In the Organization for Economic Co-Operation and Development (OECD) countries, health and long-term treatment costs are rising. For example, in the Netherlands, the percentage of gross domestic product spent on health care has increased almost 1% over 12 years. It increased from 9.1%in 2007 to 10.1%in 2019 (1). The Netherlands is relatively high in long -term treatment. In 2005, this was 4%of GDP and rose to 4.9%of GDP in 2018 (2, 3). Knowledge of the decision factors of health and long -term treatment costs is important for supporting cost isolation policy and predicting future medical expenses.
There is a practical health economics literature on the decision factor of health and long -term treatment. Some of this literature is Zweifel et al. (4). Breyer and Lorenz summarize the “red herring” discussion of health economics as follows: “One of the most important controversies in the discourse of health economics over the past 20 years is that most of the OECD countries have an additional burden on taxpayers who procure a public health system. Zweifel et al. It was not aging and claimed to be a major decision of health care (4, 6).
In many studies worldwide, costs were investigated last year. The entire discussion is out of the scope of this white paper. Zweifel et al. Switzerland’s relatively small data set showed that “if it is 65 +in death, age is not effective (4).” Breyer and Felder have predicted health care expenditures by combining the data of the statistical office using the claim data of the Swiss Disease Fund since 1999 (7). Their research shows that after the revision of last year’s costs, a significant portion of the expected demographic increase in health expenditures (60%) remains by 2050. Yang et al. (2003) had a higher cost of health care for individuals who died before the survivors (8). SHMUELI et al. Last year, people spent 20 times more time for health care than those who did not live last year and found that the difference could be caused by the cost of nursing (9). Weaver et al. The survey data from the health and retirement research (1993-2002) was used, and “the proximity of death is 50.0% of the probability of use of nursing homes and 12.4% of official home care.”
The proximity of death has been proposed to be a “red herring” itself for Lee. Increasing personal interest rates and obstacles over the past few years can at least explain that the cost of health and long -term treatment over the last few years. For example, Carreras et al. Including the reimbursement rate, it has been shown to be significantly reduced in acute outpatient patients, acute inpatient patients, primary care and pharmacies with different connection between life and health care in the past few years. Howden and RICE showed that the effects of proximity to hospital management costs decreased when the model included a dichotomy in the model (12). De Meijer et al. After controlling the disability, he showed that death time is no longer important in long -term spending (13). This study shows the importance of considering the diphetter rate and/or disorders.
The increase in the health and long -term nursing costs of individuals who died compared to survivors vary from health care expenditure to medical sectors (14, 15). Knowledge of the last year’s cost of life in various health care sectors is important for health care plans.
Dutch literature
Since the current research focuses on the Netherlands, Dutch literature is explained in more detail. Stooker et al. And polder et al. The claim data in the 1990s was used and the cost of health and long -term treatment of individuals who died compared to survivors was 5 to 13.5 times higher (16, 17). De kok et al. The average health and long -term treatment costs of individuals who die from cancer have reduced the average health management cost of age groups compared to those who die from other diseases (18). BAKX et al. 9.4%of the total expenditure showed that it was about the health of life and the cost of long -term nursing. Pot et al. I used the survey data and focused on using it. Using regression analysis, they showed more health management rates in the end of life, compared with survivors for medical professionals, hospital management, informal personal care, professional home care and institutional treatment (20). After adjusting other chronic diseases and functional limitations, the connection between last year and health care was reduced. WONG et al. During the 1995-2004 period, the Dutch hospital discharge registration was used to focus on expenditures for hospitals by disease (21). They found that the melee of death is important for most diseases, and the influence of age is statistically important, but it seems to be appropriate compared to the proximity of death. Van Baal and WONG have found that medical expenditure predictions were not lowered, including time, using macro data, including mortality, age, and gender health expenditures for 1981-2007 (22). De Meijer et al. Since 2004, it has focused on long -term treatment spending using relatively small survey data (13). Their main discovery was that after the control of the disability was no longer important. In other words, death time was mostly a deputy of disability. Age and unofficial nursing availability remained an important decision factor for long -term treatment. The cost of the end of life was extensively studied in the Netherlands, but this study was carried out before two major reforms: health and long -term treatment, which may have affected the connection between life and health and long -term treatment for the past few years. In addition, the potential heterogeneous impacts over the last few years have not been completely studied.
The goal of this study was to analyze the relevance between the Dutch life and health and long -term treatment after two major reforms to adjust the age, gender, neighboring socioeconomic status and chronic diseases between the Dutch life and health and long -term treatment costs after two major reforms.
Institutional background
As our research is carried out in the Netherlands, we present some of the main features of the Dutch institutional context. Dutch health care systems are mainly raised by two plans, one, one, by treatment (health insurance) and long -term treatment (long -term therapy). In 2006, the Dutch government introduced a treatment management competition system to promote efficiency, quality, and acceptable social costs, reduce central governance, and improve accessibility (23, 24). In this management competition system, all citizens are forced to insured to avoid adverse choices (social insurance). Health insurers are rewarded for anticipated health care expenses from risk equality funds. Dutch health insurers negotiate the quality and costs with medical service providers on behalf of insurers. Basic benefits include nurses provided by general practitioners (GPS), hospital management, home nursing (after 2015), mental health care (18 years of age or older after 2015), medical devices, maternity treatment and pharmaceutical treatment (25). Except for GP counseling, childbirth nursing, home nursing, and treatment for children under 18 years of age, there are essential deductions for the first € 385 (2019).
In 2015, the Dutch government introduced a new long -term nursing law, which basically replaced old -fashioned (AWBZ, introduced in 1968) (2). Cost wasolation was one of the goals of reform. It is a social insurance system that raises funds with income dependent tax. Only long -term treatments for those who are permanently dependent on nursing or permanent supervision are regulated by long -term treatment. Other treatments that AWBZ have previously dealt with from 2015 have been transferred to social support laws (WMO (domestic nursing, social support), health insurance law (mainly home nursing) and youth law (assistance and care for adolescents and families, childcare and development problems, psychological problems and disability, and to cope with psychological problems and disability. Somewhat inherent in reforms, such as personal care (for example, washing and dressing), a person who lives in the institution (eg, special clothes or drugs), a somewhat inherent in the reform of the formal treatment. In the case of competitive competition, the price competition among the providers is recommended to rely on informal care and more expensive institutional treatment. The cost is reduced and it is expected to be shifted from long -term treatment to treatment.
