Investigating the relationship between social care supply and healthcare utilisation by older people in England

TY - JOUR

T1 - Investigating the relationship between social care supply and healthcare utilisation by older people in England

AU - Liu, Dan

AU - Pace, Maria Lucia

AU - Goddard, Maria Karen

AU - Jacobs, Rowena

AU - Wittenberg, Raphael

AU - Mason, Anne Rosemary

N1 - © 2020 The Authors. Health Economics published by John Wiley & Sons Ltd.

PY - 2021/1/1

Y1 - 2021/1/1

N2 - Since 2010, adult social care spending in England has fallen significantly in real terms whilst demand has risen. Reductions in social care supply may also have impacted demand for NHS services, particularly for those whose care is provided at the interface of the health and care systems. We analysed a panel dataset of 150 local authorities (councils) to test potential impacts on hospital utilisation by people aged 65 and over: emergency admission rates for falls and hip fractures (‘front-door’ measures); and extended stays of 7 days or longer; and 21 days or longer (‘back-door’ measures). Changes in social care supply were assessed in two ways: gross current expenditure (per capita 65 and over) adjusted by local labour costs; and social care workforce (per capita 18 and over). We ran negative binomial models, controlling for deprivation, ethnicity, age, unpaid care, council class and year effects. To account for potential endogeneity, we ran instrumental variable regressions and dynamic panel models. Sensitivity analysis explored potential effects of funding for integrated care (the Better Care Fund).There was no consistent evidence that councils with higher per capita spend or higher social care staffing rates had lower hospital admission rates or shorter hospital stays.

AB - Since 2010, adult social care spending in England has fallen significantly in real terms whilst demand has risen. Reductions in social care supply may also have impacted demand for NHS services, particularly for those whose care is provided at the interface of the health and care systems. We analysed a panel dataset of 150 local authorities (councils) to test potential impacts on hospital utilisation by people aged 65 and over: emergency admission rates for falls and hip fractures (‘front-door’ measures); and extended stays of 7 days or longer; and 21 days or longer (‘back-door’ measures). Changes in social care supply were assessed in two ways: gross current expenditure (per capita 65 and over) adjusted by local labour costs; and social care workforce (per capita 18 and over). We ran negative binomial models, controlling for deprivation, ethnicity, age, unpaid care, council class and year effects. To account for potential endogeneity, we ran instrumental variable regressions and dynamic panel models. Sensitivity analysis explored potential effects of funding for integrated care (the Better Care Fund).There was no consistent evidence that councils with higher per capita spend or higher social care staffing rates had lower hospital admission rates or shorter hospital stays.

KW - Social care

KW - Healthcare

KW - Dementia

KW - Local Government Expenditures

U2 - 10.1002/hec.4175

DO - 10.1002/hec.4175

M3 - Article

SN - 1057-9230

VL - 30

SP - 36

EP - 54

JO - Health Economics

JF - Health Economics

IS - 1

ER -