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The direct cost of disability of community-dwelling older persons in Belgium

Published online by Cambridge University Press:  08 April 2020

Sophie Cès*
Affiliation:
Institut de Recherche Santé et Société, Université Catholique de Louvain, Brussels, Belgium
Anne-Sophie Lambert
Affiliation:
Institut de Recherche Santé et Société, Université Catholique de Louvain, Brussels, Belgium
Johanna de Almeida Mello
Affiliation:
LUCAS – Centrum voor Zorgonderzoek en Consultancy, Katholieke Universiteit Leuven, Leuven, Belgium
Anja Declercq
Affiliation:
LUCAS – Centrum voor Zorgonderzoek en Consultancy, Katholieke Universiteit Leuven, Leuven, Belgium Centrum voor Sociologisch Onderzoek, Katholieke Universiteit Leuven, Leuven, Belgium
Niko Speybroeck
Affiliation:
Institut de Recherche Santé et Société, Université Catholique de Louvain, Brussels, Belgium
Lieven Annemans
Affiliation:
Universitair Centrum voor Verpleegkunde en Vroedkunde, Universiteit Gent, Ghent, Belgium
Jean Macq
Affiliation:
Institut de Recherche Santé et Société, Université Catholique de Louvain, Brussels, Belgium
*
*Corresponding author. Email: sophie.ces@uclouvain.be

Abstract

Current policies aim to promote and develop community-based support of disabled elderly persons, yet knowledge of the cost implications is insufficient. Thus, we aimed to estimate, for three disability profiles and three presence levels of the main informal carer (none, non-cohabitant, cohabitant), the cost of formal and informal support currently provided at home in Belgium. In this cross-sectional study, a sample of 5,642 disabled elderly persons living at home was established between 2010 and 2016. The administrative database of the Belgian public healthcare insurance was merged with other prospective data on social care service utilisation, informal care and disability. The total cost of formal support ranged from €725 to €1,344 (on average, per person, per month), depending on the three disability profiles identified. Twenty-five per cent of persons with the highest level of disability (important functional limitations and cognitive impairment) and helped by a cohabitant carer, had a low total cost of formal support: below €382 per month. Informal care represented the main cost component of total support costs in the three disability profiles (between 64 and 76%). To prevent the worsening of situations of disabled older persons and their informal carers, better detection of seriously disabled persons with low levels of formal support is crucial.

Type
Article
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press.

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References

Annemans, L (2008) Health Economics for Non-economists: An Introduction to the Concepts, Methods and Pitfalls of Health Economic Evaluations. Ghent, Belgium: Academia Press.Google Scholar
Anthierens, S, Willemse, E, Remmen, R, Schmitz, O, Macq, J, Declercq, A, Arnaut, C, Forest, M, Denis, A, Vinck, I, Defourny, N and Farfan-Portet, MI (2014) Support for Informal Caregivers – An Exploratory Analysis – Synthesis (Report 223Cs, Health Services Research). Brussels: Belgian Health Care Knowledge Centre (KCE).Google Scholar
Antón, J-I, Braña, F-J and de Bustillo, RM (2016) An analysis of the cost of disability across Europe using the standard of living approach. SERIEs 7, 281306.CrossRefGoogle Scholar
Balia, S and Brau, R (2014) A country for old men? Long-term home care utilization in Europe. Health Economics 23, 11851212.CrossRefGoogle ScholarPubMed
Berthoud, R (1991) Meeting the costs of disability. In Disability and Social Policy. London: Policy Studies Institute, University of Westminster pp. 64100.Google Scholar
Bolin, K, Lindgren, B and Lundborg, P (2008) Informal and formal care among single-living elderly in Europe. Health Economics 17, 393409.CrossRefGoogle ScholarPubMed
Bonsang, E (2009) Does informal care from children to their elderly parents substitute for formal care in Europe? Journal of Health Economics 28, 143154.CrossRefGoogle ScholarPubMed
Canty, A (2017) Package ‘Boot’ Version 1.3–20. Available at https://cran.r-project.org/web/packages/boot/boot.pdf.Google Scholar
Casado, BL, van Vulpen, KS and Davis, SL (2011) Unmet needs for home and community-based services among frail older Americans and their caregivers. Journal of Aging and Health 23, 529553.CrossRefGoogle ScholarPubMed
Cès, S, de Almeida Mello, J, Macq, J, Van Durme, T, Declercq, A and Schmitz, O (2017a) A systematic review of questionnaires used to measure the time spent on family care for frail older people. International Journal of Care and Caring 1, 227245.CrossRefGoogle Scholar
Cès, S, Flusin, D, Schmitz, O, Lambert, A-S, Pauwen, N and Macq, J (2017b) Les aidants proches des personnes âgées qui vivent à domicile en Belgique: un rôle essentiel et complexe. Brussels: Fondation Roi Baudouin.Google Scholar
Chari, AV, Engberg, J, Ray, KN and Mehrotra, A (2015) The opportunity costs of informal elder-care in the United States: new estimates from the American time use survey. Health Services Research 50, 871882.CrossRefGoogle ScholarPubMed
de Almeida Mello, J, Declercq, A, Cès, S, Van Durme, T, Van Audenhove, C and Macq, J (2016) Exploring home care interventions for frail older people in Belgium: a comparative effectiveness study. Journal of the American Geriatrics Society 64, 22512256.CrossRefGoogle ScholarPubMed
de Almeida Mello, J, Van Durme, T, Macq, J and Declercq, A (2012) Interventions to delay institutionalization of frail older persons: design of a longitudinal study in the home care setting. BMC Public Health 12, 615.CrossRefGoogle ScholarPubMed
De Koker, B (2009) Socio-demographic determinants of informal caregiving: co-resident versus extra-resident care. European Journal of Ageing 6, 315.CrossRefGoogle ScholarPubMed
Defeyt, P (2017) Vers un même régime de pensions pour tous? Limelette: Institut pour un Développement Durable.Google Scholar
Degavre, F, Nyssens, M, Bode, I, Breda, J, Fernandez, J-L and Simonazzi, A (2012) Care regimes on the move: Comparing home care for dependent older people in Belgium, England, Germany and Italy, Université Catholique de Louvain.Google Scholar
de Meijer, C, Brouwer, W, Koopmanschap, M, van den Berg, B and van Exel, J (2010) The value of informal care–a further investigation of the feasibility of contingent valuation in informal caregivers. Health Economics 19, 755771.CrossRefGoogle ScholarPubMed
DiCiccio, TJ and Efron, B (1996) Bootstrap confidence intervals. Statistical Science 11, 189212.CrossRefGoogle Scholar
Drennan, VM, Cole, L and Iliffe, S (2011) A taboo within a stigma? A qualitative study of managing incontinence with people with dementia living at home. BMC Geriatrics 11, 75.CrossRefGoogle ScholarPubMed
Elliott, R and Payne, K (2005) Essentials of Economic Evaluation in Healthcare. London: Pharmaceutical Press.Google Scholar
ENEO (2017) Pensions et qualité de vie: résultats de l’étude d’Énéo de 2017. Brussels: Mouvement social des ainés.Google Scholar
Eurostat (2017) Monthly minimum wages - bi-annual data [earn_mw_cur]. Available at http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=earn_mw_cur&lang=en.Google Scholar
Evans, BC, Coon, DW and Crogan, NL (2007) Personalismo and breaking barriers: accessing Hispanic populations for clinical services and research. Geriatric Nursing 28, 289296.CrossRefGoogle ScholarPubMed
Federale Overheidsdienst Economie - Service public fédéral Economie (FOD-SPF) (2014) Average accommodation cost per day for nursing home resident. Available online.Google Scholar
Fox, P, Maslow, K and Zhang, X (1999) Long-term care eligibility criteria for people with Alzheimer's disease. Health Care Financing Review 20, 6785.Google ScholarPubMed
Frick, KD (2009) Microcosting quantity data collection methods. Medical Care 47, S76S81.CrossRefGoogle ScholarPubMed
Fried, LP, Ferrucci, L, Darer, J, Williamson, JD and Anderson, G (2004) Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. Journals of Gerontology: Biological Sciences and Medical Sciences 59A, M255M263.CrossRefGoogle Scholar
Gerves, C, Chauvin, P and Bellanger, MM (2014) Evaluation of full costs of care for patients with Alzheimer's disease in France: the predominant role of informal care. Health Policy 116, 114122.CrossRefGoogle ScholarPubMed
Gustavsson, A, Cattelin, F and Jonsson, L (2011) Costs of care in a mild-to-moderate Alzheimer clinical trial sample: key resources and their determinants. Alzheimer's and Dementia 7, 466473.CrossRefGoogle Scholar
Gustavsson, A, Jonsson, L, Rapp, T, Reynish, E, Ousset, PJ, Andrieu, S, Cantet, C, Winblad, B, Vellas, B and Wimo, A (2010) Differences in resource use and costs of dementia care between European countries: baseline data from the ICTUS study. Journal of Nutrition Health and Aging 14, 648654.CrossRefGoogle ScholarPubMed
Harrison, JD, Young, JM, Butow, PN and Solomon, MJ (2013) Needs in health care: what beast is that? International Journal of Health Services 43, 567585.CrossRefGoogle Scholar
Hartmaier, SL, Sloane, PD, Guess, HA, Koch, GG, Mitchell, CM and Phillips, CD (1995) Validation of the minimum data set cognitive performance scale: agreement with the mini-mental state examination. Journals of Gerontology: Biological Sciences and Medical Sciences 50A, M128M133.CrossRefGoogle Scholar
Hastie, TJ, Tibshirani, RJ and Friedman, JH (2009) The Elements of Statistical Learning: Data Mining, Inference, and Prediction. New York, NY: Springer.CrossRefGoogle Scholar
Hirsch, D and Hill, K (2016) The additional cost of disability: a new measure and its application to sensory impairment. Disability & Society 31, 897913.CrossRefGoogle Scholar
Jonsson, L, Jonhagen, ME, Kilander, L, Soininen, H, Hallikainen, M, Waldemar, G, Nygaard, H, Andreasen, N, Winblad, B and Wimo, A (2006) Determinants of costs of care for patients with Alzheimer's disease. International Journal of Geriatric Psychiatry 21, 449459.CrossRefGoogle ScholarPubMed
Jönsson, L and Wimo, A (2009) The cost of dementia in Europe. PharmacoEconomics 27, 391403.CrossRefGoogle ScholarPubMed
Katz, S, Ford, AB, Moskowitz, RW, Jackson, BA and Jaffe, MW (1963) Studies of illness in the aged. The Index of ADL: a standardized measure of biological and psychosocial function. Journal of the American Medical Association 185, 914919.CrossRefGoogle ScholarPubMed
Koopmanschap, MA, van Exel, NJA, van den Berg, B and Brouwer, WB (2008) An overview of methods and applications to value informal care in economic evaluations of healthcare. PharmacoEconomics 26, 269280.CrossRefGoogle Scholar
Lambert, AS, Cès, S, Malembaka, EB, Van Durme, T, Declercq, A and Macq, J (2019a) Evaluation of bottom-up interventions targeting community-dwelling frail older people in Belgium: methodological challenges and lessons for future comparative effectiveness studies. BMC Health Services Research 19, 416.CrossRefGoogle Scholar
Lambert, AS, Legrand, C, Cès, S, Van Durme, T and Macq, J (2019b) Evaluating case management as a complex intervention: lessons for the future. PLOS ONE 14, 10.CrossRefGoogle Scholar
Lavoie, JP (2000) Familles et soutien aux parents âgées dépendants. Montreal: L'Harmattan.Google Scholar
Le, S, Josse, J and Husson, F (2008) FactoMineR: an R package for multivariate analysis. Journal of Statistical Software 25, 118.CrossRefGoogle Scholar
Litwin, H and Attias-Donfut, C (2009) The inter-relationship between formal and informal care: a study in France and Israel. Ageing & Society 29, 7191.CrossRefGoogle ScholarPubMed
Mihaylova, B, Briggs, A, O'Hagan, A and Thompson, SG (2011) Review of statistical methods for analysing healthcare resources and costs. Health Economics 20, 897916.CrossRefGoogle ScholarPubMed
Morciano, M, Hancock, R and Pudney, S (2015) Disability costs and equivalence scales in the older population in Great Britain. Review of Income and Wealth 61, 494514.CrossRefGoogle Scholar
Morris, JN, Fries, BE, Mehr, DR, Hawes, C, Phillips, C, Mor, V and Lipsitz, LA (1994) MDS cognitive performance scale©. Journal of Gerontology 49, M174M182.CrossRefGoogle Scholar
Morris, JN, Fries, BE and Morris, SA (1999) Scaling ADLs within the MDS. Journals of Gerontology: Biological Sciences and Medical Sciences 54A, M546M553.CrossRefGoogle Scholar
Organisation for Economic Co-operation and Development (OECD) (2016) Ressources et utilisation des soins de longue durée. Available at https://www.oecd-ilibrary.org/content/data/data-00543-fr.Google Scholar
Organisation for Economic Co-operation and Development (OECD) (2017) Health at a Glance 2017: OECD Indicators. Paris: OECD Publishing.Google Scholar
Paraponaris, A, Davin, B and Verger, P (2012) Formal and informal care for disabled elderly living in the community: an appraisal of French care composition and costs. European Journal of Health Economics 13, 327336.CrossRefGoogle ScholarPubMed
Posnett, J and Jan, S (1996) Indirect cost in economic evaluation: the opportunity cost of unpaid inputs. Health Economics 5, 1323.3.0.CO;2-J>CrossRefGoogle Scholar
Quentin, W, Riedel-Heller, S, Luppa, M, Rudolph, A and König, HH (2010) Cost-of-illness studies of dementia: a systematic review focusing on stage dependency of costs. Acta Psychiatrica Scandinavica 121, 243259.CrossRefGoogle ScholarPubMed
Rolfson, DB, Majumdar, SR, Tsuyuki, RT, Tahir, A and Rockwood, K (2006) Validity and reliability of the Edmonton Frail Scale. Age and Ageing 35, 526529.CrossRefGoogle ScholarPubMed
Salvador-Carulla, L and Gasca, VI (2010) Defining disability, functioning, autonomy and dependency in person-centered medicine and integrated care. International Journal of Integrated Care 10, 6972.CrossRefGoogle ScholarPubMed
Schooreel, T and Valsamis, D (2017) Evaluation du système des titres-services pour les emplois et services de proximité en Région de Bruxelles-Capitale, 2016. Brussels: Service public régional de Bruxelles, Economie et Emploi, Service Emploi.Google Scholar
Schwarzkopf, L, Menn, P, Kunz, S, Holle, R, Lauterberg, J, Marx, P, Mehlig, H, Wunder, S, Leidl, R, Donath, C and Graessel, E (2011) Costs of care for dementia patients in community setting: an analysis for mild and moderate disease stage. Value in Health 14, 827835.CrossRefGoogle ScholarPubMed
Spillman, BC and Lubitz, J (2000) The effect of longevity on spending for acute and long-term care. New England Journal of Medicine 342, 14091415.CrossRefGoogle ScholarPubMed
Statbel (2017) An Overview of Belgian Wages and Salaries. Belgium in Figures. Available at https://statbel.fgov.be/en/news/overview-belgian-wages-and-salaries-0.Google Scholar
Suh, G-H, Knapp, M and Kang, C-J (2006) The economic costs of dementia in Korea, 2002. International Journal of Geriatric Psychiatry 21, 722728.CrossRefGoogle Scholar
Tan, SS, Rutten, FFH, van Ineveld, BM, Redekop, WK and Hakkaart-van Roijen, L (2009) Comparing methodologies for the cost estimation of hospital services. European Journal of Health Economics 10, 3945.CrossRefGoogle ScholarPubMed
Taylor, DH Jr, Schenkman, M, Zhou, J and Sloan, FA (2001) The relative effect of Alzheimer's disease and related dementias, disability, and comorbidities on cost of care for elderly persons. Journals of Gerontology: Biological Sciences and Medical Sciences 56A, S285S293.CrossRefGoogle Scholar
van den Berg, B, Brouwer, W, van Exel, J and Koopmanschap, M (2005) Economic valuation of informal care: the contingent valuation method applied to informal caregiving. Health Economics 14, 169183.CrossRefGoogle ScholarPubMed
van den Berg, B, Brouwer, WBF and Koopmanschap, MA (2004) Economic valuation of informal care: an overview of methods and applications. European Journal of Health Economics 5, 3645.CrossRefGoogle ScholarPubMed
van den Berg, B, Brouwer, W, van Exel, J, Koopmanschap, M, van den Bos, GAM and Rutten, F (2006) Economic valuation of informal care: lessons from the application of the opportunity costs and proxy good methods. Social Science & Medicine 62, 835845.CrossRefGoogle ScholarPubMed
Van den Bosch, K, Willemé, P, Geerts, J, Breda, J, Peeters, S, Van De Sande, S, Vrijens, F, Van de Voorde, C and Stordeur, S (2011) Soins résidentiels pour les personnes âgées en Belgique: projections 2011–2025 (Reports 167B, Health Services Research). Brussels: Belgian Health Care Knowledge Centre (KCE).Google Scholar
Van der Heyden, J and Charafeddine, R (eds) (2014) Enquête de santé 2013. Rapport 1: Santé et Bien-être. Résumé des principaux résultats. Brussels: Institut Scientifique de Santé Publique.Google Scholar
Vrijens, F, Renard, F, Camberlin, C, Desomer, A, Dubois, C, Jonckheer, P, Van den Heede, K, Van de Voorde, C, Warkiers, D, Léonard, C and Meeus, P (2016) Performance of the Belgian Health System – Report 2015 (Report 259C, Health Services Research). Brussels: Belgian Health Care Knowledge Centre (KCE).Google Scholar
Wilkinson-Meyers, L, Brown, P, McNeill, R, Patston, P, Dylan, S and Baker, R (2010) Estimating the additional cost of disability: beyond budget standards. Social Science & Medicine 71, 18821889.CrossRefGoogle ScholarPubMed
Willemé, P, Geerts, J, Cantillon, B and Mussche, N (2012) Long-term care financing in Belgium. In Costa-Font, J and Courbage, C (eds), Financing Long-term Care in Europe. London: Palgrave Macmillan, pp. 300321.CrossRefGoogle Scholar
Willemse, E, Anthierens, S, Farfan-Portet, MI, Schmitz, O, Macq, J, Bastiaens, H, Dilles, T and Remmen, R (2016) Do informal caregivers for elderly in the community use support measures? A qualitative study in five European countries. BMC Health Services Research 16, 270.CrossRefGoogle Scholar
Wimo, A, Jönsson, L, Fratiglioni, L, Sandman, PO, Gustavsson, A, Sköldunger, A and Johansson, L (2016) The societal costs of dementia in Sweden 2012 – relevance and methodological challenges in valuing informal care. Alzheimer's Research & Therapy 8, 59.CrossRefGoogle ScholarPubMed
Wimo, A, Jönsson, L, Gustavsson, A, McDaid, D, Ersek, K, Georges, J, Gulacsi, L, Karpati, K, Kenigsberg, P and Valtonen, H (2011) The economic impact of dementia in Europe in 2008 – cost estimates from the Eurocode project. International Journal of Geriatric Psychiatry 26, 825832.CrossRefGoogle ScholarPubMed
Wubker, A, Zwakhalen, SMG, Challis, D, Suhonen, R, Karlsson, S, Zabalegui, A, Soto, M, Saks, K and Sauerland, D (2014) Costs of care for people with dementia just before and after nursing home placement: primary data from eight European countries. European Journal of Health Economics 16, 689707.CrossRefGoogle ScholarPubMed