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Title: Essays on the empirical economics of long term care
Author: Gonzalo Almorox, Eduardo
ISNI:       0000 0004 8505 9174
Awarding Body: Newcastle University
Current Institution: University of Newcastle upon Tyne
Date of Award: 2019
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An ageing population combined with several socioeconomic changes are modifying the requirements and the ways by which long-term care is provided. This thesis comprises a collection of empirical chapters focused on key aspects concerning the provision and quality of long-term care services in England. The organisation of long-term care in England is characterised by an important complexity that includes several institutions involved in the management and funding of these activities and they operate both at local and national level. Chapter 2 discusses the main characteristics associated with organisation of long-term care in England. Using a sample of English local authorities and an instrumental variables design that exploits the degree of restrictiveness of urban planning regulations, chapter 3 documents, for the first time, the causal effect of house prices on the provision of long term care services in local markets. The analysis provides evidence that higher house prices lead to fewer care homes, fewer entries into the market and fewer beds available. Yet, the study also finds a positive effect of house prices on the proportion of care homes with high quality. Using data on care home quality inspections, chapter 4 examines the effect of changes in local funding on the quality of long term care services. Particularly, the chapter explores the extent by which changes in the spending power of local authorities have contributed to the improvement and deterioration of care home quality. To describe the transition between ratings over time, the analysis fits a semi-parametric hazard model and corrects for unobserved heterogeneity. The findings of this chapter suggest that negative changes in spending power are associated with a lower frequency of inspections and a lower propensity to improve the quality. On the other hand, positive changes are not necessarily related to quality improvements, especially in care homes with bad management. Chapter 5 provides the first evidence for the English care homes market on the causal effect of care home closures on other care homes. Using an instrumental variables strategy, with public administrative data, that exploits consolidations within the care home corporate group as shocks of exogenous variation for care home closures, the chapter shows that incumbent care homes increase the probability of downgrading their quality after the closure of a care home nearby. Yet, the effect is relatively small and decreases over time suggesting that remaining care homes accommodate the shock of demand and minimise the potential harm from the closure. iii The joint theme and major contribution of this thesis consists of bringing new evidence on relevant issues in applied, health and long-term care economics by using datasets and applying econometric techniques in a novel manner.
Supervisor: Not available Sponsor: Economic Social Research Council (ESRC)
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available