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Formal and informal care for disabled elderly living in the community: an appraisal of French care composition and costs

The European Journal of Health Economics volume 13, pages 327–336 (2012)Cite this article

Abstract

Objectives

Choices between formal and informal care for disabled elderly people living at home are a key component of the long-term care provision issues faced by an ageing population. This paper aims to identify factors associated with the type of care (informal, formal, mixed or no care at all) received by the French disabled elderly and to assess the care’s relative costs.

Methods

This paper uses data from a French survey on disability; the 3,500 respondents of interest lived at home, were aged 60 and over, had severe disability and needed help with activities of daily living. We use a multinomial probit model to determine factors associated with type of care. We also assess the cost of care with the help of the proxy good method.

Results

One-third of disabled elderly people receive no care. Among those who are helped, 55% receive informal, 25% formal, and 20% mixed care. Low socioeconomic status increases difficulties in accessing formal care. The estimated economic value of informal care is 6.6 billion euro [95% CI = 5.9–7.2] and represents about two-thirds of the total cost of care.

Conclusion

Public policies should pay more attention to inequalities in access to community care. They also should better support informal care, through respite care or workplace accommodations (working hours rescheduling or reduction for instance) not detrimental for the career of working caregivers.

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Fig. 1

Notes

  1. According to this methodology, a person needing help with bathing requires 4 care hours per week; with dressing: 4.67 h; with using the toilet: 7 h; with eating: 14 h; with getting in and out of bed: 4.67 h; with shopping: 3.25 h; with preparing meals: 7 h; with doing housework: 13 h; with going out: 3.5 h [38].

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Acknowledgments

The authors thank the ANR (French National Research Agency) for financial support from the Young Researcher program (ANR-06-JCJC-0022) and the joint program CNSA-INSERM-HAS-MiRe-DREES “Handicap 2007” of IRESP (French Institute for Public Health Research). At the time of this research, Bérengère Davin was a post-doctoral research fellow of the FLARE (Future Leaders of Ageing Research in Europe) program of ERA-AGE (European Research Area in Ageing), funded by the Caisse Nationale de Solidarité pour l’Autonomie (CNSA). She thanks the Foundation Médéric Alzheimer for the PhD Thesis Award 2008.

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Affiliations

  1. INSERM, U912 (SE4S), 23 rue Stanislas Torrents, 13006, Marseille, France

    Alain Paraponaris, Bérengère Davin & Pierre Verger

  2. Université Aix Marseille, IRD, UMR-S912, Marseille, France

    Alain Paraponaris, Bérengère Davin & Pierre Verger

  3. ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d’Azur, Marseille, France

    Alain Paraponaris, Bérengère Davin & Pierre Verger

Authors
  1. Alain Paraponaris
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  2. Bérengère Davin
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  3. Pierre Verger
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Correspondence to Alain Paraponaris.

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Paraponaris, A., Davin, B. & Verger, P. Formal and informal care for disabled elderly living in the community: an appraisal of French care composition and costs. Eur J Health Econ 13, 327–336 (2012). https://doi.org/10.1007/s10198-011-0305-3

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Keywords

  • Ageing
  • Activities of daily living (ADL and IADL)
  • Formal and informal care
  • Economic evaluation
  • Social inequalities

JEL Classification

  • I10
  • J14
  • J18