Relatives and Friends Facilitate Access to Formal Care
Aleksandra Torbica and Giovanni Fattore (Department of Policy Analysis and Public Management), together with Stefano Calciolari (Università della Svizzera Italiana) have published Does Informal Care Impact Utilization of Healthcare Services? Evidence from a Longitudinal Study of Stroke Patients in Social Science & Medicine (Vol. 124, 2015, DOI: 10.1016/j.socscimed.2014.11.005).
In developed countries, such as Italy, an ageing population and technological innovations have an impact on demand for care. Demographic trends and new diagnostic strategies, in fact, improve the survival rate but increase also the number of patients with disability in need of care. So demand for care is evolving in terms of how much care is offered according to the needs of individuals, and which types of care are provided. The assistance supplied by close relatives or friends, the informal care, plays an important role in the total care provided to patients. This has brought an increasing attention towards this form of care both in the policy and academic debate, in particular with respect to the interplay between informal care and the care provided by institutionalized health systems, the so-called formal care. However, the relationship between the presence and amount of informal care and healthcare utilization and costs is not clear enough. So Torbica, Calciolari and Fattore decided to shed more light on this interaction because of its important financial implications and its effect on policy making. Their study is one of the few empirical ones to use panel data for such kind of analysis, by employing a database on 532 stroke patients in 44 hospitals in Italy, from 2007 to 2008.
Stroke has a significant and raising socio-economic impact, and health care of stroke survivors in the community is becoming an increasing priority. This makes stroke a relevant issue for policy makers. As the authors explain, informal care is the most significant portion of the total societal costs of stroke, and it is thus crucial to understand its role in order to inform health policies for the affected patients. The amount of healthcare costs at 12 months after the stroke is €5,825 per patient, the rehabilitation costs being the 68,4%, namely €3,985.
The results of the study show that healthcare costs are different between the patients with and without a caregiver. The presence of a caregiver is associated with higher direct healthcare costs (by 54.7%), while this effect is not observed for the amount of informal care. If a patient who suffered a stroke is assisted by a caregiver, he/she is more likely to access rehabilitation services but, once the decision on access is made, this does not influence the amount of services the patient uses. These results interestingly suggest, the authors say, that informal caregivers facilitate or even promote the access to healthcare services.
Overall, this study highlights the double role played by caregivers: they provide support to daily activities and thus prevent the use of formal care, but at the same time they can facilitate access to formal healthcare sectors by providing advice and support. In this way policy makers can better understand the role of informal caregivers in accessing rehabilitation services, given the importance of taking them into account when designing policies for patients with disabling diseases.