Bonsang Eric
CREPP, HEC-ULg Management School, Bd du Rectorat (B31), 7, 4000 Liège, Belgium.
J Health Econ. 2009 Jan;28(1):143-54. doi: 10.1016/j.jhealeco.2008.09.002. Epub 2008 Sep 13.
This paper analyzes the impact of informal care by adult children on the use of long-term care among the elderly in Europe and the effect of the level of the parent's disability on this relationship. We focus on two types of formal home care that are the most likely to interact with informal care: paid domestic help and nursing care. Using recent European data emerging from the Survey on Health, Ageing and Retirement in Europe (SHARE), we build a two-part utilization model analyzing both the decision to use each type of formal care or not and the amount of formal care received by the elderly. Instrumental variables estimations are used to control for the potential endogeneity existing between formal and informal care. We find endogeneity of informal care in the decision to receive paid domestic help. Estimation results indicate that informal care substitutes for this type of formal home care. However, we find that this substitution effect tends to disappear as the level of disability of the elderly person increases. Finally, informal care is a weak complement to nursing care, independently of the level of disability. These results highlight the heterogeneous effects of informal care on formal care use and suggest that informal care is an effective substitute for long-term care as long as the needs of the elderly are low and require unskilled type of care. Any policy encouraging informal care to decrease long-term care expenditures should take it into account to assess its effectiveness.
本文分析了成年子女提供的非正式照料对欧洲老年人长期照料使用情况的影响，以及父母残疾程度对这种关系的影响。我们关注两种最有可能与非正式照料相互作用的正式居家照料类型：付费家务帮助和护理照料。利用来自欧洲健康、老龄化与退休调查（SHARE）的最新欧洲数据，我们构建了一个两部分的使用模型，分析老年人使用每种正式照料类型与否的决策以及他们接受的正式照料数量。使用工具变量估计来控制正式照料和非正式照料之间潜在的内生性。我们发现在接受付费家务帮助的决策中存在非正式照料的内生性。估计结果表明，非正式照料替代了这种类型的正式居家照料。然而，我们发现随着老年人残疾程度的增加，这种替代效应往往会消失。最后，无论残疾程度如何，非正式照料都是护理照料的一种微弱补充。这些结果凸显了非正式照料对正式照料使用的异质性影响，并表明只要老年人的需求较低且需要非技术性照料类型，非正式照料就是长期照料的有效替代品。任何鼓励非正式照料以降低长期照料支出的政策都应考虑到这一点以评估其有效性。
