Bremer Patrick, Cabrera Esther, Leino-Kilpi Helena, Lethin Connie, Saks Kai, Sutcliffe Caroline, Soto Maria, Zwakhalen Sandra M G, Wübker Ansgar
University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany.
Hospital Clínic de Barcelona, Spain.
Health Policy. 2015 Nov;119(11):1459-71. doi: 10.1016/j.healthpol.2015.09.014. Epub 2015 Oct 22.
Informal (dementia) care has economic consequences throughout the health care system. Whilst the health and wellbeing of the care recipient might improve, the health of the caregiver might also change, typically for the worse. Therefore, this analysis aims to examine the association between caregiving intensity and caregivers' health and health care utilization.
The empirical analysis is based on cross-sectional survey data generated by the European Project "RightTimePlaceCare" (RTPC). RTPC was a prospective cohort study conducted in eight European countries (Estonia, Finland, France, Germany, Netherlands, Sweden, Spain and the United Kingdom). The health status of 1029 informal caregivers was assessed by measures of psychological wellbeing (GHQ-12) and self-rated overall health (EQ-VAS). Health care utilization was measured by (i) the self-stated proportion of health care use influenced by caregiving and (ii) the probability of at least one visit to a general practitioner within in the last 30 days. The association between caregiving intensity and caregivers' health and health care utilization was assessed by descriptive analysis and multivariate OLS- and probit-models.
A higher amount of informal care was significantly related to negative health outcomes for informal caregivers. On average, one additional hour of informal caregiving per day was associated with a decrease of psychological wellbeing and self-rated overall health by 0.16 and 0.42 index points respectively. Furthermore, one more hour of informal caregiving corresponded with increased self-stated proportion of health care use by 0.56 percentage points. However, the claim of increased health care demand due to caregiving as measured by GP visits was only partly confirmed.
When evaluating the full economic effect of informal care, the impact of providing care on caregivers' health and health care utilization has to be taken into account.
非正式（痴呆症）照护在整个医疗保健系统中会产生经济影响。虽然受照护者的健康和幸福感可能会改善，但照护者的健康状况也可能发生变化，通常会变差。因此，本分析旨在研究照护强度与照护者健康及医疗保健利用之间的关联。
实证分析基于欧洲“适时适地照护”（RTPC）项目产生的横断面调查数据。RTPC是一项在八个欧洲国家（爱沙尼亚、芬兰、法国、德国、荷兰、瑞典、西班牙和英国）进行的前瞻性队列研究。通过心理健康指标（GHQ - 12）和自评总体健康指标（EQ - VAS）对1029名非正式照护者的健康状况进行评估。医疗保健利用情况通过以下两个指标衡量：（i）自述因照护而影响医疗保健使用的比例；（ii）过去30天内至少看一次全科医生的概率。通过描述性分析以及多元OLS模型和概率模型评估照护强度与照护者健康及医疗保健利用之间的关联。
更多的非正式照护与非正式照护者的负面健康结果显著相关。平均而言，每天额外增加一小时的非正式照护，心理健康和自评总体健康分别下降0.16和0.42个指数点。此外，每多一小时的非正式照护，自述的医疗保健使用比例就增加0.56个百分点。然而，表示因照护导致医疗保健需求增加（以看全科医生的次数衡量）这一说法仅得到部分证实。
在评估非正式照护的全部经济影响时，必须考虑提供照护对照护者健康及医疗保健利用的影响。
