Long-term care spending and hospital use among the older population in England

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4 June 2021

Published journal: Journal of Health Economics


This paper examines the impact of changes in public long-term care spending on the use of public hospitals among the older population in England. Mean per-person long-term care spending fell by 31% between 2009/10 and 2017/18, but cuts varied considerably geographically. We instrument public long-term care spending with predicted spending based on historical national funding shares and national spending trends. We find that reductions in public long-term care spending led to substantial increases in the number of emergency department (ED) visits made by patients aged 65 and above, explaining between a quarter and a half of the growth in ED use among this population over this period, and to an increase in the share of patients revisiting the ED within seven days. However, there was no impact on wider use of inpatient or outpatient services (which are more expensive to provide), and consequently little impact on overall hospital costs.


Long-term care, Hospital use, Emergency department ,Quality of care, Health expenditure, Austerity


Rowena Crawford, George Stoye and  Ben Zaranko  researched the Long-term care spending and hospital use among the older population in England

Available online 4 June 2021. Institute for Fiscal Studies  https://doi.org/10.1016/j.jhealeco.2021.102477

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