Utilization of Long-Term Care Before and After the 2015 Dutch National Reform: An Interrupted Time Series Analysis

OBJECTIVES: The Netherlands is the largest spender on long-term care (LTC) in the world and underwent controversial reforms in 2015 to enable ageing-in-place. A population-level longitudinal evaluation has yet to evaluate how this reform is associated with subsequent LTC utilization. We investigated the reform’s associations with monthly rates of LTC admission and survival time among newly admitted older adults.

METHODS: We conducted an interrupted time-series analysis, adjusted for seasonality and time, to compare incident rate ratios (IRR) of LTC admission before and after the 2015 Dutch LTC reform among newly admitted older adults aged ≥65 years old (N=402,350) using population data from Statistics Netherlands (2011-2019). Primary outcomes were the monthly national rate of LTC facility admission and individual time to death among those newly admitted. We employed a Cox model of individual LTC residents to evaluate the adjusted hazard ratio (HR) of death among those admitted before and after the reform.

RESULTS: After an initial drop of 19.5% immediately after the start of the reform, the rate of admission exhibited a positive trend over the post-reform period: (1.002 [1.001-1.003]). Over three years of follow-up, restricted mean survival time among those admitted during the post reform period was 608 days [608.72-610.74] versus 622.52 days [620.59-624.45] among those admitted in the pre-reform period. Residents admitted during the post-reform period had higher adjusted hazards of death than those admitted during the pre-reform period (HR 1.05 [1.02-1.07]].

CONCLUSIONS: The monthly rate of LTC admission temporarily decreased after the 2015 Dutch LTC reform while the restricted mean survival time decreased by two weeks. We recommend graduated implementation with ongoing systematic assessment to avoid friction costs for future reforms.