title: A country for old men? Long-term home care utilization in Europe.
abstract: This paper investigates long-term home care utilization in Europe. Data from the first wave of the Survey on Health, Ageing and Retirement (SHARE) on formal (nursing care and paid domestic help) and informal care (support provided by relatives) are used to study the probability and the quantity of both types of care. The overall process is framed in a fully simultaneous equation system that takes the form of a bivariate two-part model where the reciprocal interaction between formal and informal care is estimated. Endogeneity and unobservable heterogeneity are addressed using a common latent factor approach. The analysis of the relative impact of age and disability on home care utilization is enriched by the use of a proximity to death (PtD) indicator built using the second wave of SHARE. All these indicators are important predictors of home care utilization. In particular, a strong significant effect of PtD is found in the paid domestic help and informal care models. The relationship between formal and informal care moves from substitutability to complementarity depending on the type of care considered, and the estimated effects are small in absolute size. This might call for a reconsideration of the effectiveness of incentives for informal care as instruments to reduce public expenditure for home care services.
authors.affiliation: Department of Economics and Business, University of Cagliari and CRENoS, Cagliari, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Balia
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Brau
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D017028:Caregivers / Q000191:economics / Q000706:statistics & numerical data*; D003365:Costs and Cost Analysis; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data*; D006701:Home Nursing / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008017:Life Expectancy; D008134:Long-Term Care / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D017059:Models, Econometric; D009735:Nursing Homes / Q000191:economics / Q000706:statistics & numerical data*; D019452:Terminally Ill / Q000706:statistics & numerical data
keywords: C3; I1; ageing; discrete latent factors; long-term care; proximity to death