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The role of care home fees in the public costs and distributional effects of potential reforms to care home funding for older people in England

  • Ruth Hancock (a1), Juliette Malley (a2), Raphael Wittenberg (a3), Marcello Morciano (a4), Linda Pickard (a5), Derek King (a6) and Adelina Comas-Herrera (a7)...

In England, Local Authorities (LAs) contribute to the care home fees of two-thirds of care home residents aged 65+ who pass a means test. LAs typically pay fees below those faced by residents excluded from state support. Most proposals for reform of the means test would increase the proportion of residents entitled to state support. If care homes receive the LA fee for more residents, they might increase fees for any remaining self-funders. Alternatively, the LA fee might have to rise. We use two linked simulation models to examine how alternative assumptions on post-reform fees affect projected public costs and financial gains to residents of three potential reforms to the means test. Raising the LA fee rate to maintain income per resident would increase the projected public cost of the reforms by between 22% and 72% in the base year. It would reduce the average gain to care home residents by between 8% and 12%. Raising post-reform fees for remaining self-funders or requiring pre-reform self-funders to meet the difference between the LA and self-funder fees, reduces the gains to residents by 28–37%. For one reform, residents in the highest income quintile would face losses if the self-funder fee rises.

Corresponding author
*Correspondence to: Ruth Hancock, Health Economics Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK. Email:
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N. Barr (2010), ‘Long-term care: a suitable case for social insurance’, Social Policy and Administration, 44(4): 359374.

J. W. Cohen W. D. Spector (1996), ‘The effect of Medicaid reimbursement on quality of care in nursing homes’, Journal of Health Economics, 15: 2348.

A. Comas-Herrera , R. Wittenberg L. Pickard (2010), ‘The long road to universalism? Recent developments in the Financing of long-term care in England’, Social Policy and Administration, 44(4): 375391.

D. C. Grabowski (2007), ‘Medicare and Medicaid: conflicting incentives for long-term care’, Millbank Quarterly, 85(4): 579610.

R. Hancock , A. Comas-Herrera , R. Wittenberg L. Pickard (2003), ‘Who will pay for long-term care in the UK? Projections linking macro- and micro-simulation models’, Fiscal Studies, 24(4): 387426.

M. Harrington Meyer (2001), ‘Medicaid reimbursement rates and access to nursing homes: implications for gender, race and marital status’, Research on Aging, 23(5): 532551.

L. Mayhew , M. Karlsson B. Rickayzen (2010), ‘The role of private finance in paying for long-term care’, Economic Journal, 120: F478F504.

J. Malley , R. Hancock , M. Murphy , J. Adams , R. Wittenberg , A. Comas-Herrera , C. Curry , D. King , S. James , M. Morciano L Pickard (2011), ‘The effect of lengthening life expectancy on pension and long-term care expenditure in England, 2007 to 2032’, Health Statistics Quarterly, 52(Winter): 129.

E. A. Millers , V. Mor , D. C. Grabowski P. L. Gozalo (2009), ‘The devil's in the details: trading policy goals for complexity in Medicaid nursing home reimbursement’, Journal of Health Politics, Policy and Law, 34(1): 93135.

J. L. Troyer (2002), ‘Cross-subsidization in nursing homes: explaining rate differentials among payer types’, Southern Economic Journal, 68(4): 750773.

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Health Economics, Policy and Law
  • ISSN: 1744-1331
  • EISSN: 1744-134X
  • URL: /core/journals/health-economics-policy-and-law
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