This thesis measures the effect of the Dutch long-term care reform in 2015 on the distribution of lifetime out-of-pocket expenditures. Addition to previous research concerns the inclusion of a life-cycle perspective, a comprehensive measure of private out-of-pocket medical expenditures and a better understanding of the post-reform Dutch financing system of longterm care in terms of equity. Data from the Dutch LISS panel are used. First, age-specific transition probabilities between health states are estimated for those aged 65 and older using a logit model. Second, age-specific out-of-pocket medical expenditures are estimated prereform and post-reform using a linear regression model. Third, a markov model is set up to estimate the change in total lifetime out-of-pocket medical expenditure as well as the change in it’s proportion of lifetime income for individuals aged 65. A distinction is made across groups with different background characteristics in terms of socio-economic status, gender, initial health state and accessibility to informal care. On average, an increase from €6,448 in 2012 to €19,954 in 2017 is found. This reflects a substantial increase of 209 percent. A higher impact is found among the initially disabled, the low-income groups, women and those with children and/or a partner. The findings show an effect of the reform on both vertical and horizontal equity in the financing of long-term care. The pre-reform Dutch LTC system showed a pro-poor inequity in the delivery of LTC so whether the bigger impact on lowerincome groups is harmful or beneficial for policy implications is interesting for further research. The results could open doors for private long-term care insurance as well as for further research on the effects of the reform in reaching policy objectives such as equity and affordability.

B. Wouterse
hdl.handle.net/2105/47787
Business Economics
Erasmus School of Economics

Anneke Custers. (2019, August 14). The Effect of the Dutch Long-Term Care Reform on the Distribution of Lifetime Out-of-Pocket Expenditures. Business Economics. Retrieved from http://hdl.handle.net/2105/47787