An estimation of the value and the hidden social cost of informal caregiving in Spain Luz María Peña-Longobardo & Juan Oliva-Moreno University of Castilla-La Mancha London, 5-7 September 2016

Agenda Background Objective Data and Method Results Dicussion

Background At the beginning of the new century, Spain was based on low levels of social protection expenditure associated with long-term care compared to other European countries. Why? An estimation of the value and the hidden social cost of informal caregiving in Spain

Background There are very significant differences in how European countries respond to the problem of dependence. These differences can be mainly explained by; the social expectations regarding the role of the family in caring for their elders and, by the level of services offered by the public sector In countries such as Spain, family played a dominant role as it is the main safety to cover the needs of people in situations of dependency, while public-sector support is secondary -the approval of Act 39/2006 of 14th December Lack of evidence about the relationship between the degree of dependency and the problems related to informal services in three different categories simultaneously (health, social and professional problems) An estimation of the value and the hidden social cost of informal caregiving in Spain

Objectives Research questions: What is the economic value of informal services provided to dependents in Spain? Is it different if we apply different techniques? What is the burden supported by informal caregivers (in terms of health, professional and social-related problems? An estimation of the value and the hidden social cost of informal caregiving in Spain

Data and Methods Data The Survey on Disabilities, Personal Autonomy and Dependency Situations (EDAD-08) -The information was obtained between November 2007 and February 2008 -Sample, 22,795 persons with disabilities -A home questionnaire, on Disabilities for individuals aged 6 and over and an addressed to the primary caregivers -Questions included allows us to have an approximation of the degree of dependence as defined by the Act on the Promotion of Personal Autonomy and Care of Dependent People: 4 categories of dependency (non-elegible, moderate, severity and greatly dependent) An estimation of the value and the hidden social cost of informal caregiving in Spain

Data and Methods Methods PROXY GOOD METHOD This method values the time of caregiving as output Where Ci cost of individual i; Tj time of caregiving in each activity j and Pj price of the activity j Number of hours * cost of public in-home care Three scenarios: The average cost of public in-home care, i.e. 12.71€/h The average cost in the three Autonomous Communities (regions of Spain) with the lowest costs in the country, i.e. 7.67€/h The cost for each Autonomous Communities An estimation of the value and the hidden social cost of informal caregiving in Spain

Data and Methods Methods OPPORTUNITY COST METHOD This method values the time of caregiving as input Where Ci cost of individual i; ni working hours; wi wage/hour; hi housework hours; si price of housework hours; Ii leisure; ti price of leisure time Number of hours * Shadow prices depending on the nature of the time dedicated to provide care 3 ways of valuating time: Labour hours Housework hours Leisure hours Ci = ni*wi + hi*si + li*ti An estimation of the value and the hidden social cost of informal caregiving in Spain

Data and Methods Methods CONTINGENT VALUATION METHOD Willingness to Accept (WTA) to provide an additional hour of care 3 different scenarios (Silvia Garrido-Garcia et al., 2015) 4.5 €/hour 5.5 €/hour 7 €/hour Note: It was censored the caregiving time at maximum of 16 hours/day An estimation of the value and the hidden social cost of informal caregiving in Spain

Data and Methods Empirical model for the caregivers 'burden Probit Regression: Outcome: Probability of suffering from health/professional/social related problems: Where X is a vector for independent variables such as age of caregiver, gender of caregiver, educational level of caregiver, marital status of caregiver, economic activity of caregiver, level of income, degree of dependency of the person being cared for, size of the municipality where the patient resides, Autonomous Community where the patient resides, formal in-home care received by the person being cared for, formal out-of-home care received by the person being cared for. Y* = βX + ε An estimation of the value and the hidden social cost of informal caregiving in Spain

Results Table 1. A brief description of disabled people and their informal caregivers in Spain It has been identified 3,787,447 disabled people in Spain (8.2% of the total Spanish population) and 1,326,270 informal caregivers Almost 75% of caregivers are females The average age is almost 62 years old An estimation of the value and the hidden social cost of informal caregiving in Spain

Results Table 2. Who are the informal caregivers in Spain? Almost 54% of the caregivers are the spouses and 32% the daughters/son Father/mother represent almost 7% of informal caregivers Most of resident caregivers are spouse (63%) Most of non-resident caregivers are daughter/son (55%). An estimation of the value and the hidden social cost of informal caregiving in Spain

Results Most of caregivers had low level of education Figure 1. Level of education Most of caregivers had low level of education Figure 2. Daily caregiving hours provided Caregivers caring for full dependents spend more than 16 caregiving hours per day Those caring for non-eligible people spend 8.5 horas per day

Results Table 3. Total monetary value of informal care per year Estimated value % GDP Proxy Good Method. Scenario 1 Restriction 53,299.02 4.90% No Restriction 67,822.96 6.23% Proxy Good Method. Scenario 2 50,158.78 4.61% 63,866.86 5.87% Proxy Good Method. Scenario 3 32,163.92 2.96% 40,928.57 3.76% Opportunity cost method. Scenario 1 23,716.72 2.18% 29,077.48 2.67% Opportunity cost method. Scenario 2 24,114.67 2.22% 29,475.43 2.71% Opportunity cost method. Scenario 3 24,512.62 2.25% 29,873.38 2.75% Contingent Valuation method. Scenario 1 18,870.62 1.73% 24,012.85 2.21% Contingent Valuation method. Scenario 2 23,064.09 2.12% 29,349.04 2.70% Contingent Valuation method. Scenario 3 29,354.30 37,353.32 3.43%

Results Fig 3. Average monetary value of informal care (with restriction) The total value of the informal care equivalents at 2.12% of GDP (contingent valuation method) 2.22% of the national GDP (opportunity Cost method). 4.61% of GDP (proxy good method) An estimation of the value and the hidden social cost of informal caregiving in Spain

Results Figure 4. Health-related problems supported by Spanish caregivers An estimation of the value and the hidden social cost of informal caregiving in Spain

Results Figure 5. Social-related problems supported by Spanish caregivers An estimation of the value and the hidden social cost of informal caregiving in Spain

Results Figure 6. Professional-related problems supported by Spanish caregivers An estimation of the value and the hidden social cost of informal caregiving in Spain

Results Caregivers`burden. Probit model results Health-Overall   Health-Overall Social Overall Professional Overall dy/dx (S.D) P Caregiver’s gender (male) -0.149 (0.014) -0.08 (0.016) 0.000** -0.107 (0.026) Caregiver’s age -0.000 (0.000) -0.002 (0.000) 0.402 -0.005 (0.001) Moderately Dependent 0.112 (0.017) 0.091 (0.011) 0.007** 0.104 (0.021) Severely Dependent 0.200 (0.019) 0.174 (0.010) 0.155 (0.021) Greatly Dependent 0.384 (0.017) 0.258 (0.009) 0.249 (0.019) N 6,641 4,956 2,935 Prob > chi2 0.0000 Pseudo R2 0.1270 0.157 0.0675 An estimation of the value and the hidden social cost of informal caregiving in Spain

Discussion Main conclusions An estimation of 4,193 million hours of informal caregiving Monetary valuation ranging from 18,871 million to 53,299 million euros, depending on the method applied The value of informal care was estimated at 1.73%-4.90% of the GDP for 2008 35% of caregivers admitted to suffering from health-related problems, 62% had social/leisure problems and 48% had work-related problems. The probability of a problem arising was positively associated with the degree of dependency of the person cared for. Thus, those who cared for heavily dependents had a high probability of suffering from any type of problem. An estimation of the value and the hidden social cost of informal caregiving in Spain

Discussion Issues to be considered No information about caregiving time in each different type of task undertaken by the caregivers High differences in the monetary value (which is the technique more appropriate?) Same shadow price for both domestic housework and leisure time It was censored the maximum amount of hours of caregiving to 16 hours per day and excluded those caregivers who did not provide information relating to hours of care (this represented 9.5%) An estimation of the value and the hidden social cost of informal caregiving in Spain

Discussion Policy implications Although a high proportion of LTC expenditure continues to be allocated for institutional care, the opportunity cost of services provided by family carers might begin to overtake the expenditure on formal services, especially in countries where the family is the backbone of long-term care systems, such as Spain. Family support and informal care should be regarded as a fundamental part of the Spanish LTC system Therefore, any programmes or strategies focused on alleviating the caregivers’ burden should be the highest priority issue for policy-makers so that relatives can carry out their role as caregivers while maintaining their well-being. It should be taken into account the role and needs of caregivers to promote their social recognition An estimation of the value and the hidden social cost of informal caregiving in Spain

Thank you so much for your attention! Luz María Peña Longobardo luzmaria.pena@uclm.es