The cost of dementia in an unequal country: The case of Chile

Abstract

We study the economic cost of dementia in Chile, and its variation according to socioeconomic status (SES). We use primary data from a survey of 330 informal primary caregivers who completed both a RUD-Lite and a socio-demographic questionnaire to evaluate the severity of dementia and caregiver’s burden. The costs of dementia are broken into three components: direct medical costs (medical care, drugs, tests); direct social costs (social service, daycare); and indirect costs (mostly associated to informal care). The average monthly cost per patient is estimated at US$ 1,463. Direct medical costs account for 20 per cent, direct social costs for 5 per cent and indirect costs for 75 per cent of the total cost. The mean monthly cost is found to be inversely related to SES, a pattern largely driven by indirect costs. The monthly cost for high SES is US$ 1,083 and US$ 1,588 for low SES. A multivariate regression analysis suggests that severity of dementia and caregiver’s burden account for between 49 and 70 per cent of the difference in the indirect cost across SES. However, between one-third and one-half of the variation across SES is not due to gradient in severity of dementia. Direct medical costs increase in higher SES, reflecting differences in purchasing power, while indirect costs are inversely related to SES and more than compensate differences in medical costs. Moreover, in lower SES groups, female caregivers, typically family members who are inactive in the labor market, mostly provide informal care. The average annual cost of dementia in Chile (US$ 17,559) is lower in comparison to high-income countries (US$ 39,595) and the proportion of cost related to informal cost is higher (74 per cent compared to 40 per cent). SES is a key determinant in the cost of dementia. In the absence of universal access to treatment, part of the social cost of dementia potentially preserves or increases income and gender inequality.

Health conditions and unmet needs for assistance to perform activities of daily living among older adults with dementia in Chile

“…Formal caregivers are rare in Latin American countries, where family systems are strong. Consistent with previous literature, we found that less than 5% of PWD caregivers were paid professionals . The burden for caregiving lies primarily on family members, and a majority of PWD had one or 2 informal caregivers.…”

“…The relationship between functional ability and unmet needs can be expected, given that people with lower functional ability require more support. An association between low educational level and dementia severity has been previously documented both internationally and in Chile and can be attributed in part to reduced access to formal care . In addition, the number of caregivers was another important variable associated with unmet needs, both regarding ADL and overall needs.…”

“…Although Chile is now defined as an upper middle‐income country, social protection systems remain largely underdeveloped, and as is the case for most of Latin America, an outdated health system has not achieved the complex and multidisciplinary response required by people with chronic diseases . Available evidence suggests a shortage of public policies for PWD and their caregivers …”

Use and costs of services and unpaid care for people with mild‐to‐moderate dementia: Baseline results from the IDEAL cohort study

“…Although we valued unpaid care time at minimum wage, the proportion of total costs accounted for by unpaid care would have been even higher had we used a valuation such as national average wage or (taking a replacement cost approach) costs to social care providers of paying home carers for the time. We did not find that unpaid care costs were associated with socioeconomic status, contrary to previous findings [43]. In terms of dementia subtypes and variations in cost, and contrary to the study by Costa et al [44], we found unpaid care costs higher for Parkinson's-type dementia than for Alzheimer's disease participants.…”

Aging and Health Policies in Chile: New Agendas for Research

“…The monthly cost was USD $690 and USD $1023 for high and low for high socioeconomic status families, respectively. 18 The high percentage of informal care in the total cost of dementia partly stems from the absence of a comprehensive national long-term care program and is consistent with an outdated health system that has failed to provide the complex and multidisciplinary actions that people with chronic diseases require. 7 The need for reform is particularly evident if we consider that WHO estimates a 77% increase in the cases of dementia by 2030 for Chile, Argentina, and Uruguay.…”