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Review of Economics of the Household

, Volume 14, Issue 1, pp 155–183 | Cite as

Delegating home care for the elderly to external caregivers? An empirical study on Italian data

  • Matteo Lippi Bruni
  • Cristina Ugolini
Article

Abstract

We study care arrangement decisions in Italy, where families are increasingly delegating the role of primary caregiver to external (paid) people also for the provision of home care. We consider a sample of households with a dependent elderly person cared for either at home or in a residential home, extracted from a survey representative of the population of Italy’s Emilia-Romagna region. We investigate the determinants of a household’s decision to opt for one of the following three alternatives: the institutionalisation of elderly family members, informal home care, or paid home care. We estimate two model specifications, based on a simultaneous and a sequential decision process respectively, the results of which are fairly consistent. Disability related variables, rather than family characteristics, emerge as the main determinants of institutionalisation. On the other hand, household characteristics and socio-economic variables are more influential when it comes to choosing between informal and formal home care provisions.

Keywords

Long-term care Elderly living arrangements Informal care Household choice Health economics 

JEL Classification

C21 D13 I18 

Notes

Acknowledgments

The authors are grateful to participants to iHEA World Congress, the Conference on Long Term Care held at ZEW (Mannheim), the International Conference on Evidence-based Policy in Long-Term Care (ILPN 2012) held at the London School of Economics and the SIEP conference held at the University of Pavia for useful suggestions. We thank Irene Mammi and Rossella Verzulli for comments on a previous version of the paper.

References

  1. Balia, S., & Brau, R. (2014). A country for old men? An analysis of the determinants of long-term home care in Europe. Health Economics. doi: 10.1002/hec.2977.
  2. Bernheim, B. D., Shleifer, A., & Summers, L. (1985). The strategic bequest motive. Journal of Political Economy, 93, 1045–1076.CrossRefGoogle Scholar
  3. Bettio, F., Simonazzi, A., & Villa, P. (2006). Change in care regimes and female migration: The “care drain” in the Mediterranean. Journal of European Social Policy, 16, 271.CrossRefGoogle Scholar
  4. Boaz, R. F., & Muller, C. F. (1994). Predicting the risk of permanent nursing home residence: The role of community help ad indicated by family helpers and prior living arrangements. Health Services Research, 29, 391–414.Google Scholar
  5. Boersch-Supan, A., Hajivassiliou, V., Kotlikoff, L. J., & Morris, J. N. (1990). Health, children and elderly living arrangements: A multiperiod-multinomial probit model with unobserved heterogeneity and autocorrelated errors. NBER, Working Paper: 3343.Google Scholar
  6. Boersch-Supan, A., Kotlikoff, L. J., & Morris, J. N. (1988). The dynamics of living arrangements of the elderly. NBER, Working Paper: 2787.Google Scholar
  7. Bolin, K., Lindgren, B., & Lundborg, P. (2008). Informal and formal care among single-living elderly in Europe. Health Economics, 17, 393–409.CrossRefGoogle Scholar
  8. Bonsang, E. (2009). Does informal care from children to their elderly parents substitute for formal care in Europe? Journal of Health Economics, 28, 143–154.CrossRefGoogle Scholar
  9. Brau, R., & Lippi Bruni, M. (2008). Eliciting the demand for long-term care coverage: A discrete choice modelling analysis. Health Economics, 17, 411–433.CrossRefGoogle Scholar
  10. Brau, R., Lippi Bruni, M., & Pinna, A. M. (2010). Public vs private demand for covering long term care expenditures. Applied Economics, 42(28), 3651–3668.CrossRefGoogle Scholar
  11. Broese Van Groenou, M., Glaser, K., Tomassini, C., & Jacobs, T. (2006). Socio-economic status differences in the use of informal and formal help: A comparison of four European countries. Ageing and Society, 26, 745–766.CrossRefGoogle Scholar
  12. Byrne, D., Goeree, M. S., Hiedemann, B., & Stern, S. (2009). Formal home health care, informal car, and family decision making. International Economic Review, 50, 1205–1242.CrossRefGoogle Scholar
  13. Cameron, A. C., & Trivedi, P. K. (2010). Microeconometrics using Stata. College Station: Stata Press.Google Scholar
  14. Cheng, S., & Long, J. S. (2007). Testing for IIA in the multinomial logit model. Sociological Methods & Research, 35, 583–600.CrossRefGoogle Scholar
  15. Cocchi, D., Fabrizi, E., & Trivisano, C. (2004). The construction of sampling weights in a survey of public interest about a sensible subject. In Proceedings of the 7th international meeting: Quantitative methods for applied sciences, University of Siena.Google Scholar
  16. Courbage, C., & Eeckhoudt, L. (2012). On insuring and caring for parent’s long-term care needs. Journal of Health Economics, 31(6), 842–850.CrossRefGoogle Scholar
  17. Cremer, H., Pestieau, P., & Ponthiere, G. (2012). The economics of long-term care: A survey. Nordic Economic Policy Review, 2, 107–148.Google Scholar
  18. Davey, A., & Patsios, D. (1999). Formal and informal community care to older adults: Comparative analysis of the United States and Great Britain. Journal of Family and Economic Issues, 20(3), 271–299.CrossRefGoogle Scholar
  19. Davin, B., Paraponaris, A., & Verger, P. (2009). Socioeconomic determinants of the need for personal assistance reported by community-dwelling elderly: Empirical evidence from a French national health survey. The Journal of Socio-Economics, 38, 138–146.CrossRefGoogle Scholar
  20. Di Novi, C., Jacobs, R., & Migheli, M. (2013). The quality of life of female informal caregivers: From Scandinavia to the Mediterranean Sea. CHE Research Paper 84, York: University of York.Google Scholar
  21. Dostie, B., & Léger, P. T. (2005). The living arrangement dynamics of sick, elderly individuals. Journal of Human Resources, 40(4), 989–1014.CrossRefGoogle Scholar
  22. Engers, M., & Stern, S. (2002). Long term care and family bargaining. International Economic Review, 43(1), 73–114.CrossRefGoogle Scholar
  23. Ettner, S. L. (1996). The opportunity costs of elder care. Journal of Human Resources, 31, 189–205.CrossRefGoogle Scholar
  24. Greene, W. (2011). Econometric analysis (7th ed.). New York: McGraw Hill.Google Scholar
  25. Hanaoka, C., & Norton, E. C. (2008). Informal and formal care for elderly persons: How adult children’s characteristics affect the use of formal care in Japan. Social Science and Medicine, 7, 1002–1008.CrossRefGoogle Scholar
  26. Hanley, R. J., Alecxih, L. M. B., Wiener, J. M., & Kennell, D. L. (1990). Predicting elderly nursing home admissions. Research on Aging, 12(2), 199–228.CrossRefGoogle Scholar
  27. Hausman, J., & Mc Fadden, D. (1984). Specification tests for the multinomial logit model. Econometrica, 52(5), 12219–12240.CrossRefGoogle Scholar
  28. Heiss, F., Hurd, M., & Boersch-Supan, A. (2003). Healthy, wealthy and knowing where to live: Predicted trajectories of health, wealth and living arrangements among the oldest old. NBER Working Papers: 9897.Google Scholar
  29. Hiedemann, B., & Stern, S. (1999). Strategic play among family members when making long-term decisions. Journal of Economic Behavior & Organisation, 40, 29–57.CrossRefGoogle Scholar
  30. Hoerger, T. J., Picone, G. A., & Sloan, F. A. (1996). Public subsidies, private provision of care and living arrangements of the elderly. Review of Economics and Statistics, 78, 428–440.CrossRefGoogle Scholar
  31. Isengard, B., & Szydlik, M. (2012). Living apart (or) together? Coresidence of elderly parents and their adult children in Europe. Research on Aging, 34(4), 449–474.CrossRefGoogle Scholar
  32. Kalwij, A., Pasini, G., & Wu, M. (2014). Home care for the elderly: The role of relatives, friends and neighbors. Review of Economics of the Household, 12, 379–404.CrossRefGoogle Scholar
  33. Kotlikoff, L., & Morris, J. (1988). Why don’t the elderly live with their children? NBER Working Papers: 2734.Google Scholar
  34. Lee, M. J., & Kim, Y. S. (2012). Zero-inflated endogenous count in censored model: Effects of informal family care on formal health care. Health Economics, 21, 1119–1133.CrossRefGoogle Scholar
  35. Lippi Bruni, M., & Ugolini, C. (2006). Assistenza a domicilio e assistenza residenziale: Politiche di intervento e analisi empirica”. Rivista Italiana degli Economisti, 11, 241–267.Google Scholar
  36. Lo Sasso, A. T., & Johnson, R. W. (2002). Does informal care from adult children reduce nursing home admissions for the elderly? Inquiry, 39, 279–297.Google Scholar
  37. Long, J. S., & Freese, J. (2005). Regression model for categorical dependent variables using Stata (2nd ed.). College Sation, TX: Stata Press.Google Scholar
  38. Meng, C., & Schmidt, P. (1985). On the cost of partial observability in the bivariate probit model. International Economic Review, 26, 71–86.CrossRefGoogle Scholar
  39. Mentzakis, E., McNamee, P., & Ryan, M. (2009). Who cares and how much: Exploring determinants of co-residential informal care. Review of Economics of the Household, 7, 283–303.CrossRefGoogle Scholar
  40. Monfardini, C., & Radice, R. (2008). Texting exogeneity in the bivariate probit model: A Monte Carlo study. Oxford Bulletin of Economics and Statistics, 70, 271–282.CrossRefGoogle Scholar
  41. Orsini, C. (2010). Changing the way the elderly live. Evidence from the home health care market in the United States. Journal of Public Economics, 94, 142–152.CrossRefGoogle Scholar
  42. Paraponaris, A., Bérengère, D., & Verger, P. (2012). Formal and informal care for disabled elderly living in the community: An appraisal of French care composition and costs. European Journal of Health Economics, 13, 327–336.CrossRefGoogle Scholar
  43. Pezzin, L. E., Pollak, R. A., & Schone, B. S. (2007). Efficiency in family bargaining: Living arrangements and caregiving decisions of adult children and disabled elderly parents. CESifo Economic Studies, CESifo, 53(1), 69–96.CrossRefGoogle Scholar
  44. Pezzin, L. E., & Schone, B. S. (1997). The allocation of resources in intergenerational households: Adult children and their elderly parents. American Economic Review, 87(2), 460–464.Google Scholar
  45. Pezzin, L. E., & Schone, B. S. (1999). Intergenerational household formation, female labor supply and informal caregiving: A bargaining approach. Journal of Human Resources, 34(3), 475–503.CrossRefGoogle Scholar
  46. Sarma, S., & Simpson, W. (2007). A panel multinomial logit analysis of elderly living arrangements: Evidence from aging in Manitoba longitudinal data, Canada. Social Science and Medicine, 65, 2539–2552.CrossRefGoogle Scholar
  47. Stern, S. (1995). Estimating family long-term care decisions in the presence of endogenous child characteristics. Journal of Human Resources, 30(3), 551–580.CrossRefGoogle Scholar
  48. Suanet, B., Broese van Groneou, M. B., & van Tilburg, T. (2012). Informal and formal home-care use among older adults in Europe: Can cross national differences be explained by societal context and composition. Ageing and Society, 32(3), 491–515.Google Scholar
  49. Tomassini, C., & Wolf, D. A. (2000). Stability and change in the living arrangements of older italian women. 1990–1995. Genus LVI, 203-19.Google Scholar
  50. Tomassini, C., Wolf, D. A., & Rosina, A. (2003). Parental housing assistance and parent-child proximity in Italy. Journal of Marriage and Family, 5, 700–715.CrossRefGoogle Scholar
  51. United Nations. (2012). World population prospects: The 2010 revision, Department of Economic and Social Affairs, Population Division, New York.Google Scholar
  52. Van de Ven, W. P. M. M., & Van Praag, B. M. S. (1981). The demand for deductibles in private health insurance: A probit model with sample selection. Journal of Econometrics, 17, 229–252.CrossRefGoogle Scholar
  53. van Houtven, C. H., Coe, N. B., & Skira, M. M. (2013). The effect of informal care on work and ages. Journal of Health Economics, 32, 240–252.CrossRefGoogle Scholar
  54. van Houtven, C. H., & Norton, E. C. (2004). Informal care and health care use of older adults. Journal of Health Economics, 23, 1159–1180.CrossRefGoogle Scholar
  55. Villosio, C., & Bizzotto, G. (2011). Once there were wives and daughters, now there are badanti. Walqing Social Partnership Series no. 14, Walqing Research, 7th Framework Programme, European Commission.Google Scholar
  56. Wilde, J. (2000). Identification of multiple equation probit models with endogenous dummy regressors. Economic Letters, 69, 309–312.CrossRefGoogle Scholar
  57. Wolf, D. A., & Pinnelli, A. (1989). Living arrangements and social networks of older women in Italy. Research on Aging, 11, 354–373.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of EconomicsUniversity of BolognaBolognaItaly

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