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3 Fact Sheet
Cost Implications of Informal Supports (NA101-03)
Hollander Analytical Services Ltd.
This project is one of fifteen sub-studies of the National Evaluation
of the Cost-Effectiveness of Home Care Project (NA101). Sub-study 3 examined
the relationship between the amount of formal home care services clients
receive and the amount of informal (family) support provided.
A unique Edmonton data base of some 5,000 home care clients from the Capital
Health Region in Edmonton, Alberta was used to study the comparative resource
use of formal and informal home care services. Ideally, the analysis of
the relationship between formal and informal care is determined experimentally.
When this is not practical, a non-experimental database can be used but
must contain sufficient variables to account for the selection bias. It
must also contain sufficient descriptions of informal resources available
to clients and amount of formal services provided. The Edmonton dataset
met these criteria. Following a review of existing statistical methods
to analyse the problem, a statistical approach that encompassed survival
analysis, causal modeling and correction for selection bias was developed.
The project leader identified the following outcomes:
- Formal and informal care are complementary, not substitutive. In
general, if a client gets more of one type of care, he or she will also
receive more of the other type of care. Thus, increasing formal care
does not decrease informal care.
- An overall increase of $1 in informal care has a commensurate increase
of $1.09 in formal care, while an increase of $1 in formal care has
a commensurate increase of $0.30 in informal care.
- For higher levels of care, increases in informal care still elicit
significant increases in formal care, but increases in formal care only
elicit modest increases in informal care.
The project leader indicated the findings are significant because, in
- They suggest that increasing the capacity to provide informal care
does not generate savings to the formal care sector. Conversely, increasing
formal care service intensity increases caregiver burden, although the
mechanisms underlying these observations are not entirely clear.
- There is a concern regarding involuntary conscription into caregiving
, and addressing it will require implementation of policies that encourage
capacity and willingness to provide care. Other policies might include
examination of eligibility criteria, scope of services provided, and
As this project was analytic/evaluative in nature, please see the "Activities"
HTF Contribution to the Project:
$1,505,000 (divided among the 15 sub-studies)
Language of Report: