تجزیه و تحلیل اقتصادی از اثرات نامشهود از مراقبت غیر رسمی برای افراد مبتلا به بیماری آلزایمر و سایر اختلالات روانی
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|29083||2013||10 صفحه PDF||سفارش دهید||محاسبه نشده|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Value in Health, Volume 16, Issue 5, July–August 2013, Pages 745–754
Objectives Valuation of the intangible impacts of informal care remains a great challenge for economic evaluation, especially in the framework of care recipients with cognitive impairment. Our main objective was to explore the influence of intangible impacts of caring on both informal caregivers’ ability to estimate their willingness to pay (WTP) to be replaced and their WTP value. Methods We mapped characteristics that influence ability or inability to estimate WTP by using a multiple correspondence analysis. We ran a bivariate probit model with sample selection to further analyze the caregivers’ WTP value conditional on their ability to estimate their WTP. Results A distinction exists between the opportunity costs of the caring dimension and those of the intangible costs and benefits of caring. Informal caregivers’ ability to estimate WTP is negatively influenced by both intangible benefits from caring (P < 0.001) and negative intangible impacts of caring (P < 0.05). Caregivers’ WTP value is negatively associated with positive intangible impacts of informal care (P < 0.01). Conclusions Informal caregivers’ WTP and their ability to estimate WTP are both influenced by intangible burden and benefit of caring. These results call into question the relevance of a hypothetical generalized financial compensation system as the optimal way to motivate caregivers to continue providing care.
It has been argued that Alzheimer’s disease and other mental disorders can generate direct, indirect, and intangible costs , ,  and . Informal care, as part of the indirect and intangible impacts of caring, has been a subject of interest for both research and social policies. In the case of long-term care in particular, “family care management” is considered a substantial part of the total cost of care . Analyzing the socioeconomic impacts of Alzheimer’s-type disease in Europe (EU27), Kenisgsberg et al.  estimated that in 2008, on average 55% of the total cost of care was attributable to informal care. Informal care was described by Van den Berg et al.  as a “quasi-market composite commodity [provided] by one or more members of the social environment of the care recipient, [and resulting] of the care demand of the care recipient.” Because ageism, combined with lack of public funding, could lead to informal care becoming the cornerstone of elderly care, a value must be placed upon it. The unpaid aspects of informal care have been the main focus of economic evaluation, and informal caregivers’ time trade-off has been the subject of an abundant literature , , ,  and . In addition, most economic studies to date have focused on the negative impacts of caregiving ; however, informal caregivers may also derive benefits from caring . If research in psychology was a forerunner of the concept of the intangible impacts of caring , a growing economics literature has also deemed these impacts to be worthy of inclusion in cost-benefit or cost-utility analysis , ,  and . Intangible impacts of caring are another facet of externalities. Applied to mental health care by Mulvaney-Day , intangible costs encompassed the “pain and the suffering associated with the illness” and related to the disease’s subjective burden and lost quality of life. Such impacts have been progressively extended to informal care and the subjective burden of caring defined as the informal caregiver’s perception of “the impact of the objective burden related to caregiving” ,  and . Therefore, the subjective burden is influenced by the amount of time spent on caregiving, as well as by the social relations between the informal caregiver and his or her care recipient and the psychological and emotional consequences of caring  and . Additional intangible effects may also be considered, such as grief, anxiety and social handicap, fatigue, giving up leisure activities, and fewer social contacts, ultimately  and . There has been less literature about the intangible benefits of informal care. The latter, such as strengthened family ties, feeling of accomplishment, and alleviation of guilt or empathy, have to be part of the informal caregiver’s utility function . Caregiving satisfaction is inversely influenced by the same factors as burden of caring because it represents “the perceived subjective gains and rewards, and the experience of personal growth that occurs as a result of providing care . The main objective of our article was to examine the relationship between the positive and negative intangible impacts of caring and the monetary value informal caregivers are willing to pay to be replaced. By focusing on how intangible impacts of informal care may influence the willingness to pay (WTP), within the framework of the contingent valuation (CV) method, we developed an original approach. In our study, intangible impacts encompass both the intangible costs (i.e., lack of social relationships or negative effect on caregiver’s morale) and benefits such as the change in caregiver-care recipient relationships or fulfilled motivations to provide care. In contrast to many studies’ recommendations, we could not supervise the whole questionnaire drafting process. Because WTP does not increase at fixed intervals, the WTP question format was not standard. Furthermore, intangible impacts of caring were not approximated by any validated scale such as Caregiver Reaction Assessment or by any common measure such as quality-adjusted life-year (QALY). These impacts were therefore more broadly analyzed in a broader scope than is usual in research on informal care because we focused on more facets of intangible impacts of caring than do validated scales  and .
نتیجه گیری انگلیسی
Our results enhanced social policy–targeting incentives to care for informal caregivers dedicated to care recipients having cognitive impairments, which should pay attention to the intangible impacts of caring when valuing informal care. Taking the latter into account would permit determination of an optimal financial compensation system, for two reasons. First, for informal caregivers who are able to estimate their WTP, taking intangible impacts of caring into account might decrease the price of this potential financial compensation. Indeed, our findings suggest that benefits from caring might increase the probability of having a less than €13 WTP value. In this case, “cash for care” policies would be more socially efficient than a public investment focusing on private home working development  and . Second, for informal caregivers who are not able to estimate their WTP, taking intangible impacts into account might support the need for alternative policies in order to motivate informal caregivers to continue providing care, without replacing them. Because we showed that being unable to estimate WTP does not mean not experiencing the burden of caring, alternatives, such as respite care or work arrangements  and , might be more efficient than direct financial compensation from a societal perspective.