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Changes in the balance between formal and informal care supply in England between 2001 and 2011: evidence from census data

Published online by Cambridge University Press:  02 July 2020

Valentina Zigante Open the ORCID record for Valentina Zigante [Opens in a new window] ,
Jose-Luis Fernandez Open the ORCID record for Jose-Luis Fernandez [Opens in a new window]  and
Fernanda Mazzotta Open the ORCID record for Fernanda Mazzotta [Opens in a new window]
Valentina Zigante*
Affiliation:
Care Policy and Evaluation Centre (CPEC), LSE, London, UK
Jose-Luis Fernandez
Affiliation:
Care Policy and Evaluation Centre (CPEC), LSE, London, UK
Fernanda Mazzotta
Affiliation:
Department of Economics and Statistics, University of Salerno, Salerno, Italy
*
*Corresponding author. Email: v.a.zigante@lse.ac.uk
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Abstract

Informal care plays a crucial role in the social care system in England and is increasingly recognised as a cornerstone of future sustainability of the long-term care (LTC) system. This paper explores the variation in informal care provision over time, and in particular, whether the considerable reduction in publicly-funded formal LTC after 2008 had an impact on the provision of informal care. We used small area data from the 2001 and 2011 English censuses to measure the prevalence and intensity (i.e. the number of hours of informal care provided) of informal care in the population. We controlled for changes in age structure, health, deprivation, income, employment and education. The effects of the change in formal social care provision on informal care were analysed through instrumental variable models to account for the well-known endogeneity. We found that informal care provision had increased over the period, particularly among high-intensity carers (20+ hours per week). We also found that the reduction in publicly-funded formal care provision was associated with significant increases in high-intensity (20+ hours per week) informal care provision, suggesting a substitutive relationship between formal and informal care of that intensity in the English system.

Keywords

Instrumental variable modelSocial careUnpaid care
Type
Article
Information
Health Economics, Policy and Law , Volume 16 , Issue 2 , April 2021 , pp. 232 - 249
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

Bakx, P, De Meijer, C, Schut, F and Van Doorslaer, E (2015) Going formal or informal, who cares? The influence of public long-term care insurance. Health Economics 24, 631–643.CrossRefGoogle ScholarPubMed
Bell, DNF, Bowes, A and Heitmueller, A (2007) Did the introduction of free personal care in Scotland result in a reduction of informal care?. WDA-HSG Discussion Paper No. 2007–3. Available at http://dx.doi.org/10.2139/ssrn.1884071 (Accessed 27 May 2020).CrossRefGoogle Scholar
Bernheim, BD, Shleifer, A and Summers, L (1985) The strategic bequest motive. The Journal of Political Economy 93, 1045–1076. Available at https://scholar.harvard.edu/shleifer/publications/strategic-bequest-motive (Accessed 27 May 2020).CrossRefGoogle Scholar
Bolin, K, Lindgren, B and Lundborg, P (2008) Informal and formal care among single-living elderly in Europe. Health Economics 17, 393–409.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, 143–154.CrossRefGoogle ScholarPubMed
Bremer, P, Challis, D, Hallberg, IR, Leino-Kilpi, H, Saks, K, Vellas, B, Zwakhalen, SMG and Saurland, D (2017) Informal and formal care: substitutes or complements in care for people with dementia? Empirical evidence for 8 European countries. Health Policy 121, 613–622.CrossRefGoogle ScholarPubMed
Brown, M (2006). Informal care and the division of end-of-life transfers. Journal of Human Resources XLI, 191–219.CrossRefGoogle Scholar
Care Act (2014) London: Stationery Office. Available at http://www.legislation.gov.uk/ukpga/2014/23/pdfs/ukpga_20140023_en.pdf (Accessed 27 May 2020).Google Scholar
Carers, UK (2018) State of caring 2018. Published by Carers UK, July 2018, London. https://www.carersuk.org/images/Downloads/SoC2018/State-of-Caring-report-2018.pdf (Accessed 27 May 2020).Google Scholar
Carmichael, F and Charles, S (2003) The opportunity costs of informal care: does gender matter?. Journal of Health Economics 22, 781–803.CrossRefGoogle ScholarPubMed
Chappell, N and Blandford, A (1991) Informal and formal care: exploring the complementarity. Ageing and Society 11, 299–317.CrossRefGoogle Scholar
Chen, CC, Yamada, T, Nakashima, T and Chiu, I (2017) Substitution of formal and informal home care service use and nursing home service use: health outcomes, decision-making preferences, and implications for a public health policy. Frontiers in Public Health 5, 297.CrossRefGoogle ScholarPubMed
Clark, DO (1992) Residence differences in formal and informal long-term care. The Gerontologist 32, 227–233.CrossRefGoogle ScholarPubMed
Contreras, D and Plaza, G (2010) Cultural factors in women's labor force participation in Chile. Feminist Economics 16, 27–46.CrossRefGoogle Scholar
Courtin, E, Jemiai, N and Mossialos, E (2014) Mapping support policies for informal carers across the European Union. Health Policy 118, 84–94.CrossRefGoogle ScholarPubMed
Fernandez, R and Fogli, A (2009) Culture: an empirical investigation of beliefs, work, and fertility. American Economic Journal: Macroeconomics 1, 146–177.Google Scholar
Fernandez, J-L, Snell, T, Forder, J and Wittenberg, R (2013a) Implications of setting eligibility criteria for adult social care services in England at the moderate needs level. PSSRU Discussion Paper 2851, Personal Social Services Research Unit, London, UK.Google Scholar
Fernandez, J-L, Snell, T and Wistow, G (2013b) Changes in the patterns of social care provision in England: 2005/6 to 2012/13. PSSRU Discussion Paper 2867, Personal Social Services Research Unit, London, UK.Google Scholar
Forder, JE and Allan, S (2011) Care markets in England: lessons from research. PSSRU Discussion Paper 2815, Personal Social Services Research Unit, London, UK.Google Scholar
Gannon, B and Davin, B (2010) Use of formal and informal care services among older people in Ireland and France. The European Journal of Health Economics 11, 499–511.CrossRefGoogle ScholarPubMed
Grundy, E (2000) Co-residence of mid-life children with their elderly parents in England and Wales: changes between 1981 and 1991. Population Studies 54, 193–206.CrossRefGoogle Scholar
Grundy, E and Glaser, K (2000) Socio-demographic differences in the onset and progression of disability in early old age: a longitudinal study. Age and Ageing 29, 149–158.CrossRefGoogle ScholarPubMed
Hancock, R, Morciano, M and Pudney, S (2019) Public support for older disabled people: evidence from the English Longitudinal Study of Ageing on receipt of disability benefits and social care subsidy. Fiscal Studies 40, 19–43.Google Scholar
Heitmueller, A and Inglis, K (2007) The earnings of informal carers: wage differentials and opportunity cost. Journal of Health Economics 26, 821–841.CrossRefGoogle Scholar
Horwitz, ME and Rosenthal, TC (1994) The impact of informal care giving on labor force participation by rural farming and nonfarming families. The Journal of Rural Health 10, 266–272.CrossRefGoogle ScholarPubMed
Hughes, SL, Giobbie-Hurder, A, Weaver, FM, Kubal, JD and Henderson, W (1999) Relationship between caregiver burden and health-related quality of life. The Gerontologist 39, 534–545.CrossRefGoogle ScholarPubMed
Karlsson, M, Mayhew, L, Plumb, R and Rickayzen, B (2006) Future costs for long-term care: cost projections for long-term care for older people in the United Kingdom. Health Policy 75, 187–213.CrossRefGoogle ScholarPubMed
King, G (1997) A Solution to the Ecological Inference Problem: Reconstructing Individual Behavior from Aggregate Data. Princeton: Princeton University Press.Google Scholar
Kohli, M (1999) Private and public transfers between generations: linking the family and the state. European Societies 1, 81–104.CrossRefGoogle Scholar
Langa, KM, Chernew, ME, Kabeto, MU and Katz, SJ (2001) The explosion in paid home health care in the 1990s: who received the additional services? Medical Care 32, 147–157.CrossRefGoogle Scholar
Liker, JK, Augustyniak, S and Duncan, GJ (1985) Panel data and models of change: a comparison of first difference and conventional two-wave models. Social Science Research 14, 80–101.CrossRefGoogle Scholar
Lilly, MB, Laporte, A and Coyte, PC (2007) Labor market work and home care's unpaid caregivers: a systematic review of labor force participation rates, predictors of labor market withdrawal, and hours of work. The Milbank Quarterly 85, 641–690.CrossRefGoogle ScholarPubMed
Liu, K, Manton, KG and Aragon, C (2000) Changes in home care use by disabled elderly persons: 1982–1994. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 55, S245–S253.CrossRefGoogle ScholarPubMed
Mair, CA, Quiñones, AR and Pasha, MA (2016) Care preferences among middle-aged and older adults with chronic disease in Europe: individual health care needs and national health care infrastructure. The Gerontologist 56, 687–701.CrossRefGoogle ScholarPubMed
Pezzin, LE and Schone, BS (1999) Intergenerational household formation, female labor supply and informal caregiving: a bargaining approach. Journal of Human Resources 34, 475–503.CrossRefGoogle Scholar
Pezzin, L, Kemper, P and Reschovsky, J (1996) Does publicly provided home care substitute for family care?: experimental evidence with endogenous living arrangements. Journal of Human Resources 31, 650–676.CrossRefGoogle Scholar
Pickard, L (2013) A growing care gap? The supply of unpaid care for older people by their adult children in England to 2032. Ageing and Society 35, 96–123.CrossRefGoogle Scholar
Pinquart, M and Sörensen, S (2002) Older adults’ preferences for informal, formal, and mixed support for future care needs: a comparison of Germany and the United States. The International Journal of Aging and Human Development 54, 291–314.CrossRefGoogle ScholarPubMed
Robards, J, Vlachantoni, A, Evandrou, M and Falkingham, S (2015) Informal caring in England and Wales – stability and transition between 2001 and 2011. Advances in Life Course Research 24: 21–33.CrossRefGoogle ScholarPubMed
Ryan, A, McKenna, H and Slevin, O (2011) Family care-giving and decisions about entry to care: a rural perspective. Ageing and Society 32, 1–18.CrossRefGoogle Scholar
Spiess, CK and Schneider, AU (2003) Interactions between care-giving and paid work hours among European midlife women, 1994 to 1996. Ageing and Society 23, 41–68.CrossRefGoogle Scholar
Spillman, BC and Pezzin, LE (2000) Potential and active family caregivers: changing networks and the ‘sandwich generation’. The Milbank Quarterly 78, 347–374.CrossRefGoogle Scholar
Srivastava, MS (1971) On fixed width confidence bounds for regression parameters. Annals of Mathematical Statistics 42, 1403–1411.CrossRefGoogle Scholar
Vadean, F and Forder, J (2018) The revision of the relative needs formulae for adult social care funding and new allocation formulae for funding Care Act reforms. PSSRU Discussion Paper 2906/2, Personal Social Services Research Unit, London, UK.Google Scholar
Van Groenou, MIB and De Boer, A (2016) Providing informal care in a changing society. European Journal of Ageing 13, 271–279.CrossRefGoogle Scholar
Van Houtven, CH and Norton, EC (2004) Informal care and health care use of older adults. Journal of Health Economics 23, 1159–1180.CrossRefGoogle ScholarPubMed
Vlachantoni, A, Shaw, R, Willis, R, Evandrou, M, Falkingham, J and Luff, R (2011) Measuring unmet need for social care amongst older people. Population Trends 145, 56–72. doi: 10.1057/pt.2011.17CrossRefGoogle Scholar
Wittenberg, R, Hu, B, Hancock, R, Morciano, M, Comas-Herrera, A, Malley, J and King, D (2011) Projections of demand for and costs of social care for older people in England, 2010 to 2030, under current and alternative funding systems. PSSRU Discussion paper 2811/2. Personal Social Services Research Unit, London, UK.Google Scholar
Wooldridge, JM (2012) Introductory Econometrics: A Modern Approach. Mason, Ohio: South-Western Cengage Learning.Google Scholar
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