in a planned and targeted manner, home care services can be a lower-cost alternative to residential long-term care in integrated systems of care delivery that include both sets of services.

Résumé

l'article présente les résultats d'analyses de données administratives de la province de la Colombie-Britannique couvrant une décennie, de 1987–1988 à 1996–1997, dans le but de comparer les coûts pour le gouvernement des soins de longue durée, à domicile et en établissement d'hébergement. Les données administratives analysées couvrent une gamme de services de santé dont les soins hospitaliers, les soins médicaux, les médicaments et les soins de longue durée, à domicile et en établissement. Comme la province applique le même système de classification des niveaux de soins aux soins à domicile et aux soins en établissement d'hébergement, il a été possible de comparer ces soins entre eux des points de vue du coût et de l'utilisation. Étant donné que le type et le niveau de soins dispensés aux usagers changent grandement au fil du temps, les auteurs ont conçu une stratégie axée sur l'équivalent temps plein (ETP) pour garantir l'exactitude des comparaisons. En vertu des constatations, les soins à domicile en général constituent une option plus économique que les soins en établissement d'hébergement, en supposant que les besoins des usagers sont les mêmes. l'écart de coût entre les soins à domicile et les soins en établissement rétrécit beaucoup quand le type ou le niveau de soins change, et les soins à domicile sont plus coûteux que les soins de longue durée en établissement pour les usagers des soins à domicile qui décèdent. l'étude révèle que les soins à domicile sont une option plus économique que les soins de longue durée en établissement d'hébergement dans un système de soins intégrés qui englobe les deux types de services, pourvu que les services en établissement prennent le pas au moment voulu dans le cadre d'une planification rigoureuse.

Keywords

aginghome carelong-term careresidential carecontinuing careintegrated carecost-effectivenessvieillissementsoins à domicilesoins de longue duréesoins en établissement d'hébergementsoins continussoins intégrésrentabilité
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 26 , Issue S1: Hidden Costs/Invisible Contributions of Caregiving / Coûts cachés et contributions invisibles des soins , Winter/Hiver 2007 , pp. 149 - 161
Copyright
Copyright © Canadian Association on Gerontology 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

We would like to acknowledge the Health Transition Fund, Health Canada, for providing partial funding for this study. The views expressed herein do not necessarily represent the views of Health Canada. We would also like to acknowledge the helpful comments provided by the reviewers of this paper. Finally, we would like to thank Angela Tessaro for her assistance with the complex computer programming required for this study.

References

Chamberlayne, R., Green, B., Barer, M.L., & Hertzman, C.C. (1998). Creating a population-based linked health database: A new resource for health services research. Canadian Journal of Public Health, 89, 270–273.CrossRefGoogle ScholarPubMed
Chappell, N.L., Havens, B., Hollander, M.J., Miller, J., & McWilliam, C. (2004). Comparative costs of home care and residential care. Gerontologist, 44(3), 389–400.Google Scholar
Drummond, M.F., O'Brien, B., Stoddart, G.L., & Torrance, G.W. (1997). Methods for the economic evaluation of health care programs. New York: University of Toronto Press.Google Scholar
Greene, V.L., Ondrich, J., & Laditka, S. (1998). Can home care services achieve cost savings in long-term care for older people? Journal of Gerontology, 53(4), S228–S238.Google Scholar
Hedrick, S.C., & Inui, T. (1986). The effectiveness and cost of home care: An information synthesis. Health Services Research, 20(6), 851–880.Google ScholarPubMed
Hollander, M.J. (1994). The costs, and cost-effectiveness, of continuing care services in Canada. Working Paper No. 94-10. Ottawa: Queen's University of Ottawa Economic Projects.Google Scholar
Hollander, M.J., & Pallan, P. (1995). The British Columbia continuing care system: Service delivery and resource planning. Aging: Clinical and Experimental Research, 7(2), 94–109.Google Scholar
Hux, M.J., O'Brien, B.J., Iskedjian, M., Goeree, R., Gagnon, M., & Gauthier, S. (1998). Relation between Alzheimer's disease and costs of caring. Canadian Medical Association Journal, 159(5), 457–465.Google Scholar
Mathematica Policy Research. (1986, May). The evaluation of the national long term care demonstration. (Final Report). Princeton, NJ: Author.Google Scholar
Robert Wood Johnson Foundation. (1996, April). Call for proposals: Home care research initiative 1996. Princeton, NJ Author.Google Scholar
Saskatchewan Health Services Utilization Research Commission (HSURC) (1998). Hospital and Home Care Study. (Report No. 10). Saskatoon, SK: Author.Google Scholar
Skellie, A., Favor, F., Tudor, C., & Strauss, R. (1984). The Georgia Alternative Health Services Project: Cost-effectiveness depends on population selection. Home Health Care Service Quarterly, 4, 49–72.Google Scholar
Stuart, M., & Weinrich, M. (2001). Home- and community-based long-term care: Lessons from Denmark. Gerontologist, 41(4), 474–480.CrossRefGoogle Scholar
Weissert, W.G. (1985). Seven reasons why it is so difficult to make community-based long-term care cost-effective. Health Services Research, 20(4), 423–433.Google ScholarPubMed
Weissert, W.G., Lesnick, T., Musliner, M., & Foley, K.A. (1997). Cost savings from home and community-based services: Arizona. Journal of Health Politics, Policy and Law, 22(6), 1329–1357.Google Scholar
Weissert, W.G., Mathews Cready, C., & Pawelak, J.E. (1988). The past and future of home and community-based long-term care. Millbank Quarterly, 66(2), 309–389.Google Scholar