خویشاوندان نزدیک و یا دوستان حرفه ای خود ؟ : مراقبت و کار در میان 50 ساله ها به بالای اروپا
|کد مقاله||سال انتشار||تعداد صفحات مقاله انگلیسی||ترجمه فارسی|
|16299||2008||21 صفحه PDF||سفارش دهید|
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Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Journal of Health Economics, Volume 27, Issue 3, May 2008, Pages 718–738
An increasing demand for both formal and informal care is likely to result from the ongoing demographic transition at the same time as there is a further move away from the traditional domestic division of labour. Public policy-making that aims at increasing the supply of informal care necessitates knowledge about the relative importance of various incentives for individual care providers. This paper takes as a point of departure that the willingness to supply informal care is partly explained by the extent to which it adversely affects labour-market outcomes and analyses the effect on labour-market outcomes of providing informal care to one's elderly parent(s) among the 50+ of Europe. Data from SHARE (Survey of Health, Ageing, and Retirement in Europe) was used to examine the association between, on the one hand, hours of informal care provided and, on the other, (1) the probability of employment, (2) hours worked, and (3) wages, respectively. The results suggest that giving informal care to one's elderly parents is associated with significant costs in terms of foregone labour-market opportunities and that these adverse effects vary between countries.
The simultaneous processes of a demographic transition, towards a higher share of elderly people in Europe, and the emancipation of women from being the sole providers of domestic labour mean that the demand for informal care will increase, while the supply will decrease. If public policy-makers are anxious to increase the supply of informal care, the importance of incentives for individual care providers must be carefully studied. This paper addresses the question of whether or not the supply of informal care conveys costs to the provider over and above the immediate loss of income and whether or not the institutional context is important in this respect. The individual's incentives for supplying informal care are comprised of a large array of benefits and costs. Apart from the willingness to provide informal care out of altruism, there are certainly several additional benefit-components, such as the fulfillment of what is considered an obligation and improved relationships (Bamford et al., 1998). At the cost side of the equation there is the opportunity cost of time. In principle, allocating time to informal-care purposes encompasses both direct and indirect costs. Direct costs are costs, which arise when an hour is used for the provision of informal care instead of working in the labour market. Indirect costs are costs which are caused by disturbance of the process of human-capital accumulation—a student may suffer adverse effects from absence from school not only because he or she misses a day of schooling but also, and maybe more important, since there are accumulation effects over time of 1 day of missed schooling. Similarly, an employee may suffer not only 1 day's payment but also on-the-job-training, which will have accumulation effects over time. Further, the expectation held by an employer that, for instance, a specific employee will be more absent from work, or will be less devoted to his or her career, since he or she has supplied significant amounts of informal care at the expense of job devotion in the past, may reinforce the adverse effects on human-capital accumulation and, hence, wages. These adverse effects may be different depending on the specific institutional setting of a country. Thus, the various institutional settings among the European countries may induce different patterns. Despite their (potentially) important policy implications, relatively few studies outside the US have analysed the relationship between informal-care provision and labour-market outcomes and how these influences depend on the institutional setting. For US conditions, Wolf and Soldo (1994) found no effect of giving informal care on employment or hours worked among married women, but most prior US studies have identified large opportunity costs of informal care in the form of reduced occupational attainment (Muurinen, 1986, Stone and Farley-Short, 1990, Boaz and Muller, 1992, Ettner, 1996, Pavalko and Artis, 1997, Johnson and Lo Sasso, 2000, Kolodinsky and Shirey, 2000 and Pavalko and Henderson, 2006). Outside the US, a few studies for British conditions exist (Arber and Ginn, 1995, Carmichael and Charles, 1998, Carmichael and Charles, 2003a, Carmichael and Charles, 2003b, Heitmueller, 2004 and Heitmueller and Inglis, 2007). In the latter studies, a negative effect of informal-care provision was obtained, although the magnitude of the effect varied. In this study, we focus on the effects of informal-care-giving on labour-market outcomes and on differences in the effects among European regions. Until recently, such analyses have been hindered by a lack of comparable data. With the recent development of the SHARE (Survey of Health, Ageing, and Retirement in Europe) database, however, new, cross-national research possibilities within a European context appear. In our analyses, we take advantage of the cross-national character of SHARE and examine differences in the effects of care-giving on labour-market outcomes according to a north–south gradient. Focusing on the north–south gradient is motivated by the fact that there exist considerable cultural and institutional differences between northern and southern European countries that may be of importance when studying informal care and labour-market outcomes. Southern European countries are commonly referred to as “strong family-ties countries”, and are often contrasted with the “weak family-ties countries” of Northern Europe (Reher, 1998). The strength of the ties is usually discussed in terms of cultural patterns of family loyalties, allegiances, and authority, but also concerns demographic patterns of intra-generational co-residence and patterns of support for the elderly.1 A cross-sectional interview survey, carried out in Norway, England, Germany, Spain and Israel in 2000/2001, examined contemporary European norms and ideals for the support and care of older people (Daatland and Herlofson, 2003). It was found that the support for filial norms as well as personal preferences for own long-term care follow a north–south gradient—generally higher in Spain (and Israel) and lower in Norway, England and Germany. Analysing SHARE data, Kohli et al. (2005) concluded that the European north–south “weak–strong” gradient persists. Here, the Scandinavian countries were found to have the “weakest” family ties, the Mediterranean countries the “strongest”, whereas the continental countries lay somewhere in between. Cultural differences in norms, traditions and preferences are reflected in institutional differences. True, as can be seen in Table 1, there are substantial publicly financed long-term-care programmes in all the countries studied, regarding both informal care and formal care at home or at institutions. The extent of the various programmes, the supply of services, and the utilisation of programmes seem to differ, however, leading to the north–south gradient in the public-spending on long-term care share of GDP and in the share of 65+ residing in institutional care, respectively, reported in Table 2. This table also shows a north–south gradient in employment rates, specifically for women and for older workers, unemployment rates, income distributions and whether or not children are legally obligated to care for and/or support their parents. Table 1. Overview of publicly financed long-term-care programmes in the countries under study Type of public service/support Home care Institutional care Informal care at home Formal care at home Denmark Informal carers can be hired at a wage similar to that of public agency employees (s.t. harsh eligibility criterions) The user chooses provider. Tax financed. Free at point of use for the elderly The user chooses provider. Nursing and care tax financed, accommodation co-financed by user Sweden Informal carers can be hired at a wage similar to that of public agency employees. The attendance allowance is another source of support to informal carers Choice of provider available in about 5% of municipalities. Mainly tax financed, co-financed by the user subject to means test Choice of provider available in about 5% of municipalities. Mainly tax financed, co-financed by the user subject to means test Netherlands The consumer-directed budget (CDB) allows the user to choose between providers, including relatives, of needed care services The CDB allows the user to choose between providers of needed care services Paid for via the CDB Austria The dependent can use the tax-financed care allowance to reward informal carers The user chooses provider of formal home care and pays for it via the care allowance. Home nursing is financed by the health insurance Paid for via the care allowance Germany The dependent can use the insurance-financed care allowance to reward informal carers The care allowance allows the dependent to choose between benefits in-kind or in-cash. Home nursing is financed by the health insurance Paid for via the care allowance. Social assistance available for uninsured persons France Tax exemptions available for informal carers. Part-time work-wide spread among informal carers. Un-paid leave, as well as a few days of paid leave, available Home nursing is financed by the health insurance and provided free of charge for the user. The tax-financed care allowance is used for other home help Nursing financed by health insurance, social care and accommodation financed by the care allowance. Social assistance available if needed Switzerland Financed by a 50–50 mix of public insurance and private contributions Financed by a mix of public insurance and private contributions Greece Tax exemptions and a few days of un-paid leave available for informal carers Home help programme targeted at lonely and dependent elderly. Tax-financed Usually no co-financing in public or NFP institutions. Private institutions financed by private contributions Italy The care allowance to disabled persons can be used to pay informal carers. There is also a means-tested support for caring families. Care leave, paid or unpaid, is available for informal carers but only a realistic alternative for public employees Home nursing provided free of charge for the user. Other services subject to a means test. The general care allowance can be used to pay the costs of formal care. Means-tested support available Institutional care mainly tax-financed, but co-payments are significant Spain Tax exemptions available for informal carers Home nursing provided free of charge for the user. Other services subject to a means test. Private help financed by user Public institutional care mainly tax-financed, but co-payments are significant. Private residential care financed by user Sources: Jenson and Jacobzone (2000), Comas-Herrera et al. (2003), Lamura (2003), Lundsgaard (2005), OECD (2005), Szebehely (2005) and European Commission (2005). Table options Table 2. Overview of variations in institutional factors among the countries under study Country Employment rate (2004) (%) Employment rate among women (2004) (%) Employment rate among older workers (55–64) (2004) (%) Unemployment rate (2004) (%) Income distribution measured as income quintile share ratio (2004) Expenditure on LTC (share of GDP, 2004) (%) Share of 65+ in institutional care (1992–1995) (%) Children obligated to care for and/or support parents Denmark 75.7 71.6 60.3 5.5 3.4 1.7 7 No Sweden 72.1 70.5 69.1 6.3 3.3 2.6 8.7 No Netherlands 73.1 65.8 45.2 4.6 4 (2005) 0.9 8.8 n.a. Austria 67.8 60.7 28.8 4.8 3.8 1.1 4.9 Yes Germany 65.4 59.2 41.8 9.5 4.1 (2005) 0.3 6.8 Yes France 63.1 57.4 37.3 9.6 4.2 0.3 6.5 Yes Switzerland 77.4 70.3 65.1 n.a. n.a. 0.3 5.4 (2000) Yes Greece 60.1 45.2 39.4 10.5 5.9 0.1 1 Yes Italy 57.6 45.2 30.5 8 5.6 0.1 3.9 Yes Spain 63.3 48.3 41.3 10.6 5.1 0.3 2.9 In some regions Sources: Eurostat, Buchele et al. (1998), Jacobzone (1999), Comas-Herrera et al. (2003), Lamura (2003) and OECD (2005). Table options Thus, it seems rather natural to ask the question whether there is a north–south gradient also in the effects of informal care on labour-market outcomes. A hypothesis would be that the potential adverse effects of informal care on labour-market outcomes are less severe in countries where norms, traditions, preferences, and institutions favouring family loyalties and intra-generational support are stronger, since, for instance, more acceptance might exist among employers and employees for the fact that you are caring for your elderly parents. In most prior studies, informal care has been treated as an exogenous variable. As noted by Ettner (1996), who analysed a family in which children provide the residual necessary care left over when the spouse has provided a certain amount, this means that implicitly a number of assumptions are assumed to be fulfilled. First, it assumes that the allocation of care-giving tasks within the family does not depend on endogenous characteristics of the children, such as employment status. Second, it assumes that there is a required amount of “needed” informal care that the family does not allow to leave unmet. Third, it assumes that the family care-givers cannot substitute informal care by buying formal care. Given these assumptions, an informal care-giver takes the required level of informal care as given and then decides how to allocate remaining time. Obviously, if the parent's demand for informal care increases, this means that less time will remain to spend in paid work. For a number of reasons, however, these assumptions may fail. The allocation of the care-giving burden within the family may certainly depend on the endogenous characteristics of the children. Unemployed children, for instance, face lower time costs and may be expected to provide a greater share of the total amount of informal care than their employed counterparts. In the literature, a typical care-giver has been found to be an unemployed, single-living daughter, living nearby the parent (Engers and Stern, 2002). Similarly, children with a time cost that exceeds the price of professional homecare may decide to pay for formal care instead of providing informal care. Finally, the assumption that there is a certain amount of required informal care that has to be provided is questionable. Consider a model of care-giving where the child's utility function includes the parent's level of health (Johnson and Lo Sasso, 2000) or the parent's utility (Ettner, 1996), because of altruistic and/or bequest motives, and where the health or utility of the parent is a concave function of the amount of informal care provided by the child. In such a model, the child will provide informal care up to the point where the marginal utility of the time spent on various activities are equalised. So, in equilibrium, the child will allocate his/her time so that the marginal utility of care-giving equals the marginal utility of leisure and the value of an additional hour of work. A positive chock in the marginal utility of informal care will induce the child to increase the time spent on informal care and reduce the number of hours on leisure and/or paid work, in order to restore equilibrium conditions. Thus, empirical estimates of the effect of informal care-giving on labour supply based on simple OLS regression are potentially biased towards overstating the effect (Ettner, 1996). In this paper, we address the potential endogeneity of informal care by using instruments for informal care. In particular, the SHARE database contains information on the respondent's parents, such as their age and health status, and on the number of siblings of the respondents, which are used to identify the effect of informal care on occupational attainment. We consider the effects on employment, hours worked, and the wage rate among both men and women of care-giving to an elderly parent. Most prior studies only concern the probability of employment and are only conducted for women, who traditionally have been the main providers of informal care. However, as the female labour-market participation rate has been increasing in many countries, men are becoming more important as care providers (Carmichael and Charles, 2003a). To summarise our results: we found that (1) informal care reduced the probability of employment among women and men, (2) informal care reduced the number of hours worked when analysing women and men together and (3) informal care showed no significant effect on the wage rate, neither among men nor among women. Thus, our results suggest that giving informal care is associated with a substantial opportunity cost in the form of reduced occupational attainment. The hypothesis that informal care is exogenous could not be rejected. The influence of informal-care provision was, however, found to differ between the Nordic, central and southern parts of Europe: the negative effect on the employment probability and the number of hours worked, respectively, of informal-care provision was found to be stronger in central Europe than in southern Europe, while the wage rate was found to be less negatively affected in the central European countries. The paper proceeds as follows. First, the data will be presented. Second, the empirical methods used in the paper are described. Third, the results are reported. The paper concludes with a summary and discussion of our results.