Impact of regional inequalities in long-term care on health spending: evidence from dementia patients in France

Aging and health research Pub Date : 2025-05-28 DOI:10.1016/j.ahr.2025.100239

Anne Penneau , Zeynep Or

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Abstract

Background

Unmet need for long-term care (LTC) could be associated with higher health care utilization and medical spending. In France funding of LTC is decentralised and there are significant disparities in accessibility of LTC. We analyse the impact of geographical variations in LTC funding and supply on healthcare expenditure focusing on dementia patients.

Methods

Healthcare spending of individuals is calculated from a national linked claims database. We run multilevel models exploiting the variations in spending across two geographical levels (residential areas nested in local authorities (LA)) to estimate the impact of local LTC supply and funding on health spending of patients with dementia. We estimated the generosity of LTC funding at LA with a stochastic frontier model and developed a taxonomy of LTC supply.

Results

Dementia patients living in LAs with most generous LTC funding have significantly lower acute (-11 %) and post-acute (-35 %) hospital spending while they have higher (+17 %) primary care spending. Moreover, people in areas with the highest LTC supply spend 3 % less on hospital care per year and per person compared to those in underserved areas.

Conclusions

Our results suggest that better accessibility of LTC with better funding and LTC supply can reduce hospital spending and improve overall health system efficiency.

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长期护理方面的地区不平等对卫生支出的影响：来自法国痴呆症患者的证据

长期护理需求低可能与较高的医疗保健利用率和医疗支出有关。在法国，LTC的资金是分散的，在LTC的可及性方面存在显著差异。我们分析了LTC资金和供应的地理差异对痴呆症患者医疗保健支出的影响。方法从国家关联索赔数据库中计算个人医疗保健支出。我们运行多层模型，利用两个地理水平（嵌套在地方当局（LA）的住宅区）的支出变化来估计当地LTC供应和资金对痴呆症患者医疗支出的影响。我们用随机前沿模型估计了洛杉矶大学LTC资金的慷慨程度，并开发了LTC供应的分类。结果：生活在LTC资助最慷慨的LAs的痴呆患者，其急性期（- 11%）和急性期后（- 35%）的医院支出显著降低，而其初级保健支出较高（+ 17%）。此外，长期医疗服务供应最多的地区的人们每年和每人在医院护理上的花费比服务不足地区的人少3%。结论改善长期门诊的可及性，改善长期门诊的资金和供应，可以减少医院的支出，提高卫生系统的整体效率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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