Yoo Byung-Kwang, Bhattacharya Jay, McDonald Kathryn M, Garber Alan M
Health Serv Res. 2004 Dec;39(6 Pt 2):1971-92. doi: 10.1111/j.1475-6773.2004.00328.x.
To quantify the effects of informal caregiver availability and public funding on formal long-term care (LTC) expenditures in developed countries.
DATA SOURCE/STUDY SETTING: Secondary data were acquired for 15 Organization for Economic Cooperation and Development (OECD) countries from 1970 to 2000.
Secondary data analysis, applying fixed- and random-effects models to time-series cross-sectional data. Outcome variables are inpatient or home heath LTC expenditures. Key explanatory variables are measures of the availability of informal caregivers, generosity in public funding for formal LTC, and the proportion of the elderly population in the total population.
DATA COLLECTION/EXTRACTION METHOD: Aggregated macro data were obtained from OECD Health Data, United Nations Demographic Yearbooks, and U.S. Census Bureau International Data Base.
Most of the 15 OECD countries experienced growth in LTC expenditures over the study period. The availability of a spouse caregiver, measured by male-to-female ratio among the elderly, is associated with a $28,840 (1995 U.S. dollars) annual reduction in formal LTC expenditure per additional elderly male. Availability of an adult child caregiver, measured by female labor force participation and full-time/part-time status shift, is associated with a reduction of $310 to $3,830 in LTC expenditures. These impacts on LTC expenditure vary across countries and across time within a country.
The availability of an informal caregiver, particularly a spouse caregiver, is among the most important factors explaining variation in LTC expenditure growth. Long-term care policies should take into account behavioral responses: decreased public funding in LTC may lead working women to leave the labor force to provide more informal care.
量化发达国家非正式照料者的可获得性及公共资金对正式长期护理（LTC）支出的影响。
数据来源/研究背景：获取了1970年至2000年期间15个经济合作与发展组织（OECD）国家的二手数据。
对时间序列横截面数据应用固定效应模型和随机效应模型进行二手数据分析。结果变量为住院或居家健康LTC支出。关键解释变量包括非正式照料者的可获得性指标、正式LTC公共资金的慷慨程度以及老年人口在总人口中的比例。
数据收集/提取方法：汇总的宏观数据来自经合组织卫生数据、联合国人口年鉴以及美国人口普查局国际数据库。
在研究期间，15个经合组织国家中的大多数国家LTC支出都有所增长。以老年男性与女性的比例衡量的配偶照料者的可获得性，与每增加一名老年男性每年正式LTC支出减少28,840美元（1995年美元）相关。以女性劳动力参与率和全职/兼职状态转变衡量的成年子女照料者的可获得性，与LTC支出减少310美元至3,830美元相关。这些对LTC支出的影响在不同国家以及一个国家内的不同时间有所不同。
非正式照料者，尤其是配偶照料者的可获得性，是解释LTC支出增长差异的最重要因素之一。长期护理政策应考虑行为反应：LTC公共资金减少可能导致职业女性离开劳动力市场以提供更多非正式照料。
