EXCELC: Exploring Comparative Effectiveness and Efficiency in Long-term Care

To meet societal and economic challenges, health and care welfare regimes need to become better at understanding how services affect people. There is a need to measure the outcomes of using services, especially in the extent to which they improve the health and quality of life of service users. This project worked with a cross-country study to measure quality-of-life outcomes for long-term care (LTC), in particular, personal care in people’s own homes (‘home care’). Three countries were involved, each with a different LTC system: Austria, England and Finland. 


With regard to people’s relative valuation (preferences), it was found that:

  • People in different countries were relatively consistent about the value they placed on aspects of numerical ‘outcomes’ scale (LTC-QoL) for service users. 
  • Relative valuations varied according to personal characteristics e.g. age and education.

The LTC-related quality of life of carers was also measured and valued – for example, the most valued aspect by English participants was the occupation attribute at its highest level (‘I am able to spend my time as I want, doing things I value or enjoy’). Results further showed participants rated having ‘no control over their daily life’ as the least valued outcome. The project also measured the LTC-QoL of a sample of people using home care services and found that LTC-QoL varies between countries and is affected by service user’s characteristics e.g. prior disability, social capital (living circumstances) and financial means. Some characteristics (e.g. degree of impairment) influenced LTC-QoL gain in all countries, whereas other (e.g. people’s living arrangements) only affected people in particular countries. The study added to our knowledge and help decisions about LTC to become more ‘outcomes-focused’. It provides a means to systematically measure and compare the impact of LTC services, using a fully-tested indicator – which can be used by LTC professionals, policy-makers and researchers for assessment of LTC outcomes in the population, for monitoring of service impact, and for evaluation.

Project links

Research Team

Prof. J.E. Forder
University of Kent at Canterbury

Prof. I.E.O. Linnosmaa
National Insitute for Health and Welfare Helsinki

J.N. Malley
London School of Economics and Political Science

Dr. B. Trukeschitz
Vienna University of Economics and Business