Measuring Nursing Home Performance Using Administrative Data

Do different shocks in health matter for wealth?

We study the effect of hospital admissions for specific conditions on wealth for the Dutch population aged 70-79. We consider 14 disease groups that affect mortality and disability to different extents. We apply a "difference-in-timing" design comparing individuals admitted in one year to similar individuals admitted later. Because the protection against income risks and medical spending is high, we can identify changes in saving behaviors driven by preferences for consumption, saving, and bequests, rather than by changes in budget constraints. Although the health shocks differ in mortality and disability, we find hardly any impact on wealth across conditions.

Quality-Adjusted Life-Years Lost Due to COVID-19 Mortality: Methods and Application for The Netherlands

OBJECTIVES

The COVID-19 pandemic has increased mortality worldwide considerably in 2020. Nevertheless, it is unknown how the increase in mortality translates into a loss in quality-adjusted life-years (QALYs), which is a function of age and the health condition of the deceased patient at time of death. We estimate the QALYs lost in The Netherlands as a result of deaths because of COVID-19 in 2020.

METHODS

As a starting point, we use estimates of underlying diseases and the number of COVID-19 deaths in nursing homes as a proxy for underlying health status. In a next step, these are combined with estimates of excess mortality rates and quality of life for different groups to calculate QALYs lost. We compare the results with an alternative scenario, in which COVID-19 deaths occurred randomly across the population regardless of underlying conditions. For this alternative scenario, we use population mortality and average quality of life by age and sex.

RESULTS

Accounting for underlying health status, we estimate that QALYs lost because of COVID-19 mortality are on average 3.9 per death for men and 3.5 for women. This is approximately 3.5 QALYs less than when not taking selective mortality into account. Given 16 308 excess deaths, this translates into 61 032 QALYs lost because of COVID-19.

CONCLUSIONS

We conclude that QALYs lost because of COVID-19 mortality are still substantial, even if mortality is strongly concentrated in people with poor health.