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Additional file 1.

Additional file 3.

Additional file 2.

Additional file 1: Supplementary Material 1. Example choice set, DCE breast cancer.

Additional file 1: Table A1. Descriptive characteristics of patients who received physical therapy after knee or hip replacement surgery (2018). Table A2. Multilevel linear model predicting PT use after TKA surgery (2018). Table A3. Multilevel linear model predicting PT use after THA surgery (2018).

Additional file 2: Supplementary Material 2. Hospital characteristics (attributes) and levels, the four general hospitals.

Additional file 3: Supplementary Material 3. Results of additional analyses.

Background & objectives Long-term care (LTC) expenses for older individuals are rising rapidly in almost all high-income countries. In an attempt to slow the growth of LTC costs, governmental policy focusses increasingly on ageing-in-place to prevent expensive nursing home admissions. Ageing-in-place is often what individuals prefer. Following this trend, the “complete in-home package” (VPT) became available in 2015 in the Netherlands. This package allows clients to receive nursing home care within their own environment. This study compares the survival, days in care and costs of older individuals who use VPT-care or institutional care. Methods Data from two healthcare providers covering the period between January 2016 and August 2020 were used. The study sample included 2,136 clients, of whom 559 received VPT care. Information on survival, days in care, costs as well as other individual (health) characteristics was available. Survival analyses techniques were used. Results After correction for differences in individual (health) characteristics across the care groups, our study shows that VPT clients on average live longer than those in institutions and that especially clients with lower LTC entitlement benefit from VPT care. VPT clients were observed to spend 366 days longer in care and the average daily costs of VPT care was €58 lower than those of institutional care. Discussion/Conclusion Our study provides preliminary results on longer survival outcomes and lower costs for VPT clients compared to those in institutions. In the absence of random allocation, future research should investigate differences in quality of life and include additional health-related factors in the analyses on mortality. Finally, to investigate the LTC costs more in depth, an elaborate economic evaluation is recommended. If VPT care turns out to be an appropriate alternative for institutional care based on a combination of costs, health and QoL outcomes, it should be offered in the future on a larger scale.

Universal access and generous coverage are important goals of the Dutch long‐term care (LTC) system. It is a legal requirement that everyone eligible for LTC should be able to receive it. Institutional care (IC) made up for 90% of Dutch LTC spending. To investigate whether access to IC is as equitable as the Dutch government aspires, we explored practice variation in entitlements to IC across Dutch regions. We used a unique dataset that included all individual applications for Dutch LTC in January 2010–December 2013 (N = 3,373,358). This dataset enabled an accurate identification of the need for care. We examined the local variation in the probability of being granted long‐term IC and in the intensity of the care granted given that individuals have applied for LTC. We also investigated whether the variation observed was related to differences in the local availability of care facilities. Although our analyses indicated the presence of some practice variation, its magnitude was very small by national and international standards (up to 3%). Only a minor part of the practice variation could be accounted for by local supply differences in care facilities. Overall, we conclude that, unlike many other developed countries, the Dutch system ensured equitable access to long‐term IC.

Online questionnaire. This file contains a translated version of the online questionnaire used in this study. (DOCX 82 kb)

Policy analysis. This file contains the results of the literature review and expert consultations conducted prior to this study. (DOCX 154 kb)