Understanding Long-Term Care Outcomes: The Contribution of Conventional and Behavioral Economics

  • Birgit TrukeschitzEmail author
Part of the International Perspectives on Aging book series (Int. Perspect. Aging, volume 10)


Aging societies are confronted by a growing need for adequate and reliable long-term care (LTC). Against the background of limited financial resources, measurement of LTC outcomes has attracted increasing interest. This chapter discusses how conventional and behavioral economic approaches contribute to our understanding of LTC outcomes and how LTC outcomes can be measured. A production-centered approach is used to identify final LTC outcomes that indicate the impact of LTC on care recipients’ and carers’ quality of life (QoL). Conventional economic approaches assume rational, utility-maximizing individuals as well as perfect markets and suggest that it is possible to measure LTC outcomes indirectly, using revealed-preference approaches, with preferences inferred from care recipients’ choices. However, behavioral economics holds that revealed preferences are not a reliable starting point for measuring QoL gains from LTC services. At the same time, behavioral economists also caution against taking self-assessments of QoL outcomes and stated-preference approaches in economic evaluation at face value. Whichever approach is being followed to measure LTC outcomes, at least three issues need to be addressed: specifying LTC outcome domains, eliciting preferences for these domains, and measuring the impact of LTC on QoL.


Care Arrangement Care Recipient Adult Social Care Outcome Toolkit Hedonic Adaptation Conventional Economic 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



I would like to acknowledge the valuable contributions of Juliette Malley (PSSRU at LSE and the University of Kent), Susanne Mayer and Ulrike Schneider (Institute for Social Policy, WU Vienna University of Economics and Business), Julia Kleindienst (Research Institute for Economics of Aging, WU Vienna), and Ivo Ponocny (MODUL University Vienna). Any errors remain my responsibility. This work has been funded by WU and the Wiener Gesundheitsfoerderung (Vienna Health Promotion).


  1. Albrecht GL, Devlieger PJ (1999) The disability paradox: high quality of life against all odds. Soc Sci Med 48(8):977–988. doi: 10.1016/S0277-9536(98)00411-0 CrossRefGoogle Scholar
  2. Amundson R (2010) Quality of life, disability, and hedonic psychology. J Theory Soc Behav 40(4):374–392CrossRefGoogle Scholar
  3. Ariely D (2009) Predictably irrational. The hidden forces that shape our decisions. HarperCollins, LondonGoogle Scholar
  4. Ariely D, Wertenbroch K (2002) Procrastination, deadlines, and performance: self-control by precommitment. Psychol Sci 13(3):219–224. doi: 10.1111/1467-9280.00441 CrossRefGoogle Scholar
  5. Baldock J (1997) Social care in old age: more than a funding problem. Soc Policy Admin 31(1): 73–89CrossRefGoogle Scholar
  6. Brandtstädter J, Renner G (1990) Tenacious goal pursuit and flexible goal adjustment: explication and age-related analysis of assimilative and accommodative strategies of coping. Psychol Aging 5(1):58–67CrossRefGoogle Scholar
  7. Brouwer W, Rutten F, Koopmanschap M (2001) Costing in economic evaluations. In: Drummond MF, McGuire A (eds) Economic evaluations in health care: merging theory with practice. Oxford University Press, New York, pp 68–93Google Scholar
  8. Byford S, Sefton T (2003) Economic evaluation of complex health and social care interventions. Natl Inst Econ Rev 186(1):98–108. doi: 10.1177/002795010300100114 CrossRefGoogle Scholar
  9. Coons S, Rao S, Keininger D, Hays R (2000) A comparative review of generic quality-of-life instruments. Pharmacoeconomics 17(1):13–35. doi: 10.2165/00019053-200017010-00002 CrossRefGoogle Scholar
  10. Diener E, Suh EM, Lucas RE, Smith HL (1999) Subjective well-being: three decades of progress. Psychol Bull 125(2):276–302CrossRefGoogle Scholar
  11. Dimitrov DM, Rumrill JPD (2003) Pretest-posttest designs and measurement of change. Work 20(2):159–165Google Scholar
  12. Flynn TN, Peters TJ, Coast J (2013) Quantifying response shift or adaptation effects in quality of life by synthesising best-worst scaling and discrete choice data. J Choice Model 6:34–43. doi: 10.1016/j.jocm.2013.04.004 CrossRefGoogle Scholar
  13. Forder J, Netten A, Caiels J, Smith J, Malley J (2007) Measuring outcomes in social care: conceptual development and empirical design. PSSRU discussion paper 2422. University of Kent, CanterburyGoogle Scholar
  14. Forder J, Malley J, Towers A-M, Netten A (2013) Using cost-effectiveness estimates from survey data to guide commissioning: an application to home care. Health Econ. doi: 10.1002/hec.2973 Google Scholar
  15. Gertler PJ, Martinez S, Premand P, Rawlings LB, Vermeersch CMJ (2011) Impact evaluation in practice. The World Bank, WashingtonGoogle Scholar
  16. Gilbert DT, Pinel EC, Wilson TD, Blumberg SJ, Wheatley TP (1998) Immune neglect: a source of durability bias in affective forecasting. J Pers Soc Psychol 75(3):617–638. doi: 10.1037/0022-3514.75.3.617 CrossRefGoogle Scholar
  17. Johnson M, Maas M, Moorhead S (2005) Pflegeergebnisklassifikation NOC, deutschsprachige Ausgabe übersetzt, bearbeitet und herausgegeben von Andreas Büscher und Peter Tackenberg. Hans Huber, BernGoogle Scholar
  18. Kahneman D, Krueger AB (2006) Developments in the measurement of subjective well-being. J Econ Perspect 20(1):3–24. doi: 10.1257/089533006776526030 CrossRefGoogle Scholar
  19. Kahneman D, Thaler RH (2006) Anomalies: utility maximization and experienced utility. J Econ Perspect 20(1):221–234CrossRefGoogle Scholar
  20. Kahneman D, Tversky A (1979) Prospect theory: an analysis of decision under risk. Econometrica 47(2):263–292CrossRefGoogle Scholar
  21. Kahneman D, Tversky A (1996) On the reality of cognitive illusion. Psychol Rev 103(3):582–593CrossRefGoogle Scholar
  22. Kahneman D, Wakker PP, Sarin R (1997) Back to Bentham? Explorations of experienced utility. Q J Econ 112:375–405CrossRefGoogle Scholar
  23. Knapp M (1984) The economics of social care. Macmillan, LondonGoogle Scholar
  24. Le Grand J, Barlett W (1993) Quasi-markets and social policy. Macmillan, LondonGoogle Scholar
  25. Leibenstein H (1950) Bandwagon, snob, and Veblen effects in the theory of consumers’ demand. Q J Econ 64(2):183–207CrossRefGoogle Scholar
  26. Loewenstein G (2000) Emotions in economic theory and economic behavior. Am Econ Rev 90(2):426–432CrossRefGoogle Scholar
  27. Malley J, Fernández J-L (2010) Measuring quality in social care services: theory and practice. Ann Public Coop Econ 81(4):559–582. doi: 10.1111/j.1467-8292.2010.00422.x CrossRefGoogle Scholar
  28. Malley J, Trukeschitz B, Trigg L (forthcoming) Policy instruments to promote good quality long-term care services. In: Fernández J-L, Gori C (eds) Long-term care reforms in OECD countries: successes and failures. Policy Press, Bristol.Google Scholar
  29. Mullainathan S, Thaler RH (2000) Behavioral economics. Working paper 7948. National Bureau of Economic Research, CambridgeGoogle Scholar
  30. Netten A (1993a) Costing informal care. In: Netten A, Beecham J (eds) Costing community care. Theory and practice. Ashgate, AldershotGoogle Scholar
  31. Netten A (1993b) Ökonomische Aspekte sozialer Dienste. In: Braun H, Johne G (eds) Die Rolle sozialer Dienste in der Sozialpolitik. Campus, Frankfurt/Main, pp 27–47Google Scholar
  32. Netten A (2011) Overview of outcome measurement for adults using social care services and support. Methods review 6. National Institute for Health Research, School for Social Care Research, LondonGoogle Scholar
  33. Netten A, Davis B (1990) The social production of welfare and consumption of social services. J Public Policy 10(3):331–347CrossRefGoogle Scholar
  34. Netten A, Beadle-Brown J, Trukeschitz B, Towers A-M, Welch E, Forder J, Smith J, Alden E (2010) Measuring the outcomes of care homes: final report. PSSRU discussion paper 2696/2. University of Kent, CanterburyGoogle Scholar
  35. Netten A, Burge P, Malley J, Potoglou D, Towers AM, Brazier J, Flynn T, Forder J, Wall B (2012a) Outcomes of social care for adults: developing a preference-weighted measure. Health Technol Assess 16(16):1–166Google Scholar
  36. Netten A, Trukeschitz B, Beadle-Brown J, Forder J, Towers A-M, Welch E (2012b) Quality of life outcomes for residents and quality ratings of care homes: is there a relationship? Age Ageing 41:512–517. doi: 10.1093/ageing/afs050 CrossRefGoogle Scholar
  37. Nicholas E, Qureshi H (2004) Developing outcome-focused practice: examining the process. Res Policy Plann 22(3):1–13Google Scholar
  38. Pindyck RS, Rubinfeld DL (2013) Microeconomics, 8th edn. Pearson, BostonGoogle Scholar
  39. Potoglou D, Burge P, Flynn T, Netten A, Malley J, Forder J, Brazier JE (2011) Best–worst scaling vs. discrete choice experiments: an empirical comparison using social care data. Soc Sci Med 72(10):1717–1727. doi: 10.1016/j.socscimed.2011.03.027 CrossRefGoogle Scholar
  40. Qureshi H, Nicholas E (2001) A new conception of social care outcomes and its practical use in assessment with older people. Res Policy Plann 19(2):11–25Google Scholar
  41. Qureshi H, Patmore C, Nicholas E, Bamford C (1998) Overview: outcomes of social care for older people and carers. Outcomes in community care practice series. Social Policy Research Unit, University of York, YorkGoogle Scholar
  42. Raftery J (2000) Costing in economic evaluation. Br Med J 320(10):1597CrossRefGoogle Scholar
  43. Rand SE, Malley J, Netten A (2012) Measuring the social care outcomes of informal carers. An interim technical report for the identifying the impact of social care (IIASC) study. PSSRU discussion paper 2833. University of Kent, CanterburyGoogle Scholar
  44. Rapley M (2003) Quality of life research. A critical introduction. Sage, LondonGoogle Scholar
  45. Rossi PH, Lipsey MW, Freeman HE (2004) Evaluation: a systematic approach, 7th edn. Sage, Newbury ParkGoogle Scholar
  46. Samuelson PA (1948) Consumption theory in terms of revealed preference. Economica 15(60):243–253. doi: 10.2307/2549561 CrossRefGoogle Scholar
  47. Schneider U, Trukeschitz B, Mühlmann R, Ponocny I (2013) “Do I stay or do I go?”—Job change and labor market exit intentions of informal caregivers to the elderly. Health Econ 22(10):1230–1249CrossRefGoogle Scholar
  48. Schneider U, Sundström G, Johannson L, Tortosa MÁ (forthcoming) Policies to support informal care. In: Fernández J-L, Gori C (eds) Long-term care reforms in OECD countries: successes and failures. Policy Press, BristolGoogle Scholar
  49. Schooler JW, Ariely D, Loewenstein G (2001) The pursuit and assessment of happiness can be self-defeating. In: Brocas I, Carillo JD (eds) The psychology of economic decisions. Oxford University Press, New York, pp 41–70Google Scholar
  50. Schwartz C, Rapkin B (2004) Reconsidering the psychometrics of quality of life assessment in light of response shift and appraisal. Health Qual Life Outcomes 2(1):1–11. doi: 10.1186/1477-7525-2-16 CrossRefGoogle Scholar
  51. Schwartz CE, Sajobi TT, Lix LM, Quaranto BR, Finkelstein JA (2013) Changing values, changing outcomes: the influence of reprioritization response shift on outcome assessment after spine surgery. Qual Life Res 22:2255–2264. doi: 10.1007/s11136-013-0377-x CrossRefGoogle Scholar
  52. Sen AK (1985) Commodities and capabilities. North-Holland, AmsterdamGoogle Scholar
  53. Sharp C (1981) The economics of time. Martin Robertson, OxfordGoogle Scholar
  54. Simon HA (1956) Rational choice and the structure of the environment. Psychol Rev 63(2): 129–138CrossRefGoogle Scholar
  55. Thaler RH (1980) Toward a positive theory of consumer choice. J Econ Behav Organ 1:39–60CrossRefGoogle Scholar
  56. Trukeschitz B (2006) Im Dienst Sozialer Dienste. Ökonomische Analyse der Beschäftigung in sozialen Dienstleistungseinrichtungen des Nonprofit Sektors, Forschungsergebnisse der Wirtschaftsuniversität Wien, Band 11. Peter Lang, Frankfurt am MainGoogle Scholar
  57. Trukeschitz B (2010) Safeguarding good quality in long-term care: the Austrian approach. Eurohealth 16(2):17–20Google Scholar
  58. Trukeschitz B (2011) Worauf es letztlich ankommt. Ergebnisqualität in der Langzeitpflege und Betreuung Kurswechsel 26(4):22–35Google Scholar
  59. Trukeschitz B, Fliegenschnee K (2012) Ergebnisqualität in Wiener Tageszentren—eine qualitative Analyse, Forschungsbericht 4/2012. WU Wirtschaftsuniversität Wien, Forschungsinstitut für Altersökonomie,Google Scholar
  60. Trukeschitz B, Michalitsch V (2011) “Wo der Schuh drückt”—Stellungnahmen und Verbesserungsvorschläge pflegender Angehöriger zu Betreuungs- und Pflegedienstleistungen in Wien. Forschungsbericht 2/2011, WU Wirtschaftsuniversität Wien, Forschungsinstituts für Altersökonomie,Google Scholar
  61. Trukeschitz B, Schneider U, Mühlmann R, Ponocny I (2013) Informal eldercare and work-related strain. J Gerontol B Psychol Sci Soc Sci 68(2):257–267. doi: 10.1093/geronb/gbs101 CrossRefGoogle Scholar
  62. Tversky A, Kahneman D (1974) Judgment under uncertainty: heuristics and biases. Science 185(4157):1124–1131CrossRefGoogle Scholar
  63. Vaarama M (2009) Care-related quality of life in old age. Eur J Ageing 6(2):113–125CrossRefGoogle Scholar
  64. Wilkinson N, Klaes M (2012) An introduction to behavioural economics, 2nd edn. Palgrave macmillan, BasingstokeGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  1. 1.WU-Vienna University of Economics and Business, Research Institute for Economics of AgingViennaAustria

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