Home and Community Care Digest
Methods: Study subjects were limited to single elderly care recipients aged over 70 with adult children in the United States. The authors tested the impact of unpaid care on five types of formal health care utilization by the recipient: homecare services; long-term care; hospital inpatient care; hospital outpatient surgery; and physician visits. Utilization was measured using a sample of 4752 care recipients from two nationally representative surveys dated 1995 and 1998. Unpaid care was measured as the number of hours in the previous month that a child provided assistance. Formal home care services were limited to unskilled services provided to assist recipients with activities of daily living and instrumental activities of daily living. The use of other types of formal health services was based on any use during the previous two-year period. A single caregiver and the remainder by two to seven caregivers provided seventy-eight of unpaid care. On average, care recipients received 65.7 hours of unpaid care per month.
Findings: (1) Unpaid care partially substitutes formal care for most types of health services. (2) A 10% increase in unpaid care hours reduces the likelihood of having any formal unskilled home care services by 0.87 percentage points (from 8.30% to 7.43%) and reduces the number of nights in long-term care from 25 to 23 nights. In addition, parents with unpaid caregivers have shorter lengths of inpatient hospital stay (2.4 nights) than those who do not (7 nights). Unpaid care also reduces the number of visits to physicians. However, unpaid care increased the likelihood that a parent would receive outpatient surgery from 14% to 30%. (3) Decisions regarding the use of unpaid care and paid care are made together, rather than independently, and there is no clear direction of causality between them. (4) While using incentives to encourage unpaid caregivers to increase their services would represent cost savings to Medicare in terms of reduced service utilization, lost tax revenues resulting from caregivers leaving their paid employment would result in an overall net cost to the government. Only tax incentives geared at caregivers who were not employed would represent net cost savings.
Conclusions: Services provided by unpaid caregivers to elderly parents represent important savings in public health expenditures in the United States by reducing overall use of formal services. However, creating tax incentives to encourage these caregivers to increase their service commitments may come at a net cost to society, if it results in reducing hours of paid employment or leaving the labour market entirely. The government should explore broader societal effects when designing tax instruments to encourage further commitments by unpaid caregivers.
Reference: Van Houtven, CH, Norton, EC. "Informal care and health care use of older adults". Journal of Health Economics. 2004, 23: 1159-1180.
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