Short- and medium-term effects of informal care provision on female caregivers' health

Long-term care insurance and labor-force participation of adult children: an analysis of substitution and anticipation effects

Background

Many informal caregivers at working age and face the dual burden of providing care and working. This study examines how China's long-term care insurance (LTCI) pilot programs affect the labor-force participation of adult children who may provide informal care to parents.

Methods

We analyze four waves (2011, 2013, 2015, and 2018) of micro panel data from the China Health and Retirement Longitudinal Study and exploit the staggered rollout of LTCI pilots across cities from 2012 to 2017. A difference-in-differences design estimates the causal impact of LTCI implementation on labor-force participation of adult children, with robustness checks and subgroup analyses by gender, age, cohabitation status, and skill level.

Results

Implementation of LTCI significantly increases the likelihood of adult children remaining in the labor force. Mechanism analysis indicates this effect is driven by both reduced caregiving time (substitution effect) and improved expectations of future support (anticipation effect). The positive impact is particularly strong among men, individuals under 45 years old, cohabitation without parents, and lower-skilled workers.

Conclusion

Expanding LTCI can effectively alleviate the caregiving-employment conflict and enhance labor participation of adult children. To maximize workforce and social welfare benefits, policymakers should expand LTCI coverage, strengthen community care services, and focus support on high-burden caregiver groups.

Deterioration of health-related quality of life: the hidden health burden of informal caregiving

Informal caregiving is physically and mentally demanding and may lead to poor health and impaired well-being. We aim to check the effects of informal caregiving on health-related quality of life (HRQoL). We utilised longitudinal data from the most recent sixteen waves of the Household, Income and Labour Dynamics in Australia (HILDA) Survey. We measured HRQoL through the physical component summary (PCS), the mental component summary (MCS), the short-form six-dimension (SF-6D) utility index, and the eight dimensions of the SF-36 health survey. The primary exposure variable is informal caregiving. The variable was categorised into not a caregiver, lighter (< 5 hours [h]/week), moderate (5-19 h/week), and intensive (≥ 20 h/week) caregiving based on the hours of providing informal care per week. We have found that informal caregiving negatively affects HRQoL. We found that moderate (β = -0.0035, standard error [SE] = 0.0012) and intensive caregiving (β = -0.0074, SE = 0.0020) reduced SF-6D utility value. We also found that lighter (β = -0.29, SE = 0.07), moderate (β = -0.55, SE = 0.12), and intensive (β = -1.53, SE = 0.19) caregiving lowered MCS scores. Moreover, our results revealed that lighter, moderate and intensive caregiving decreases the scores of mental health-related dimensions (e.g., role emotional, social functioning, and mental health) of the SF-36 health survey. Our study findings have significant policy implications for improving the HRQoL and well-being of caregivers. To effectively support the health and well-being of informal carers, it is crucial to implement strategies that address their diverse needs, including supporting work-life balance, providing financial assistance and social security measures, ensuring access to community-based services, providing access to relevant information and training, and offering respite care options.

Does Publicly-Funded Adult Social Care Impact Informal and Unpaid Carers' Quality of Life in England?

Informal carers are important for their care recipients, but the burden of care may have a detrimental effect on the carer's well-being. Publicly-funded Adult Social Care (simply, ASC) in England may alleviate this burden. We therefore investigate whether ASC expenditure improves carers' quality of life and the channels through which this effect may exist. We analyze data on informal carers from the biennial Survey of Adult Carers in England in 2014/15, 2016/17, 2018/19 and 2021/22. We implement panel data instrumental variables methods that use conditionally exogenous variability in the local taxation to identify the causal effect of ASC expenditure. Our main finding suggests that a £1000-increase in ASC expenditure per client increases, on average, the carer-reported quality of life score by 0.3, which amounts to 4.2% of its average in 2021/22. Moreover, ASC expenditure has a beneficial impact on informal carers' care tasks, health, range of employment choices, and finances.

Unpacking the care-related quality of life effect of England's publicly funded adult social care. A panel data analysis

Adult Social Care (ASC) is the publicly-funded long-term care program in England that provides support with activities of daily living to people experiencing mental and/or physical challenges. Existing evidence suggests that ASC expenditure improves service users' care-related quality of life (CRQoL). However, less is known about the channels through which this effect exists and the effect on outcomes other than CRQoL. We fill this gap by analyzing survey data on ASC service users who received long-term support from 2014/15 to 2019/20 using panel data instrumental variable methods. We find that the beneficial impact of ASC expenditure on the CRQoL of both new and existing users is mostly driven by users aged 18-64 without any learning disability and users with no learning disability aged 65 or older receiving community-based ASC. Moreover, control over daily life, occupation, and social participation are the CRQoL domains that are improved the most. We also find that ASC expenditure has a beneficial effect on several other outcomes beyond CRQoL for both new and existing users including user satisfaction and experience, the ability to carry out activities of daily living independently, whether their home is designed around needs, accessibility to local places, general health, and mental health through reduced anxiety and depression. Greater ASC expenditure, however, does not address the need for other forms of support such as unpaid informal and privately-funded care.

The Effects of Spousal Caregiving on Middle-Age and Older Caregivers' Health and Well-Being: Evidence From Vietnam

Background: Population aging is escalating globally, intensifying the demand for long-term care (LTC), primarily met by informal caregivers, notably spouses. Evidence from developed countries suggests potential adverse effects on caregivers' well-being. Yet, research on this topic is scarce in developing nations. We investigate the effect of informal caregiving on older spousal caregivers' health and well-being in Vietnam, a rapidly aging country with an early stage of LTC system development. Methods: Utilizing the national survey on aging in Vietnam with propensity score matching estimations to mitigate potential endogenous problems of the decision to provide care between caregivers and non-caregivers. Results: Findings showed caregiving increased poor psychological well-being, life dissatisfaction, and functional limitations by 7.3%, 9.7%, and 8.6%, respectively. The caregiving effects are heterogenous by demographic characteristics. Conclusions: We are the first to examine spousal caregiving in Vietnam, highlighting the urgency of addressing its negative impacts and suggesting several potential policy interventions.

Unpaid Caring and Health-Related Quality of Life: Longitudinal Analysis of Understanding Society (the UK Household Longitudinal Survey)

OBJECTIVES

Decision models for economic evaluation are increasingly including health-related quality of life (HRQoL) for informal/unpaid carers, but these estimates often come from poor quality data and typically rely on cross-sectional analysis. We aimed to identify within-person effects using longitudinal analysis of 13 waves of Understanding Society (the UK Household Longitudinal Survey).

METHODS

We analyzed data for coresident carer and care-recipient dyads, where the carer reported "looking after or giving special help to" the care recipient in any of the 13 waves. We used fixed-effects models to study the effects of caring for the care recipient (the "caregiving" effect) using volume of care (hours per week) and continuous duration of caregiving (years) and caring about the care recipient (the "family" effect) using the care recipient's HRQoL on the carer's HRQoL. HRQoL was measured using the Short Form 6 Dimension, calculated from the Short Form 12.

RESULTS

We found consistent evidence for the family effect: improving care recipient's HRQoL by 0.1 would improve carer's HRQoL by approximately 0.012. We also consistently found evidence of a small but statistically significant decrement to carer's HRQoL for each additional year of caring. These findings were robust to scenario analyses. Evidence for the relationship between volume of care and carer's HRQoL was less clear.

CONCLUSIONS

We propose that our estimates can be used to populate economic models to predict changes in carers' HRQoL over time and allow disutilities to be estimated separately for the family and caregiving effect.

The effect of long-term care insurance on women's health outcomes in China: evidence from a disability inclusion action

BACKGROUND

Long-term care insurance (LTCI) in China provides financial and care security for persons with disabilities and includes caregivers in the paid labour workforce. However, it is unclear how the LTCI affects health outcomes in female recipients, female caregivers, and female non-recipients and female non-caregivers.

METHODS

Using the China Health and Retirement Longitudinal Study data and staggered difference-in-differences method, we evaluated the effect of LTCI on health outcomes in women with different roles, including female recipients, female caregivers, and female non-recipients and female non-caregivers, and discussed the heterogeneity of the effect on women's health outcomes.

RESULTS

LTCI statistically significant increased self-rated health and reduced depression in women and improved the health in women with different roles by increasing self-rated health in female recipients, reducing chronic diseases in female caregivers, and reducing depression in female non-recipients and female non-caregivers. There was a more pronounced improvement in health outcomes among women in the west and northeast and women in rural village.

CONCLUSIONS

After the implementation of LTCI, health outcomes in female recipients, female caregivers, and female non-recipients and female non-caregivers were improved. LTCI' improvement on women's health outcomes was heterogeneous geographically and socially. Our findings highlight the importance of delivering differentiated health interventions for women with different roles in the implementation process of LTCI and minimizing women's health inequalities in geography and society.

Informal care and financial stress: Longitudinal evidence from Australia

The number of people providing informal care has increased considerably in the last years while, at the same time, about one in four Australians have financial stress problems. This study uses rich longitudinal data from the Household, Income and Labour Dynamics in Australia (HILDA) survey to estimate the effect of informal care on financial stress. To establish causality, we exploit a fixed effect-instrumental variable approach to address omitted variable bias and reverse causality problems. Our findings show that informal caregiving increases financial stress between 9.9 and 14.5 percentage points. This finding is robust across a battery of quasi-experimental methods. The effect of informal caregiving on financial stress is more pronounced among males, rural residents and those living in low socioeconomic areas. Our analyses further show that financial fragility and social isolation are important channels through which informal caregiving affects financial stress.

Youth Caregivers of Adults in the United States: Prevalence and the Association Between Caregiving and Education

A growing proportion of individuals adopt family caregiving roles. Family caregivers are the primary providers of long-term care in the United States yet limited federal policy supports exist, despite the known negative impacts of caregiving. There is also limited information about the prevalence of youth/young adult caregivers and the impacts of caregiving at formative ages in the United States. Our objective is to estimate the prevalence of youth caregivers and examine the association of caregiving with educational investments. We use the American Time Use Survey (2013-2019) to identify and describe youth caregivers (aged 15-18) and young adult caregivers (aged 19-22) and compare them with non-caregiving peers. We estimate that there are approximately 1,623,000 youth caregivers and 1,986,000 young adult caregivers, corresponding to 9.2% and 12.7% of these age groups, respectively. However, there is a wide range in the estimated prevalence per year, from approximately 364,000 to 2.8 million youth caregivers and from 353,000 to 2.2 million young adult caregivers, depending on caregiver definition. Unlike adult caregivers, we find that young men and women were nearly equally likely to provide care. We also find that non-White individuals are disproportionately represented as youth caregivers. Compared with non-caregiving peers, both youth and young adult caregivers are less likely to be enrolled in school and, among those enrolled in school, spend significantly less time on educational activities. Considering the association of caregiving among youth/young adults and education, policies supporting youth and young adult caregivers are critical.

Long-run consequences of informal elderly care and implications of public long-term care insurance

We estimate a dynamic structural model of labor supply, retirement, and informal caregiving to study short and long-term costs of informal caregiving in Germany. Incorporating labor market frictions and the German tax and benefit system, we find that in the absence of Germany's public long-term insurance scheme, informal elderly care has adverse and persistent effects on labor market outcomes and, thus, negatively affects lifetime earnings and future pension benefits. These consequences of caregiving are heterogeneous and depend on age, previous earnings, and institutional regulations. Policy simulations suggest that while public long-term care insurance policies are fiscally costly and induce negative labor market effects, they can largely offset the personal costs of caregiving and increase welfare, especially for low-income individuals.

Informal care and mental health in Germany: What are the differences between non-migrants and ethnic German immigrants? A longitudinal comparative analysis

OBJECTIVE

In aging Germany, a large part of care is provided by informal caregivers. We aimed to analyze the main drivers of the mental health of caregivers and their intersection with migration status.

METHODS

Using panel data covering 18 years (n = 25,659 individuals, aged 16 to 103 years; mean age of 49.5 years) and applying linear regression models we investigated the association between informal caregiving and mental health. We compared non-migrant Germans (NMG) and ethnic German immigrants (EGI), who are the oldest immigrant group in Germany. Informal caregiving was defined as living with a person in need of care or by providing care for ≥2 h per day; the main health outcomes were mental health and mental health changes, measured by a metric scale of six items.

RESULTS

Even accounting for selection into caregiving, short-term care seemed to be disadvantageous only for NMG, while long-term care was generally associated with poorer mental health, with a particular disadvantage for EGI. Socio-economic characteristics and personality traits affected mental health changes, but only weakly the caregiving-health association.

CONCLUSION

Informal caregiving presents a health burden which is not explained by socio-economic characteristics and personality, but by migration status. Policies to promote health in an aging society need to consider differences in short- and long-term care provision and between migrants and the non-migrants.

Impact of informal caregiving on caregivers' subjective well-being in China: a longitudinal study

BACKGROUND

While informal caregiving is crucial for improving and maintaining health of the elderly, there is limited evidence of its potential effect on caregivers' wellbeing. Understanding this effect is important for policy makers to design effective long-term care policies. This longitudinal study aims to investigate the impact of informal caregiving on caregivers' subjective wellbeing in China.

METHODS

Three waves (2016, 2018, 2020) of data from the China Family Panel Studies (CFPS) are constructed for empirical analysis. Ordered logit model is first used to estimate the effect. Fixed effects ordered logit model and mixed effects ordered logit model are further employed to control for the possible bias from unobserved individual heterogeneity.

RESULTS

Informal caregiving significantly reduces caregivers' subjective wellbeing and the negative effect is stronger for high-frequency caregivers. Subgroup analysis reveals that informal caregiving imposed greater negative impacts on women, those living in rural areas, being married, working, and living separately from parents. Further analysis of mechanism indicates that decrease in wage income, leisure and sleep time were channels through which informal caregiving affects caregivers' well-being.

CONCLUSION

When policy makers formulate sustainable long-term care policies and home support services, interventions to improve caregivers' stress-coping skills and ensure their engagement in leisure and social activities could be adopted to mitigate the negative effects on caregivers' subjective well-being.

Health spillover studies of long-term care insurance in China: evidence from spousal caregivers from disabled families

BACKGROUND

To alleviate the shortage of caregivers associated with disabled persons, China has implemented a pilot policy for long-term care insurance. This policy has the characteristics of "familialization" and "de-familialization" policy orientation, and it is indeed essential to clarify whether the policy has a positive spillover effect on the health of family caregivers, which is of great value to the pilot from local practice to national institutional arrangement.

METHODS

Based on the China Health and Retirement Longitudinal Study microdata and time-varying DID method, our study used the implementation of the pilot policy as a "quasi-natural experiment" to assess the health spillover effects of the pilot policy on family spousal caregivers.

RESULTS

This policy significantly improved the health of spousal caregivers, increasing self-rated health and life satisfaction, and reducing depression; Compared with female, urban and central-western spousal caregivers, male, rural and eastern spousal caregivers were "beneficiaries" in more dimensional health.

CONCLUSIONS

Our research indicated that spousal caregivers of disabled people, particularly male, rural and eastern spousal caregivers, experienced positive health spillovers after implementing long-term care insurance. These results suggest that the imbalance between supply and demand of nursing staff could be solved in terms of de-familialization and familialization, spousal caregivers should be promoted to equally enjoy the policy benefits on gender, urban-rural and regions.

Informal Caregiving Provision for Disabled or Elderly in the Families and Work Productivity: Evidence from 11 Waves of an Australian Population-Based Cohort

BACKGROUND

Informal carers are family members, friends or neighbours who care for persons in need. In 2018, around one in ten Australians offered some informal care, most of which was unpaid. It is essential to comprehend how informal caregivers' productivity at work is affected by their caregiving responsibilities. We examine the association between informal caregiving and productivity loss in Australia.

METHODS

We utilised 11 waves of data drawn from the Household, Income and Labour Dynamics in Australia (HILDA) survey. Longitudinal random-effects logistic regression and random-effects Poisson regression techniques were used to assess the between-person differences in the association between informal caregiving and productivity loss (absenteeism, presenteeism and working hour tension).

RESULTS

The results suggest informal caregiving is associated with a higher rate of absenteeism, presenteeism and working hour tension. We reveal that absence/leave rates at work are greater for those with lighter, moderate and intensive care responsibilities than those without caregiving responsibilities, given other covariates reference categories remain constant. Our findings also indicate that workers with intensive, moderate, and light caregiving responsibilities have considerably higher rates of working hour tension than their peers without caregiving commitments if other covariate reference categories are held constant. The result further shows that, on average, an individual with lighter, moderate and intensive caregiving roles had incurred AUD 276.13, AUD 246.81, and AUD 1927.16, respectively, in absenteeism costs annually compared with their counterparts without caregiving duties.

CONCLUSION

Our study reveals that working-age caregivers experience greater absenteeism, presenteeism and working hour tension. Adverse effects of informal caregiving are required to perform the cost effectiveness of an intervention given to caregivers to improve carer and patient health. Our findings will assist health technology assessment (HTA) practitioners in performing an economic evaluation of interventions given to caregivers by providing the indirect cost (productivity loss) of caregiving.

Family spillovers and long-term care insurance

We examine how long-term care insurance (LTCI) affects informal care use and expectations among the insured individuals and co-residence and labor market outcomes of their adult children. We address the endogeneity of LTCI coverage by instrumenting for LTCI with changes in state tax treatment of LTCI insurance policies. We do not find evidence of reductions in informal care use over a horizon of approximately eight years. However, we find that LTCI coverage reduces parents' perceptions of the willingness of their children to care for them in the future and that the behavior of adult children changes, with LTCI resulting in lower likelihoods of adult children co-residing and stronger labor market attachment. These findings provide empirical support for the presence of spillovers of LTCI on the economic behaviors of family members.

Informal caregiving, time use and experienced wellbeing

Informal carers report lower evaluative wellbeing than non-carers. In contrast to this literature and our own analysis of evaluative wellbeing, we find carers have a small but higher level of experienced wellbeing than non-carers do. To investigate why, we use decomposition analysis which separates explanatory factors into how time is used and how those uses of time are experienced. We analyze activities and associated experienced wellbeing measured in ten-minute intervals over two days by 4817 adults from the 2014/15 UK Time Use Survey. We use entropy balancing to compare carers with a re-weighted counterfactual non-carer group and then apply Oaxaca-Blinder decomposition. The experienced wellbeing gap of 0.066 is the net result of several substantial competing effects of time use. Carers experienced wellbeing would be higher by 0.188 if they had the same patterns and returns to time use as non-carers which is driven by sleep, time stress and alternative characteristics of time use. However, leisure and non-market activities serve to dampen this increase in experienced wellbeing. Initiatives to improve and assess carer wellbeing should pay close attention to how carers spend their time.

Formal care of the elderly and health outcomes among adult daughters

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.

Informal care, older people, and COVID-19: Evidence from the UK

The negative health effects and mortality caused by the COVID-19 pandemic disproportionately fell upon older and disabled people. Protecting these vulnerable groups has been a key policy priority throughout the pandemic and related vaccination campaigns. Using data from the latest survey of the UK Household Longitudinal Study on COVID-19 we found that people who receive informal care have higher probability of being infected when compared to those not receiving informal care. Further, we found that care recipients who are in the lowest income groups have a higher probability of catching the virus when compared to those in the highest income groups. We also estimated the likelihood of being infected for informal carers versus those who did not provide any care during the pandemic and found no significant differences between these two groups. Our empirical findings suggest that the standard measures introduced with the aim of protecting vulnerable groups, such as closing care homes or prioritising the vaccination of their staff, were not sufficient to avoid the spread of the virus amongst disabled and older people. Informal carers play an important role in the social care sector. As such, protecting vulnerable people by investing in the informal care sector should be a priority for future health policy.

Understanding the effects of informal caregiving on health and well-being: Heterogeneity and mechanisms

This study examines the heterogenous effects of informal caregiving on caregivers' health and well-being and the mechanisms of the effects, which remain largely undiscussed in previous literature. We used a combined estimation of fixed effects and the instrumental variables to address unobserved time-invariant individual characteristics and the endogeneity problem between caregivers' health and caregiving status. Using data from the four waves of the Japanese Study of Aging and Retirement collected in 2007, 2009, 2011, and 2013, and covering individuals aged 50 to 75 at the baselines, we found robust evidence of the negative effects of informal caregiving on caregivers' mental health and life satisfaction, but not on their physical health. Regarding heterogenous effects, we found that informal caregiving adversely affected female but not male caregivers' mental health and life satisfaction. Our results also showed that informal caregiving had greater effects on individuals providing care for their mothers-in-law, with a higher socioeconomic status, living with their in-laws, and belonging to younger groups. Our results indicated that the loss of social networks and leisure and social activities were channels through which informal caregiving might negatively affect caregivers' health and well-being. This study provides suggestions that policy makers may use to mitigate the negative effects of caregiving with targeted interventions, while formulating policies to support informal caregivers.

Long-term care insurance, mental health of the elderly and its spillovers

The paper studies the effects of the long-term care insurance (LTCI) program in China on the mental health of older adults and the wellbeing of their families. We employ the staggered difference-in-differences approach based on the LTCI pilots from 2015 to 2017. First, we find the LTCI program improves older adults' happiness and reduces depression symptoms significantly. The effects on the improvement in memory and cognition are associated with the elderly with activities of daily living-related need for care. Second, the effects of LTCI are partially mediated through providing community services, relieving care burdens, and reducing the incidence of diseases. More importantly, LTCI coverage improves caregivers' physical health and social activities, reflecting its welfare spillover effects. Furthermore, the relationship between LTCI and mental health differs due to the difference in LTCI designs and older adults' demographic characteristics. This presents a need to consider mental health in the services and evaluation criteria of LTCI.

Value-Based Health Care: Long-Term Care Insurance for Out-of-Pocket Medical Expenses and Self-Rated Health

Long-term care insurance (LTCI) is a significant approach in the effort to actively manage aging and the currently unmet need for aged care in China. Based on data from the 2011, 2013, 2015, and 2018 phases of the China Health and Retirement Longitudinal Study, we used the propensity score matching-difference in difference (PSM-DID) approach to explore the impact of LTCI on out-of-pocket medical expenses and self-rated health. Results showed that LTCI can significantly reduce out-of-pocket medical expenses by 37.16% (p < 0.01) per year and improve self-rated health by 5.73% (p < 0.01), which conforms to the spirit of “value-based health care”. The results were found to be stable in the robustness tests conducted. Currently, China is at the intersection of “low-value-based health care” and “value-based health care”. Improving the health level of aged individuals while keeping medical costs under reasonable control is crucial for formulating and implementing a new round of healthcare reform in China.

Heterogeneity in informal care intensity and its impact on employment

Working-age individuals are under growing pressure to contribute unpaid time to the care of elderly family members and friends. Existing work has generally found informal care to negatively impact labor market outcomes, an effect that varies considerably by caregiving intensity, as defined by average hours of care or co-residence with the care receiver. I construct a new measure of caregiving intensity based on the length of caregiving spells. To do so, I use the Longitudinal and International Study of Adults, which provides data on the monthly caregiving status of respondents over a six-year period. I investigate how this dimension of caregiving intensity intersects with better-known measures, and show that results relying on the latter conceal substantial heterogeneity in the impact of caregiving on employment. These differences are particularly important to understand disparities in the impact of caregiving on female and male employment.

Family Caregivers of Veterans Experience Clinically Significant Levels of Distress Prepandemic and During Pandemic: Implications for Caregiver Support Services

BACKGROUND

Of the 26.4 million family caregivers in the United States, nearly 40% report high levels of emotional strain and subjective burden. However, for the 5 million caregivers of Veterans, little is known about the experiences of caregivers of Veterans during the coronavirus disease 2019 (COVID-19) pandemic.

OBJECTIVE

The aim was to examine pandemic-related changes of caregiver well-being outcomes.

RESEARCH DESIGN, SUBJECTS, AND MEASURES

Using a pre/post design and longitudinal data of individual caregivers captured pre-COVID-19 and during COVID-19, we use multilevel generalized linear mixed models to examine pandemic-related changes to caregiver well-being (n=903). The primary outcome measures include Zarit Subjective Burden, Center for Epidemiologic Studies Short Depression Scale, perceived financial strain, life chaos, and loneliness.

RESULTS

During the pandemic, we observe slight improvements for caregivers across well-being measures except for perceived financial strain. Before the pandemic, we observed that caregivers screened positive for clinically significant caregiver burden and probable depression. While we do not observe worsening indicators of caregiver well-being during the COVID-19 pandemic, the average predicted values of indicators of caregiver well-being remain clinically significant for caregiving subjective burden and depression.

CONCLUSIONS

These findings illuminate pandemic-related impacts of caregivers receiving support through the Veterans Affairs (VA) pre-COVID and during the COVID-19 pandemic while caring for a population of frail, older care-recipients with a high burden of mental illness and other chronic conditions. Considering the long-term impacts of the pandemic to increase morbidity and the expected increased demand for caregivers in an aging population, these consistently high levels of distress despite receiving support highlight the need for interventions and policy reform to systematically support caregivers more broadly.

Supporting family care: a scoping app review

BACKGROUND

Mobile applications (apps) may provide family caregivers of people with chronic diseases and conditions with access to support and good information. However, thorough understanding of how these apps meet the main needs and requirements of the users is currently lacking. The aim of this study was to review the currently available apps for family caregivers and evaluate their relevance to main domains of caregiving activities, caregivers' personal needs, and caregivers' groups found in previous research on family caregivers.

METHODS

We conducted a scoping review on English-language and German-language apps for family caregivers on two major app stores: Google Play Store and iOS App Store. Apps were included if the main target group were family caregivers. Data were extracted from the app descriptions provided by the app producers in the app stores.

RESULTS

The majority of the apps was designed to assist caregivers in their caregiving activities. Apps were rarely tailored to specific groups of family caregivers such as young carers and their needs. Further, apps addressing caregivers' personal health, financial security, and work issues were scarce. Commercial apps dominated the market, often intermediating paid services or available for users of specific hardware. Public and non-profit organizations provided best-rated and free-of-charge apps but had a very limited range of services with focus on caregivers' health and training.

CONCLUSIONS

Our results indicate that current apps for family caregivers do not distinguish specific groups of family caregivers, also they rarely address caregivers' personal needs.

A Comparison of Methods for Identifying Informal Carers: Self-Declaration Versus a Time Diary

OBJECTIVES

Two main methods for identifying whether an individual is an informal carer are self-declaration and the use of a time diary. We analysed the level and predictors of agreement between these two methods among co-residential informal carers of adult recipients.

METHODS

We used the 2014/15 UK Time Use Survey, which is a large-scale household survey for those aged 8 years old and over. It contains an individual questionnaire for self-declaration and a time diary for activity-based identification that records all activity in 10-min slots for two 24-h periods. Our analysis: (i) assesses the degree of overlap across approaches; (ii) explores the differences in characteristics between carers identified via one approach relative to non-carers using a bivariate probit estimator; and (iii) shows what factors are associated with being identified by both approaches using two independent probit estimators.

RESULTS

Out of 6301 individuals, we identified 545 carers (8.6%) by at least one method and only 104 (19.1% of 545 carers) by both methods. We found similar factors predicted caregiving using either method but the magnitudes of the effects of these factors were larger for self-declared carers. Activity-based carers who provided more activities to a dependent adult and spent more time caregiving were more likely to also self-declare.

CONCLUSIONS

Our results show low levels of agreement between the two main methods used to identify informal carers. Any assessment of current caregiving research or future means to collect caregiving information should pay particular attention to the identification method as it may only relate to certain carer groups.

The Impact of Care Intensity and Work on the Mental Health of Family Caregivers: Losses and Gains

OBJECTIVES

We estimate the causal impact of intensive caregiving, defined as providing at least 80 h of care per month, and work on the mental health of caregivers while considering possible sources of endogeneity in these relationships.

METHODS

We use 2 linked data sources from the United States by matching caregivers in the National Study of Caregiving with corresponding care recipients in the National Health and Aging Trends Study for years 2011-2017. We address possible sources of endogeneity in the relationships between caregiving, work, and mental health by using instrumental variables methodology, instrumenting for both caregiving and work behavior. We examine 2 measures used to screen for depression (PHQ-2, psychodiagnostic test) and anxiety (GAD-2, generalized anxiety disorders screening instrument), a composite measure that combines these measures (PHQ-4), and positive well-being variables to ascertain possible gains from caregiving.

RESULTS

Providing at least 80 h of care per month to a parent compared to less intensive caregiving increases the PHQ-4 scale for anxiety and depression disorders. This is driven by the screening score for anxiety and not psychodiagnostic test scores for depression. Relationship quality decreases substantially for intensive caregivers, and intensive caregiving leads to less satisfaction that the care recipient is well-cared for. We do not find offsetting mental health gains for intensive caregivers compared to nonintensive caregivers. Work does not independently affect the mental health of caregivers.

DISCUSSION

Caregiver interventions that reduce objective demands or support intensive caregivers could reduce or prevent well-being losses and improve the caregiver's relationship with the recipient.

Why we need population data on gender norms, and why this is important for population health

Gender norms are essential barometers of gender equality; inequitable gender norms are indicative of core inequalities in society that undermine the health of many groups. Fundamentally embedded in the gender system, prescriptive and restrictive gender norms have been shown to have deleterious effects on the health of women, men, girls and boys, as well as gender and sexual minorities. Gender norms are mutable, and there is potential to target and transform harmful and inequitable gender norms to drive gender equality. Gender-transformative approaches are needed, but a necessary first step is to identify and benchmark restrictive and inequitable gender norms, monitor change and progress, and highlight areas where interventions can be targeted for greatest effect. Efforts to do this are currently stymied by a lack of fit-for-purpose data. Routinely collected, population representative data on gender norms is urgently needed. This is vital to supporting and progressing gender equality and will contribute substantially to lifting population health.

The effect of informal caregiving on physical health among non-migrants and Ethnic German Immigrants in Germany: a cohort analysis based on the GSOEP 2000-2018

BACKGROUND

The number of people in need of care in Germany has been rising since decades, which is related to an increasing need and relevance of informal caregiving. Likewise, the number of people with a migration background has been increasing. This study aims to analyse the impact of informal caregiving on physical health in comparative perspective for Ethnic German Immigrants (EGI) - the largest and oldest immigrant group in Germany - and non-migrant Germans (NMG).

METHODS

The sample was drawn from the years 2000-2018 of the German Socio-Economic Panel (n = 26,354). NMG (n = 24,634) and EGI (n = 1,720) were categorized into non-caregivers (n = 24,379) and caregivers (n = 1,975), where the latter were distinguished by 1) their caregiving status and history (current, former, and never caregiver) and 2) the number of years in the caregiver role. Generalized Estimating Equations were applied to examine main effects and the interaction effects of caregiving status and migration background for changes in physical health (n = 102,066 observations).

RESULTS

Adjusting for socioeconomic, household related, and individual characteristics, NMG and EGI had similar caregiving patterns and physical health. However, the interaction between migration background and caregiving revealed significantly higher declines in physical health for currently caregiving EGI. Sensitivity analyses indicated that particularly socioeconomic resources moderated this effect.

CONCLUSIONS

Findings suggest that caregiving is associated with declines in physical health, particularly in the long term and for EGI. This implies that care-related disadvantages accumulate over time and that the association of caregiving, health and associated determinants are culturally diverse and shaped by migration background. Both the health disadvantages of caregivers and EGI might be mitigated by a positive social and socioeconomic setting, which highlights the relevance of supporting structures and benefits for these subgroups.

The impact of long-term care insurance in China on beneficiaries and caregivers: A systematic review

BACKGROUND

China's long-term care insurance (LTCI) policy has been minimally evaluated. This systematic review aimed to assess the impact of China's LTCI pilot on beneficiaries and their caregivers.

METHODS

This review is based on a search of peer-reviewed studies in English (Embase, MEDLINE, Web of Science) and Chinese (China National Knowledge Infrastructure [CNKI], VIP, Wanfang) databases from January 2016 through July 2020, with all studies published in English or Chinese included. We included quantitative analyses of beneficiary-level data that assessed the impact of LTCI on beneficiaries and their caregivers, with no restriction placed on the outcomes studied.

RESULTS

Nine studies met our inclusion criteria. One study was a randomised trial and two used quasi-experimental approaches. Four studies examined LTCI's effect on beneficiaries' quality of life, physical pain, and health service utilisation; one study reported the effect on beneficiaries' healthcare expenditures; and one study evaluated the impact on caregivers' care tasks. These studies generally found LTCI to be associated with an improvement in patients' quality of life (including decreased physical pain), a reduction in the number of outpatient visits and hospitalisations, decreased patient-level health expenditures (e.g. one study reported a reduction in the length of stay, inpatient expenditures, and health insurance expenditures in tertiary hospitals by 41.0%, 17.7%, and 11.4%, respectively), and reduced informal care tasks for caregivers. In addition, four out of four studies that evaluated this outcome found that beneficiaries' overall satisfaction with LTCI was high.

CONCLUSION

The current evidence base for the effects of LTCI in China on beneficiaries and their caregivers is sparse. Nonetheless, the existing studies suggest that LTCI has positive effects on beneficiaries and their caregivers. Further rigorous research on the impacts of LTCI in China is needed to inform the future expansion of the program.

Formal home care use and spousal health outcomes

This study explores the relationship between formal home care provided by paid professionals and spousal health outcomes. We use data from the Survey of Health, Ageing, and Retirement in Europe, a panel of older adults living in several European countries. We match new formal home care users to non-users to eliminate baseline (t-1) differences between couples who decide to seek formal home care in t and those who do not. After considering several potentially confounding changes between baseline and t, and looking closer at specific subgroups, we conclude that in the short run, use of formal home care is unlikely to affect spousal physical or mental health.

The scope of carer effects and their inclusion in decision-making: a UK-based Delphi study

Background and objective

Health and social care may affect unpaid (family) carers’ health and wellbeing in addition to patients’ lives. It is recommended that such impacts (carer effects) are considered in decision-making. However, the scope of carer effects and range of decisions where carer effects should be considered is uncertain. This study aimed to identify: (i) how different categories of healthcare and social care were perceived to impact on unpaid carers; and (ii) whether there was consensus about when carer effects should be formally considered in decision-making contexts.

Methods

A two round, online Delphi study was conducted with 65 UK-based participants (unpaid carers, care professionals, and researchers) with expertise in dementia, mental health, and stroke. Participants considered two broad forms of ‘interventions’ (patient treatment and replacement care) and two broad forms of ‘organisational change’ (staffing and changes in timing/location of care). Participants assessed the likely impacts of these on unpaid carers and whether impacts should be considered in decision-making.

Results

Participants predicted interventions and organisational changes would impact on multiple domains of unpaid carers’ lives, with ‘emotional health’ the most likely outcome to be affected. Patient treatment and replacement care services (‘interventions’) were associated with positive impacts across all domains. Conversely, timing/location changes and staffing changes (‘organisational changes’) were perceived to have mixed and negative impacts. There was widespread support (80–81 %) for considering carer effects in research studies, funding decisions, and patient decision-making.

Conclusions

This study highlights a perception that carer effects are widespread and important to consider in economic evaluation and decision-making. It highlights the particular need to measure and value effects on carers’ emotional health and the need to use a societal perspective to avoid cost shifting to unpaid carers when introducing interventions and making organisational changes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06742-4.

[Highly Burdened Groups of Family Caregivers - Results of a Cluster Analysis]

AIM

The aim of this study was to explore caregiving situations and to identify highly burdened caregiver groups.

METHODOLOGY

Survey data was collected from 1,429 family caregivers. Family caregivers were defined as relatives, friends, or neighbors who take care of and look after a person in need of care. Cluster analysis identified groups of family caregivers. Group differences were tested for statistical significance using the chi-squared test and analysis of variance.

RESULTS

Five groups of family caregivers were identified based on their caregiving tasks. Groups were characterized by the care situation (relationship to the person in need, intensity, and duration of care) and socio-demographic factors (gender, age, and employment). Groups differed in the perception of the care-related burden. While emotional burden was high in almost all groups, caregivers who provided everyday care reported high physical burden and those who provided continuous care over a long period reported high financial burden.

CONCLUSIONS

Caregivers are not a homogeneous group. They take on different roles and are exposed to various health and financial burdens. Information and services need to be addressed target group specifically. The presented typology supports health insurances and municipalities by enabling effective support approaches for highly burdened groups of family caregivers.

Is the grass greener on the other side? The health impact of providing informal care in the UK and the Netherlands

Facing rapidly ageing populations, many Western countries aim to stimulate informal care provision as a way to meet the growing long-term care (LTC) demand. While various studies report the impact of providing informal care on the health of caregivers, it is less clear whether and to what extent this impact differs across countries. Using propensity score matching we match caregivers to similar non-caregiving individuals using four waves of the Dutch Study on Transitions in Employment, Ability and Motivation and the UK Household Longitudinal Study. The samples consist of 8129 Dutch and 7186 UK respondents, among which respectively 1711 and 1713 individuals are identified as caregivers. We explore whether the health impact of providing informal care differs by country once similar caregivers, in terms of the intensity of provided care, are compared. In both countries we find negative mental health effects of providing informal care. While these effects slightly differ by country, the main differences arise between subgroups of caregivers. Individuals that provide more than 20 hours of informal care per week, and those who face a double burden of care and full-time employment experience the most severe negative mental health effects. These results indicate that health effects of providing informal care are mediated by the specific caregiving context, allowing policymakers to use information on this context to provide targeted aid. In addition, it suggests that previously reported differences of caregiving effects across countries could be driven by differences in the population of informal caregivers which are shaped by countries' LTC policies.

Effect Evaluation of the Long-Term Care Insurance (LTCI) System on the Health Care of the Elderly: A Review

Background

How to cope with the rapid growth of LTC (long-term care) needs for the old people without activities of daily living (ADL), which is also a serious hazard caused by public health emergencies such as COVID-2019 and SARS (2003), has become an urgent task in China, Germany, Japan, and other aging countries. As a response, the LTCI (long-term care insurance) system has been executed among European countries and piloted in 15 cities of China in 2016. Subsequently, the influence and dilemma of LTCI system have become a hot academic topic in the past 20 years.

Methods

The review was carried out to reveal the effects of the LTCI system on different economic entities by reviewing relevant literature published from January 2008 to September 2019. The quality of 25 quantitative and 24 qualitative articles was evaluated using the JBI and CASP critical evaluation checklist, respectively.

Results

The review systematically examines the effects of the LTCI system on different microeconomic entities such as caretakers or their families and macroeconomic entities such as government spending. The results show that the LTCI system has a great impact on social welfare. For example, LTCI has a positive effect on the health and life quality of the disabled elderly. However, the role of LTCI in alleviating the financial burden on families with the disabled elderly may be limited.

Conclusion

Implementation of LTCI system not only in reducing the physical and mental health problems of health care recipients and providers, and the economic burden of their families, but also promote the development of health care service industry and further improvement of the health care system. However, the dilemma and sustainable development of the LTCI system is the government needs to focus on in the future due to the sustainability of its funding sources.

Consequences on depression of combining grandparental childcare with other caregiving roles

Objective: This study examines the effect of combining grandchild care with other care roles on depression among individuals aged 50 to 84. Previous research investigating the health consequences of multiple care roles among older adults found mixed evidence, with most studies being predominantly cross-sectional.Methods: We use longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE) to understand how grandparents' mental health, measured as depressive symptoms, is affected when combining multiple care roles. We estimate logistic regression models, for grandfathers and grandmothers separately, to investigate how depression at wave 2 is affected by multiple care roles at wave 1, controlling for depression at baseline.Results: Consistent with previous studies, we find that providing grandchild care only reduces risk of depression for grandmothers, but not for grandfathers. For both genders, we find a higher risk of depression among those who provide intensive care to co-residents. The negative effect of grandchild care on depression found for grandmothers disappears if they also provide other types of care. In particular, grandmothers who provide care both to grandchildren and to a sick or disabled person show a higher risk of depression compared to those who only provide grandchild care.Conclusions: While multiple caregiving roles are not common, it is important to understand their combined effect on caregivers' health. Grandmothers who provide childcare and other intensive types of care may lose the positive effects grandchild care exert over their wellbeing.

Vereinbarkeit von Beruf und Pflege: Wie wirkt sich Erwerbstätigkeit auf die Gesundheit pflegender Angehöriger aus?

Ziel Die Studie untersucht, inwieweit die Gesundheitsauswirkungen der informellen Pflege durch den kontextuellen Faktor Erwerbstätigkeit beeinflusst werden.

Methodik Die Analyse basiert auf repräsentativen Bevölkerungsdaten aus den Jahren 2015 und 2016 (n=19 791). Als Untersuchungsgruppe „pflegende Angehörige“ definiert werden Personen, die mindestens eine Stunde pro Woche eine pflegebedürftige Person informell unterstützen, betreuen oder versorgen. Durch Anwendung von Propensity Score Matching wird eine strukturangepasste Vergleichsgruppe identifiziert. Anhand eines multivariaten Regressionsmodells werden Zusammenhänge in der Gruppe der pflegenden Angehörigen und der strukturangepassten Vergleichsgruppe analysiert. Für eine grafische Darstellung werden Untergruppen zum zeitlichen Einsatz im Hinblick auf Angehörigenpflege und Erwerbstätigkeit gebildet.

Ergebnisse Die psychische Gesundheit pflegender Angehöriger verschlechtert sich mit zunehmendem Aufwand für die Betreuung (B=-0,44; p=0,02). Die negativen gesundheitlichen Auswirkungen der Angehörigenbetreuung werden durch die Erwerbstätigkeit verringert (B=0,58; p<0,01), allerdings nur bis zum einem bestimmten zeitlichen Arbeitseinsatz. Bei einem höheren zeitlichen Aufwand für beide Tätigkeiten nimmt der moderierende Effekt ab (bis zu 32% der Standardabweichung).

Schlussfolgerungen Der signifikante moderierende Effekt der Erwerbstätigkeit ist in der Wirkung maßgeblich durch die Gesamtbelastung aus den beiden Tätigkeitsbereichen geprägt. Die Ergebnisse vermitteln einen Eindruck von der potentiell stärkenden und schützenden Wirkung von Erwerbstätigkeit auf die gesundheitlich negativen Auswirkungen der Angehörigenbetreuung.

The Impact of Informal Caregiving for Older Adults on the Health of Various Types of Caregivers: A Systematic Review

Objective

Informal care, the provision of unpaid care to dependent friends or family members, is often associated with physical and mental health effects. As some individuals are more likely to provide caregiving tasks than others, estimating the causal impact of caregiving is difficult. This systematic literature review provides an overview of all studies aimed at estimating the causal effect of informal caregiving on the health of various subgroups of caregivers.

Methodology

A structured literature search, following PRISMA guidelines, was conducted in 4 databases. Three independent researchers assessed studies for eligibility based on predefined criteria. Results from the studies included in the review were summarized in a predefined extraction form and synthesized narratively.

Results

The systematic search yielded a total of 1,331 articles of which 15 are included for synthesis. The studies under review show that there is evidence of a negative impact of caregiving on the mental and physical health of the informal caregiver. The presence and intensity of these health effects strongly differ per subgroup of caregivers. Especially female, and married caregivers, and those providing intensive care appear to incur negative health effects from caregiving.

Conclusion

The findings emphasize the need for targeted interventions aimed at reducing the negative impact of caregiving among different subgroups. As the strength and presence of the caregiving effect differ between subgroups of caregivers, policymakers should specifically target those caregivers that experience the largest health effect of informal caregiving.

Does long-term care insurance reduce hospital utilization and medical expenditures? Evidence from China

This study examines the effect of long-term care insurance (LTCI) on hospital utilization and expenditures among the elderly in China. We exploit the introduction of public LTCI in Shanghai, China, and implement a difference-in-difference technique to disentangle the effects of LTCI. We find that the introduction of LTCI significantly reduces the length of stay, inpatient expenditures, and health insurance expenditures in tertiary hospitals by 41.0%, 17.7%, and 11.4%, respectively. We find a greater effect on people over 80 years old. Outpatient visits in tertiary hospitals decrease by 8.1% per month after LTCI. The possible mechanisms are the substitution of long term care for hospitalization and health improvement. Our cost-effectiveness analysis indicates that every extra 1 yuan spent in LTCI will generate a decrease of 8.6 yuan in health insurance expenditures.

The effect of informal caregiving on social capital investments

Social capital is a resource derived from a person's social network and is important for various outcomes. Social capital declines over time and requires investments to avoid further declines or to increase the stock. However, certain life events can negatively affect social capital. This paper analyzes how informal caregiving, defined as unpaid assistance to persons who cannot perform the usual activities of daily living without help, affects social capital investments. Drawing on the German Socio-Economic Panel (GSOEP) with data for 15 years, I apply fixed-effects (FE) regressions to estimate the effect of changing caregiving status (extensive margin) and the effect of an additional hour of caregiving (intensive margin) on social capital investments. The results show that caregiving negatively affects investments in social capital for weak and strong ties unrelated to the care task. Furthermore, caregiving increases investments in strong ties that are care related.

Ex-post moral hazard in the health insurance market: empirical evidence from German data

In this paper, I analyze whether premium refunds can reduce ex-post moral hazard behavior in the health insurance market. I do so by estimating the effect of these refunds on different measures of medical demand. I use panel data from German sickness funds that cover the years 2006-2010 and I estimate effects for the year 2010. Applying regression adjusted matching, I find that choosing a tariff that contains a premium refund is associated with a significant reduction in the probability of visiting a general practitioner. Furthermore, the probability of visiting a doctor due to a trivial ailment such as a common cold is reduced. Effects are mainly driven by younger (and, therefore, healthier) individuals, and they are stronger for men than for women. Medical expenditures for doctor visits are also reduced. I conclude that there is evidence that premium refunds are associated with a reduction in ex-post moral hazard. Robustness checks support these findings. Yet, using observable characteristics for matching and regression, it is never possible to completely eliminate a potentially remaining selection bias and results may not be interpreted in a causal manner.

Health shock and preference instability: assessing health-state dependency of willingness-to-pay for corrective eyeglasses

BACKGROUND

Differences in contingent valuation (CV) estimates for identical healthcare goods can cast considerable doubt on the true economic measures of consumer preferences. Hypothetical nature of CV methods can potentially depend on the salience, context and perceived relevance of the good or service under consideration. Thus, the high demand elasticity for healthcare goods warrants careful selection of study population as the contexts of valuation significantly changes after experiencing health shock.

METHODS

In this study, using triple-bounded dichotomous choice (TBDC) experiments, we test how negative health shock (namely, being diagnosed with refractive errors), can alter preference over a common health good (namely, corrective eyeglasses). We compared elicited WTP of diagnosed patients with a synthetically constructed comparable cohort without the same health shock, controlling for the possible self-selection using a number of matching techniques based on the observable socio-demographic characteristics.

RESULTS

The consumers diagnosed with vision problems exhibit a rightward shift in their demand curve compared to observationally identical consumers without such problems resulting in about 17% higher consumer surplus. The consumers without the health shock are willing to pay about BDT 762.4 [95% CI: BDT 709.9 - BDT 814.9] for corrective eyeglasses, which gets 15-30% higher for the matched with-health-shock consumers. Multivariable analyses suggest more educated and wealthier individuals are willing to pay respectively BDT 208 and BDT 119 more for corrective eyeglasses. We have tested the models for different matching protocols. Our results are fairly robust to alternate specifications and various matching techniques.

CONCLUSION

The preferences for healthcare goods, such as eyeglasses, can significantly depend upon the respondent being diagnosed with refractive errors. Our findings have implications for general cost-benefit analyses often relying on WTP, which can vary depending on the contexts. There are also increasing interests in cost recovery models, which require understanding the demand for healthcare goods and services. We find eliciting the demand needs to consider the health status of the population from which the respondents are sampled.

New Evidence on Employment Effects of Informal Care Provision in Europe

OBJECTIVE

To estimate how labor force participation is affected when adult children provide informal care to their parents.

DATA SOURCE

Survey of Health, Ageing and Retirement in Europe from 2004 to 2013.

STUDY DESIGN

To offset the problem of endogeneity, we exploit the availability of other potential caregivers within the family as predictors of the probability to provide care for a dependent parent. Contrary to most previous studies, the dataset covers the whole working-age population in the majority of European countries. Individuals explicitly had to opt for or against the provision of care to their care-dependent parents, which allows us to more precisely estimate the effect of caregiving on labor force participation.

PRINCIPAL FINDINGS

Results reveal a negative causal effect that indicates that informal care provision reduces labor force participation by 14.0 percentage points (95 percent CI: -0.307, 0.026). Point estimates suggest that the effect is larger for men; however, this gender difference is not significantly different from zero at conventional levels.

CONCLUSIONS

Results apply to individuals whose consideration in long-term care policy is highly relevant, that is, children whose willingness to provide informal care to their parents is altered by available alternatives of family caregivers.

Informal care and health behaviors among elderly people with chronic diseases

BACKGROUND

The mechanism by which social relationships influence health can be interpreted as a social network regulating one's health behaviors. Based on the hypothesis that relatives, friends, or neighbors are sources of social support and may monitor one's health behaviors, researchers have gotten significant and consistent results that a social network can regulate health behaviors. However, few empirical studies have been conducted to examine the role of informal care in the regulation of health behaviors, especially for elderly individuals with chronic diseases that can be controlled by healthy behaviors. This paper researched the effects of informal care on health behaviors-smoking control, dietetic regulation, weight control, and maintenance of exercise-among elderly patients with chronic diseases in China who are facing the challenge of aging.

METHODS

We used the propensity score matching method to control the impacts of a very rich set of family and individual characteristics. The 2011-2012 national baseline data of the China Health and Retirement Longitudinal Study (CHARLS) was used.

RESULTS

Our findings showed that informal care could significantly help improve the health behaviors of elderly people. Informal care could improve the compliance of smoking control and dietetic regulation significantly. Elderly people with informal care smoked less and consumed more meals per day. For weight control, informal care helped decrease the possibility of weight gain of elderly people, but its impacts were not significant for BMI and weight loss. Last, for the elders, informal care could only help increase the probability of walking exercise; however, there was no significant result for moderate exercise.

CONCLUSIONS

Findings from this study highlight the importance of informal care among elderly people. Our results appeal to policy makers who aim to control chronic diseases that they should take informal care into account and provide appropriate policies to meet the demand of informal care for elderly people.

Spillover effect of Japanese long-term care insurance as an employment promotion policy for family caregivers

We evaluate a spillover effect of the Japanese public long-term care insurance (LTCI) as a policy to stimulate family caregivers' labor force participation. Using nationally representative data from 1995 to 2013, we apply difference-in-difference propensity score matching to investigate the spillover effect in two periods: before and after the introduction of the LTCI in 2000 and before and after its major amendment in 2006. Our results show that the LTCI introduction has significant and positive spillover effects on family caregivers' labor force participation and the effects vary by gender and age. In contrast, the LTCI amendment is found to have generally negative spillover effects on their labor force participation. We draw attention to these spillover effects, as expanding labor market supply to sustain the economy would be a priority for Japan and other rapidly aging countries in the coming decades.

Informal care and long-term labor market outcomes

In this paper we estimate long-run effects of informal care provision on female caregivers' labor market outcomes up to eight years after care provision. We compare a static version, where average effects of care provision in a certain year on later labor market outcomes are estimated, to a partly dynamic version where the effects of up to three consecutive years of care provision are analyzed. Our results suggest that there are significant initial negative effects of informal care provision on the probability to work full-time. The reduction in the probability to work full-time by 4 percentage points (or 2.4-5.0 if we move from point to partial identification) is persistent over time. Short-run effects on hourly wages are zero but we find considerable long-run wage penalties.

Will you still need me, will you still feed me when I'm 64? The health impact of caregiving to one's spouse

Informal care may substitute for formal long-term care that is often publicly funded or subsidized. The costs of informal caregiving are borne by the caregiver and may consist of worse health outcomes and, if the caregiver has not retired, worse labor market outcomes. We estimate the impact of providing informal care to one's partner on the caregiver's health using data from the Survey of Health, Ageing, and Retirement in Europe. We use statistical matching to deal with selection bias and endogeneity. We find that in the short run caregiving has a substantial effect on the health of caregivers and, for female caregivers, on their health care use. These effects should be taken into account when comparing the costs and benefits of formal and informal care provision. The health effects may, however, be short-lived, as we do not find any evidence that they persist after 4 or 7 years.

Fear of Unemployment and its Effect on the Mental Health of Spouses

Unemployment has been shown to have adverse effects on different aspects of a person's life, and even the fear of losing a job affects individuals negatively. In addition, not only the individuals directly affected but also their spouses and other family members might be affected. Using data from the German Socio-economic Panel, this study analyzes the relationship between individual job worries and spouse's mental well-being. The empirical results remain robust to different specifications and indicate that fear of job loss is negatively related to spouses' mental well-being and that this relationship seems to be stronger in single-income than in dual-income households. Copyright © 2015 John Wiley & Sons, Ltd.

Health shocks and risk aversion

We empirically assess whether a health shock influences individual risk aversion. We use grip strength data to obtain an objective health shock indicator. In order to account for the non-random nature of our data regression-adjusted matching is employed. Risk preferences are traditionally assumed to be constant. However, we find that a health shock increases individual risk aversion. The finding is robust to a series of sensitivity analyses and persists for at least four years after the shock. Income changes do not seem to be the driving mechanism.

Quantile treatment effects of job loss on health

Studies on health effects of job loss mostly estimate mean effects. We argue that the effects might differ over the distribution of the health status and use quantile regression methods to provide a more complete picture. To take the potential endogeneity of job loss into account, we estimate quantile treatment effects where we rely on job loss due to plant closures. We find that the effect of job loss indeed varies across the mental and physical health distribution. Job loss due to plant closures affects physical health adversely for individuals in the middle and lower part of the health distribution while those in best physical condition do not seem to be affected. The results for mental health, though less distinct, point in the same direction. We find no effects on BMI.