Abstract

Recent decades have witnessed an increase in the relevance given to users’ experiences and preferences in the evaluation and allocation of long-term care, in what has usually been termed as the ‘personalization of care’. Besides providing users with the care they want (allocative efficiency), personalization has also been heralded as able to improve how care is produced and delivered (production efficiency), thus rendering long-term care more cost-effective. This presentation aims to assess the evidence base for cost-effectiveness of personalization in long-term care and take stock of recent policy developments at the national level. The latter could indicate emerging trends and promising initiatives.

Findings are based on a rapid review of existing evidence on the cost-effectiveness of personalization published in peer reviewed journals, as well as grey literature, which was carried out in English, German, French and Spanish. The recent policy developments were gathered through national experts in England, Germany, Austria, Spain, Italy, Sweden, Finland, Poland, Czech Republic and France, thus covering a wide range of long-term care systems. The geographical scope of the majority of studies reviewed is limited to the USA and England. Furthermore, most studies present a number of methodological shortcomings that severely limit any definite conclusion regarding the cost-effectiveness of personalization. Among these shortcomings is lack of evaluation using experimental design or based on randomized control trials, while most studies merely assess the outcomes of different initiatives and stop short of carrying out proper cost-effectiveness analysis. The reviewed evidence strongly suggests that personalization can bring about improved satisfaction with care, thus lending support to the claim of improved allocative efficiency. Results are mixed when clinical health outcomes are considered. There are only a very limited number of studies assessing cost-effectiveness and the evidence presented falls short of establishing the cost-effectiveness of personalization. Among the possible reasons for this are the fact that personalization may in fact lead to an increase in the take-up (i.e. woodwork effect) and intensity of use of services.

Regarding recent policy developments at the national level, these have been limited, partially reflecting the fact that many countries established some form of personalization (e.g. user choice) already in the early 2000s or even before. While there was no repeal of personalization as such, it seems that only in England is personalization still being taken further and expanded, both in terms of users and services covered (e.g. personal health budgets).