Does the amount of formal care affect informal care? Evidence among over-60s in France

Abstract

This paper investigates the causal effect of the amount of formal care used on the informal care received by formal care users. We use an original instrument for formal care volume based on local disparities (NUTS 3 level, 96 units) in the price of formal care. Using the French CARE survey, we use a two-part model to assess the effect of formal care on the extensive and the intensive margin of informal care. An increase in the amount of formal care is found to be associated with a small decrease in the probability of using informal care. Heterogeneity tests show that this negative effect is mainly driven by help for daily activities provided by women. At the intensive margin, informal care is not significantly affected by the amount of formal care. Reforms increasing subsidies for formal care can thus be suspected to have a limited effect on informal care arrangements.

How Do Shifts in Patients with Mental Health Problems’ Formal and Informal Care Utilization Affect Informal Caregivers?: A COVID-19 Case Study

“…These shifts in formal care utilization, however, also affect the provision of informal care, with a 1% decrease in formal care associated with a 4–6% increase in informal care hours for patients with schizophrenia and bipolar disorder [ 26 ]. Similar results have been found for elderly care, where an increase in formal care has been associated with a significant decrease in the probability informal care use [ 27 ]. These findings indicate that shifts in patients’ care utilization can result in long-term substitution [ 26 , 27 ] and a causal effect of changes in patient’s formal care utilization on their informal care utilization.…”

“…Similar results have been found for elderly care, where an increase in formal care has been associated with a significant decrease in the probability informal care use [ 27 ]. These findings indicate that shifts in patients’ care utilization can result in long-term substitution [ 26 , 27 ] and a causal effect of changes in patient’s formal care utilization on their informal care utilization. Furthermore, an increase in care intensity (i.e., hours of informal care provision) have been linked to role overload [ 28 ], worse psychological wellbeing [ 29 ], and a higher subjective burden [ 30 , 31 ] in informal caregivers.…”

“…When substitution of formal care occurs, it manifests as a negative relationship between the level of patients’ formal care utilization and informal care utilization, with informal caregivers increasing their care intensity in response to the insufficient formal care [ 25 ]. The substitution of formal care in response to healthcare reform has been demonstrated in several patient groups with long-term care needs [ 26 , 27 , 60 , 61 , 62 ]. Substitution of formal care may not have been observed in our study findings, due to the high proportion of emotional and practical support that was provided by our study population.…”

“…Substitution of formal care may not have been observed in our study findings, due to the high proportion of emotional and practical support that was provided by our study population. Emotional and practical support are essential caregiving tasks provided by informal caregivers of persons with mental health problems [ 63 , 64 ] and are less susceptible to increased availability of formal care [ 27 ]. The provision of informal care originates from social bonds of reciprocity and existing relationships between the informal caregiver and care recipient [ 65 ], which allows informal caregivers to provide emotional support that cannot be substituted by formal care [ 23 , 27 ].…”

Can formal home and community-based long-term care replace informal care? Evidence from Chinese Longitudinal Healthy Longevity Survey

“…Services such as nursing or physiotherapy can provide relief to informal carers who may nd it challenging in managing medical procedures or engaging in physical therapy. Empirical literature on formal home and community-based care programs suggests that these interventions play a crucial role in reducing the demand for informal care [7]. Studies indicate that community-based care services, such as home health care and day care centers, contribute to enhanced independence for older adults [8][9].…”