More long-term care for better healthcare and vice versa: investigating the mortality effects of interactions between these public sectors

Public healthcare (HC) and long-term care (LTC) sectors coexist in several OECD countries. Economic interactions between these two sectors have been found to occur even in the absence of formal integrated care arrangements. We investigate whether and how interactions between the HC and LTC sectors impact mortality. We analyse data on English local authorities in 2014–15 and employ a sequence of cross-sectional econometric specifications based on instrumental variables to identify the effect that LTC expenditure has on mortality through its interactions with HC services, and vice versa. Our findings suggest that any effect of LTC expenditure on mortality is likely to run through the HC sector by allowing the latter to reallocate resources from less to more effective services. A 10 per cent increase in LTC expenditure per user can indirectly save, on average, about three lives per million individuals. In addition, on top of the known HC direct mortality effects, we find that investing an extra £42 million in the HC sector – equivalent to a 10 per cent increase in HC expenditure per capita for the average local authority – can decrease the use of LTC services, producing around £7.8 million of savings. These can generate mortality effects if invested in services having an impact on mortality.     

大跨度预应力混凝土连续刚构桥跨中下挠原因分析

在大跨度预应力混凝土连续刚构桥迅速发展的同时，如何有效抑制跨中长期过度下挠成为大跨度预应力连续刚构桥病害防治研究的核心问题。以一座处于服役期间的大跨度预应力连续刚构桥为研究对象，运用有限元软件进行全桥建模，从混凝土长期徐变、底板钢束径向力和钢束预应力损失比3个方面进行分析，讨论各因素所导致的不利状态对大跨度预应力连续刚构桥跨中下挠的影响。     

Lapses in long-term care insurance

About a quarter of long-term care insurance (LTCI) policy holders aged 65 let their policies lapse before death, forfeiting all benefits. We find that lapse rates are substantially higher among the cognitively impaired in the Health and Retirement Study. This generates a pernicious form of dynamic advantageous selection, as the cognitively impaired are more likely to use care. Simulations show that an inappropriately optimistic asset drawdown path further increases the individual welfare cost of unanticipated lapses. Meanwhile, we find evidence of a significant but very small role for either strategic or financial motives for lapsing.