Regional variation in public long-term home care : Regional differences in the Netherlands and the role of patient experiences

Practice variation is often defined as variation in access to healthcare - usually across regions - that cannot be explained by differences in patient populations. Practice variation may therefore lead to inefficiency and violate the principle of equal access to healthcare. The study of practice variation in long-term care (LTC) is a comparatively new area of research. This paper focuses on variation in publicly financed home care, which is gaining popularity as an alternative for institutional care. In addition, this paper focuses on whether and how patient experiences are associated with this variation. We use multinomial logistic regression analyses to assess regional variation in entitlements for publicly financed home care. Linear regression analyses were added to examine regional variation in intensity of entitled publicly financed home care, and the relationship between variation and patient experiences. The study showed a maximum difference of 34 percentage points across regions. Moreover, a maximum of 23 out of 31 regions showed significant differences in intensity of entitled care. Almost none of the observed variation can be explained by patient experiences. Our study showed evidence that eligibility for publicly financed home care depended partially on where a client lived. This study has been performed before the major decentralisation of the Dutch LTC system in January 2015. We expect regional variation to increase as a result of local demand, supply factors and the budgetary restrictions of the local stakeholders. This imposes challenges for countries as the Netherlands, which introduced a shift towards using more publicly financed home while striving towards equal access. Published: Online December 2020.