19th Alzheimer Europe Conference - Session “ Assistance and support (Home and respite care) ”

28-30 May 2009 - Brussels

Economic valuation of formal and informal care

for French disabled elderly living at home

Bérengère DAVIN – Alain PARAPONARIS

Context

Demographic trends in France– Persons aged 60 and over (Insee, 2008)

• 2006: 13 million (20.7% of the total population)

• 2035: 21 million (30.6%)

– Disabled elderly (Duée & Rebillard, 2006)

• 2006: 1 million

• 2035: about 1.4 million

Long-term care costs– Public costs

• 19 billion euro / year (Sénat, 2008)

• 1.1% of the GDP in 2005 between 2 and 2.8% in 2050 (OECD, 2005)

– Private costs• Out-of-pocket payments???

• Informal care?

Introduction

Methods

Results

Discussion

Objective

Sharing between formal care and informal care

– Informal care represents ¾ of care provided to the French elderly (Breuil-Genier, 1999; Petite & Weber, 2006; Davin et al, 2008)

Introduction

Methods

Results

Discussion

Objective of the study:

Assessing cost of care provided to French disabled elderly living at home

Data

French representative survey on health and disability (HID survey)– Carried out in 1999 among people living at home– Information on

• Sociodemographic characteristics: household composition, education level, income

• Living conditions: care received, home modifications, use of assistive devices

• Health: impairments, disability, need for care

Daily activities– 6 ADL: bathing, dressing, using the toilet, eating, getting in and out of bed,

going out– 3 IADL: shopping, preparing meals, doing housework

Introduction

Methods

Results

Discussion

Sample restricted to disabled people aged 60 and over

who receive assistance with daily activities (n = 2,686)

Economic valuation

First step: assessing hours of care

– Use of a methodology developed by French social experts that defines the

number of hours required to perform each activity (Pampalon et al., 1991)

– Application to HID data

– Distinction between formal and informal care

Second step: assessing cost of care

– Use of the proxy good method that applies to a non-market activity the labour

market wage of a close substitute (van den Berg

et al., 2004)

– Wage rate used

• French minimum gross hourly wage in 1999 : 11.05 euro / hour

Introduction

Methods

Results

Discussion

Cost of careIntroduction

Methods

Results

Discussion

Informal care Formal care Total

Persons with dementia 3.0 [2.5 ; 3.5] 2.2 [1.8 ; 2.7] 5.2 [4.3 ; 6.2]

Other disabled persons 3.6 [3.1 ; 4.0] 1.8 [1.4 ; 2.1] 5.4 [4.6 ; 6.2]

Total 6.6 [5.9 ; 7.2] 4.0 [3.4 ; 4.6] 10.6 [9.4 ; 11.9]

Billion euro per year [95% confidence interval]

Persons with dementia in the HID survey

– Criteria used in a report for the Fondation Médéric Alzheimer (Colvez & Royer, 2008)

• Reported or assessed impairment of intellectual functions

• Disorientation to time and place

• Disability with managing paperwork, taking medication and using phone

Cost of careIntroduction

Methods

Results

Discussion

Annual cost of informal care per person

• with dementia: 12,840 euro

• with other disabilities: 12,745 euro

Informal care represents about

• 57% of cost of care provided to persons with dementia

• 67% of cost of care provided to persons with other disabilities

Comparison with other results (EuroCode working group - Wimo et al, 2008)

• Total cost of dementia in EU27: 130 billion euro

• Annual cost of informal care per person with dementia: 11,773 euro

• Informal care represents 56% of the total cost

Discussion

Limits:

– Underestimation of cost• 9 activities only• Supervision / surveillance not considered• Hypothesis: provided care meets the whole needs

– Cost assessment method (proxy good method) (McDaid, 2001; Van den Berg et al, 2004,

Koopmanschap et al, 2008)

• No distinction between the different care tasks provided• Formal and informal care are assumed to be perfect substitute, with no

difference in efficiency and quality • Which value for care provided by people who don’t work? • How distinguish between normal household tasks and informal care tasks for

people living together?

– Exclusion of people living in institutions

Introduction

Methods

Results

Discussion

Discussion

Consequences of providing care

– On economic and financial resources of informal caregivers • Decrease of working time, career break, early retirement

(Carmichael & Charles, 1998, 2003; Fast et al., 1999; Heitmueller & Inglis, 2007; Stone & Short, 1990)

• Out-of-pocket payments for care (Rice et al., 1993)

– On caregiver’s life• Isolation from family and social network

(McDaid, 2008)

– On caregiver’s health• Either physical, mental or psychological health

(Joël et al., 2000; Navaie-Waliser et al., 2002; Schulz & Beach, 1999)

Introduction

Methods

Results

Discussion

19th Alzheimer Europe Conference - Session “ Assistance and support (Home and respite care) ”

28-30 May 2009 - Brussels

Economic valuation of formal and informal care

for French disabled elderly living at home

berengere.davin@inserm.fr