Informal care and economic appraisal: A discussion of possible methodological approaches

Abstract

The role played by informal carers in the care of people with chronic disabilities is well known. Given its importance, it is essential to consider the evaluation methodology applied in economic appraisals of different care options. Few studies attempt any evaluation and those that do use varied, inconsistent and controversial methodologies. This paper aims to elicit the major issues and methodological problems related to economic appraisal of informal care. The main concern over the present methods utilized is the lack of explicit exploration of the benefits, as perceived by carers. Carers, through their decision to care it is argued, will consider both costs and benefits. Although concepts encompassed by benefits tend to be less tangible they may considerably outweigh any financial burdens. Various methods have been utilized in the past. Financial outlays are fairly straightforwardly costed, personal effort on the part of carers causes more problems. Methods applied include: the cost of substitute services; state benefits; and travel time values. The most useful is probably the latter, although it is not problem-free. Assessing benefits relating to concepts of direct and indirect utility and welfare is more complex and difficult to measure. Despite considerable literature on carers' attitudes, often these concepts are not applied (especially to residential care options) or if they are, negative aspects are emphasized (with domiciliary care). A useful application of economic appraisal would elicit optimal solutions to care dilemmas. Producing economic burden information about informal care may not be particularly constructive. Brief assessment of eight scenarios of care, considering cost differences for the public sector and the preferences of patient and carer gives insight to the problem. It emphasizes the complexity of the issue and the essential role likely to be placed on care managers in helping carers to maximize the net benefit of their efforts.

Prospective One-Year Cost-of-Illness Study in a Cohort of Patients with Dementia of Alzheimer's Disease Type in Spain: The ECO Study

“…However, hours of care by informal caregivers and explicitly devoted to patients' care were computed as direct non-healthcare costs and priced as the median of caregiver income collected in the study. Supervision time costs by informal caregivers were also priced with the same values as it was considered an opportunity cost [33,34].…”

The amount of informal and formal care among non‐demented and demented elderly persons—results from a Swedish population‐based study

“…There are also studies describing the amount of informal care (Rice et al, 1993;Clipp and Moore, 1995;Cavallo and Fattore, 1997;Artaso Irigoyen et al, 2002;Wimo et al, 2002). Nevertheless, studies with population-based data are limited and often restricted, such as studies on minority elderly with Alzheimer's disease (AD) in low-income areas (Albert et al, 1998) or quantity and cost of informal care-giving to demented persons only (Langa et al, 2001;Moore et al, 2001), and the methodological difficulties are obvious regarding quantification and costing (Smith and Wright, 1994;Winblad et al, 1997;McDaid, 2001) . As clinical and convenient samples, due to their health status, are known by the care system, it is logical to consider that such samples use more resources than population-based study populations.…”

Transitions to informal care in Great Britain during the 1990s

“…1 The economic value of informal caregiving in Britain is reported to be around £34 billion per year, although the methodologies used to produce such estimates are contested. 1a 2 However, few would argue that state provision of care could ever replace the carers' role or that, without their contribution, community health and social care services could cope with the additional demands on their resources. On the contrary, supporting informal carers in their caring role is high on the public policy agendas of many developed countries.…”