Department of Economics, University of Bergen, Bergen, Norway.
Norwegian Institute of Public Health, Oslo, Norway.
Health Econ. 2023 Feb;32(2):436-461. doi: 10.1002/hec.4628. Epub 2022 Nov 5.
Health-care expenditures and the demand for caregiving are increasing concerns for policy makers. Although informal care to a certain extent may substitute for costly formal care, providing informal care may come at a cost to caregivers in terms of their own health. However, evidence of causal effects of care responsibilities on health is limited, especially for long-term outcomes. In this paper, we estimate short and long-term effects of a formal care expansion for the elderly on the health of their middle-aged daughters. We exploit a reform in the federal funding of formal care for Norwegian municipalities that caused a greater expansion of home care provision in municipalities that initially had lower coverage rates. We find that expanding formal care reduced sickness absence in the short run, primarily due to reduced absences related to musculoskeletal and psychological disorders. The reduction in sickness absence is concentrated among workers with little work flexibility (e.g., shift workers), whereas there are no effects for workers with more flexible jobs. We were unable to detect effects on long-term health and healthcare utilization outcomes. Our results imply that sickness absence uptake could be hiding a need for more flexibility around work for people with caregiving responsibilities.
医疗保健支出和对护理的需求是政策制定者日益关注的问题。尽管在一定程度上，非正式护理可以替代昂贵的正式护理，但提供非正式护理可能会以照顾者自身健康为代价。然而，关于护理责任对健康的因果影响的证据有限，尤其是对于长期结果。在本文中，我们估计了一项针对老年人的正式护理扩大计划对其中年女儿健康的短期和长期影响。我们利用了一项针对挪威市政当局的正式护理联邦资金改革，该改革导致最初覆盖范围较低的市政当局提供更多的家庭护理。我们发现，在短期内，扩大正式护理减少了病假，这主要是由于与肌肉骨骼和心理障碍相关的缺勤减少。病假减少主要集中在工作灵活性较小的工人（例如，轮班工人）中，而对于工作更灵活的工人则没有影响。我们无法检测到对长期健康和医疗保健利用结果的影响。我们的结果表明，病假的增加可能掩盖了有护理责任的人对工作更灵活的需求。
