19 th alzheimer europe conference - session “ assistance and support (home and respite care) ”...
TRANSCRIPT
![Page 1: 19 th Alzheimer Europe Conference - Session “ Assistance and support (Home and respite care) ” 28-30 May 2009 - Brussels Economic valuation of formal and](https://reader030.vdocument.in/reader030/viewer/2022032804/56649e445503460f94b391ce/html5/thumbnails/1.jpg)
19th Alzheimer Europe Conference - Session “ Assistance and support (Home and respite care) ”
28-30 May 2009 - Brussels
Economic valuation of formal and informal care
for French disabled elderly living at home
Bérengère DAVIN – Alain PARAPONARIS
![Page 2: 19 th Alzheimer Europe Conference - Session “ Assistance and support (Home and respite care) ” 28-30 May 2009 - Brussels Economic valuation of formal and](https://reader030.vdocument.in/reader030/viewer/2022032804/56649e445503460f94b391ce/html5/thumbnails/2.jpg)
Context
Demographic trends in France– Persons aged 60 and over (Insee, 2008)
• 2006: 13 million (20.7% of the total population)
• 2035: 21 million (30.6%)
– Disabled elderly (Duée & Rebillard, 2006)
• 2006: 1 million
• 2035: about 1.4 million
Long-term care costs– Public costs
• 19 billion euro / year (Sénat, 2008)
• 1.1% of the GDP in 2005 between 2 and 2.8% in 2050 (OECD, 2005)
– Private costs• Out-of-pocket payments???
• Informal care?
Introduction
Methods
Results
Discussion
![Page 3: 19 th Alzheimer Europe Conference - Session “ Assistance and support (Home and respite care) ” 28-30 May 2009 - Brussels Economic valuation of formal and](https://reader030.vdocument.in/reader030/viewer/2022032804/56649e445503460f94b391ce/html5/thumbnails/3.jpg)
Objective
Sharing between formal care and informal care
– Informal care represents ¾ of care provided to the French elderly (Breuil-Genier, 1999; Petite & Weber, 2006; Davin et al, 2008)
Introduction
Methods
Results
Discussion
Objective of the study:
Assessing cost of care provided to French disabled elderly living at home
![Page 4: 19 th Alzheimer Europe Conference - Session “ Assistance and support (Home and respite care) ” 28-30 May 2009 - Brussels Economic valuation of formal and](https://reader030.vdocument.in/reader030/viewer/2022032804/56649e445503460f94b391ce/html5/thumbnails/4.jpg)
Data
French representative survey on health and disability (HID survey)– Carried out in 1999 among people living at home– Information on
• Sociodemographic characteristics: household composition, education level, income
• Living conditions: care received, home modifications, use of assistive devices
• Health: impairments, disability, need for care
Daily activities– 6 ADL: bathing, dressing, using the toilet, eating, getting in and out of bed,
going out– 3 IADL: shopping, preparing meals, doing housework
Introduction
Methods
Results
Discussion
Sample restricted to disabled people aged 60 and over
who receive assistance with daily activities (n = 2,686)
![Page 5: 19 th Alzheimer Europe Conference - Session “ Assistance and support (Home and respite care) ” 28-30 May 2009 - Brussels Economic valuation of formal and](https://reader030.vdocument.in/reader030/viewer/2022032804/56649e445503460f94b391ce/html5/thumbnails/5.jpg)
Economic valuation
First step: assessing hours of care
– Use of a methodology developed by French social experts that defines the
number of hours required to perform each activity (Pampalon et al., 1991)
– Application to HID data
– Distinction between formal and informal care
Second step: assessing cost of care
– Use of the proxy good method that applies to a non-market activity the labour
market wage of a close substitute (van den Berg
et al., 2004)
– Wage rate used
• French minimum gross hourly wage in 1999 : 11.05 euro / hour
Introduction
Methods
Results
Discussion
![Page 6: 19 th Alzheimer Europe Conference - Session “ Assistance and support (Home and respite care) ” 28-30 May 2009 - Brussels Economic valuation of formal and](https://reader030.vdocument.in/reader030/viewer/2022032804/56649e445503460f94b391ce/html5/thumbnails/6.jpg)
Cost of careIntroduction
Methods
Results
Discussion
Informal care Formal care Total
Persons with dementia 3.0 [2.5 ; 3.5] 2.2 [1.8 ; 2.7] 5.2 [4.3 ; 6.2]
Other disabled persons 3.6 [3.1 ; 4.0] 1.8 [1.4 ; 2.1] 5.4 [4.6 ; 6.2]
Total 6.6 [5.9 ; 7.2] 4.0 [3.4 ; 4.6] 10.6 [9.4 ; 11.9]
Billion euro per year [95% confidence interval]
Persons with dementia in the HID survey
– Criteria used in a report for the Fondation Médéric Alzheimer (Colvez & Royer, 2008)
• Reported or assessed impairment of intellectual functions
• Disorientation to time and place
• Disability with managing paperwork, taking medication and using phone
![Page 7: 19 th Alzheimer Europe Conference - Session “ Assistance and support (Home and respite care) ” 28-30 May 2009 - Brussels Economic valuation of formal and](https://reader030.vdocument.in/reader030/viewer/2022032804/56649e445503460f94b391ce/html5/thumbnails/7.jpg)
Cost of careIntroduction
Methods
Results
Discussion
Annual cost of informal care per person
• with dementia: 12,840 euro
• with other disabilities: 12,745 euro
Informal care represents about
• 57% of cost of care provided to persons with dementia
• 67% of cost of care provided to persons with other disabilities
Comparison with other results (EuroCode working group - Wimo et al, 2008)
• Total cost of dementia in EU27: 130 billion euro
• Annual cost of informal care per person with dementia: 11,773 euro
• Informal care represents 56% of the total cost
![Page 8: 19 th Alzheimer Europe Conference - Session “ Assistance and support (Home and respite care) ” 28-30 May 2009 - Brussels Economic valuation of formal and](https://reader030.vdocument.in/reader030/viewer/2022032804/56649e445503460f94b391ce/html5/thumbnails/8.jpg)
Discussion
Limits:
– Underestimation of cost• 9 activities only• Supervision / surveillance not considered• Hypothesis: provided care meets the whole needs
– Cost assessment method (proxy good method) (McDaid, 2001; Van den Berg et al, 2004,
Koopmanschap et al, 2008)
• No distinction between the different care tasks provided• Formal and informal care are assumed to be perfect substitute, with no
difference in efficiency and quality • Which value for care provided by people who don’t work? • How distinguish between normal household tasks and informal care tasks for
people living together?
– Exclusion of people living in institutions
Introduction
Methods
Results
Discussion
![Page 9: 19 th Alzheimer Europe Conference - Session “ Assistance and support (Home and respite care) ” 28-30 May 2009 - Brussels Economic valuation of formal and](https://reader030.vdocument.in/reader030/viewer/2022032804/56649e445503460f94b391ce/html5/thumbnails/9.jpg)
Discussion
Consequences of providing care
– On economic and financial resources of informal caregivers • Decrease of working time, career break, early retirement
(Carmichael & Charles, 1998, 2003; Fast et al., 1999; Heitmueller & Inglis, 2007; Stone & Short, 1990)
• Out-of-pocket payments for care (Rice et al., 1993)
– On caregiver’s life• Isolation from family and social network
(McDaid, 2008)
– On caregiver’s health• Either physical, mental or psychological health
(Joël et al., 2000; Navaie-Waliser et al., 2002; Schulz & Beach, 1999)
Introduction
Methods
Results
Discussion
![Page 10: 19 th Alzheimer Europe Conference - Session “ Assistance and support (Home and respite care) ” 28-30 May 2009 - Brussels Economic valuation of formal and](https://reader030.vdocument.in/reader030/viewer/2022032804/56649e445503460f94b391ce/html5/thumbnails/10.jpg)
19th Alzheimer Europe Conference - Session “ Assistance and support (Home and respite care) ”
28-30 May 2009 - Brussels
Economic valuation of formal and informal care
for French disabled elderly living at home