Valuing patient and caregiver time
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As healthcare expenditures continue to rise, financial pressures have resulted in a desire for countries to shift resources away from traditional areas of spending. The consequent devolution and reform have resulted in increased care being provided and received within homes and communities, and in an increased reliance on unpaid caregivers. Recent empirical work indicates that costs incurred by care recipients and unpaid caregivers, including time and productivity costs, often account for significant proportions of total healthcare expenditures. However, many economic evaluations do not include these costs. Moreover, when indirect costs are assessed, the methods of valuation are inconsistent and frequently controversial.
This paper provides an overview and critique of existing valuation methods. Current methods such as the human capital method, friction cost method and the Washington Panel approach are presented and critiqued according to criteria such as potential for inaccuracy, ease of application, and ethical and distributional concerns. The review illustrates the depth to which the methods have been theoretically examined, and highlights a paucity of research on costs that accrue to unpaid caregivers and a lack of research on time lost from unpaid labour and leisure. To ensure accurate and concise reporting of all time costs, it is concluded that a broad conceptual approach for time costing should be developed that draws on and then expands upon theoretical work to date.
KeywordsIndirect Cost Leisure Time Labour Force Participation Rate Care Recipient Time Loss
This paper was presented, in part, at the Canadian Health Economics Research Association meetings in Halifax, Nova Scotia in May 2002. The authors would like to thank conference participants for their contributions, especially C. Donaldson, S. Hadad, A. Shiell and W. Tholl. In addition, comments from Bernie O’Brien were also much appreciated, as was funding from the Canadian Institutes for Health Research (Grant number 37883). The author has no real or potential conflicts of interest relevant to this manuscript.
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