Trade-Off between Formal and Informal Care in Spain

Abstract

The remarkable growth of older population has moved long term care to the front ranks of the social policy agenda. Understanding the factors that determine the type and amount of formal care is important for predicting use in the future and developing long-term policy. In this context we jointly analyze the choice of care (formal, informal, both together or none) as well as the number of hours of care received. Given that the number of hours of care is not independent of the type of care received, we estimate, for the first time in this area of research, a sample selection model with the particularity that the first step is a multinomial logit model.With regard to the debate about complementarity or substitutability between formal and informal care, our results indicate that formal care acts as a reinforcement of the family care in certain cases: for very old care receivers, in those cases in which the individual has multiple disabilities, when many care hours are provided, and in case of mental illness and/or dementia.There exist substantial differences in long term care addressed to younger and older dependent people and dependent women are in risk of becoming more vulnerable to the shortage of informal caregivers in the future. Finally, we have documented that there are great disparities in the availability of public social care across regions.JEL Codes: I1, J14.

Paid and unpaid support received by co-resident informal caregivers attending to community-dwelling older adults in Spain

“…The inclusion of the variables, income and educational level, in the paid support logistic regression model highlights that paid support is linked, not only to the availability of financial resources, but also to the cultural value placed on informal care and private domestic services. Higher socioeconomic classes place greater value on paid support than do lower classes, mainly due to the higher opportunity costs of informal care among highly educated caregivers (Jiménez-Martín and Vilaplana 2008). The relationship between household size and paid support received indicates that paid support is associated with the lack of other potential caregivers within immediate proximity to the receiver (Lafreniere et al 2003).…”

Inequity in long-term care use and unmet need: Two sides of the same coin

“…Although the baseline is very different between countries and the evolution of the health status of their populations is uncertain, the demographic evolution of European countries in the forthcoming decades is expected to pose significant pressure on public budgets regarding pension benefits, health care and LTC costs (DG ECFIN, 2006;Economic Policy Committee, 2009). The evolution of LTC expenditures will be conditioned by several distinct factors: demographics (percentage of the population over 65), institutions (organization of the LTC system, tradeoff between formal and informal care and support for the latter type of care) and health (Spillman, 2004;European Commission, 2007;Lafortune et al, 2007;Manton et al, 2007;Manton, 2008;de Meijer et al, 2011;Jiménez-Martín and Vilaplana-Prieto, 2012). Therefore, ageing of the population will not only challenge the organisation of health care systems but also imply a redefinition of LTC systems in the years to come.…”

Impacts of Informal Caregiving on Caregiver Employment, Health, and Family

“…With the right public policies, therefore, formal support can relieve caregivers (Bolin et al 2008a) and help care receivers avoid hospitalization (Bonsang 2009, Jiménez-Martín & Prieto 2012. However, because caregiving arrangements are heterogeneous, flexible public support is needed that is adaptable to caregiver needs.…”