1. 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

2. Agenda
Background
Objective
Data and Method
Results
Dicussion

3. 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

4. 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

5. 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

6. 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

7. 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 €/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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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%

15. 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

16. 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

17. 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

18. 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

19. Results Caregivers`burden. Probit model results Health-Overall
Health-Overall
Social Overall
Professional Overall
dy/dx (S.D) P
Caregiver’s gender (male)
(0.014)
-0.08 (0.016)
0.000**
(0.026)
Caregiver’s age
(0.000)
(0.000)
0.402
(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

20. 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

21. 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

22. 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

23. Thank you so much for your attention!
Luz María Peña Longobardo